Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review

Table 3

Included review characteristics and results. MS: multiple sclerosis; OT: occupational therapy; RCT: randomized clinical trial; SR: systematic review; CCT: controlled clinical trial, AMSTAR: Assessment of Multiple Systematic Reviews; QoL: quality of life: ADL: activity of daily living; EDSS: Expanded Disability Status Scale, FACETS: Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to life Style.

Author	Type of study	Topic	Finding	Limits	AMSTAR
Khan [8]	Systematic review (15 Cochrane review and 24 other review)	(i) Multi disciplinary rehabilitation with OT; (ii) FACETS programs; (iii) Energy conservation; (iv) Vocational therapy	Moderate evidence for TO	Lack of methodologically robust trials, 4 review included are of their group	10
Tur [9]	Review	(i) Energy conservation; (ii) FACETS programs	Effective treatment to reduce fatigue	Not clear process of selection	2
Hourihan [10]	Review	(i) Energy conservation; (ii) FACETS programs	Effective treatment to reduce fatigue	Not clear process of selection	2
Khan [11]	Systematic review (12 RCT 12 SR 2CCT 1 other; 6 about OT)	Energy conservation	Effective in reducing fatigue and improving QoL in short-term.	More high-quality RCTs are still needed	10
Asano [12]	Systematic review (38 RCT)	Fatigue management	Effective treatment to reduce fatigue	Small sample size	10
Asano et Finlayson [13]	Meta-analysis, (8 RCTs)	(i) Fatigue management program; (ii) Energy conservation course; (iii) Cognitive Behavioural Therapy; (iv) Mindfulness intervention	Strong evidence for educational rehabilitation for reducing fatigue	None of the studies reported long-term results	6
Yu [14]; Yu [15]	Systematic review (70 trials)	(i) Face-to-face format (managing fatigue course and fatigue: take control course); (ii) Telerehabilitation; (iii) ADL training	High effectiveness for face-to-face format; Low effectiveness for telerehabilitation	(i) All types of MS; (ii) Limited evidence	4
Blikman [16]	Systematic review, meta-analysis 6 trials (4 RCTs and 2 CCTs)	(i) Energy conservation interventions	Effective reduction of fatigue in Short term and improved QoL	More high-quality RCTs are still needed	6
Bradley [17]	Review	(i) Energy conservation; (ii) Relaxation therapy	Some benefit	(i) Use of a single therapist; (ii) Potential underpowering,; (iii) exclusion of patients with EDSS scores > 6	2
NICE [8]	Guideline	(i) Assessment; (ii) Fatigue management programme; (iii) Multidisciplinary team	Some benefit	Low quality of evidence	-