Meta-Analysis of Three Different Types of Fatigue Management Interventions for People with Multiple Sclerosis: Exercise, Education, and Medication

Table 2

Corresponding table for forest plots.

1st author	Experimental; intervention	Comparison intervention	Outcome measure	ES	95% CI
Exercise intervention trials
Kargarfard [25]	Aquatic exercise	No intervention	MFIS	2.05	1.00–3.11
Hebert [26]	Vestibular rehabilitation	Endurance and stretch exercise	MFIS	1.83	0.90–2.77
Velikonja [27]	Climbing	Yoga	MFIS	0.21	−0.69–1.11
Dalgas [28]	Progressive resistance training	No intervention	FSS	0.81	0.08–1.15
Mostert [29]	Bicycle aerobic exercise	No intervention	FSS	0.34	−0.43–1.11
van den Berg [30]	Treadmill Walking	No intervention	FSS	0.01	−0.96–0.99
Klefbeck [31]	Inspiratory muscle exercise	Usual care	FSS	1.01	−0.06–2.09
Cakt [32]	Cycling progressive resistance training	Home exercise for lower limb muscle; strength and balance	FSS	0.20	−0.60–1.02
Hayes [33]	High intensity resistance training plus standard exercise	Standard exercise	FSS	−0.24	−1.15–0.64
Oken [34]	Aerobic exercise	Yoga	MFI	−0.17	−0.82–0.48
Pooled  ES	Random  effects			0.57	0.10–1.04  (P  =  0.02)
Educational intervention trials
Finlayson [35]	Fatigue management (teleconference)	Waitlisted	FIS	0.53	0.19–0.86
Mathiowetz [36]	Energy conservation course (in-person)	Waitlisted	FIS	0.42	0.08–0.76
Hugos [37]	Take control	Waitlisted	MFIS	0.43	−0.29–1.57
Grossman [38]	Mindfulness; intervention	Usual care	MFIS	0.42	0.09–0.74
Kos [39]	Multidisciplinary Fatigue management	Placebo (nonfatigue focused program)	MFIS	−0.16	−0.72–0.38
Moss-Morris [40]	Cognitive Behavioral Therapy (CBT)	Standard care	MFIS	1.11	0.43–1.78
van Kessel [41]	CBT	Relaxation	FS	0.99	0.50–1.48
Mohr [42]	CBT	Group Psychotherapy	FAI	0.80	0.19–1.42
Pooled  ES	Random  effects			0.54	0.30–0.77  (P  <  0.001)
Pharmacological intervention trials
Shaygannejad [43]	Amantadine	Aspirin	FSS	−0.21	−0.76–0.32
Tomassini [44]	Amantadine	ALCAR	FSS	−0.59	−1.26–0.06
Ashtari [45]	Amantadine	Placebo	FSS	0.55	−0.06–1.16
Krupp^† [46]	Amantadine	Placebo	FSS	0.24	−0.23–0.73
The Canadian MS Research Group [47]	Amantadine	Placebo	VAS (0–50 mm)	0.21	−0.08–0.51
Möller [48]	Modafinil	Placebo	FSS	0.50	0.13–0.86
Stankoff^† [49]	Modafinil	Placebo	MFIS	−0.33	−0.70–0.02
Pooled ES	Random effects			0.07	−0.22–0.37 (P  =  0.63)

†ES was estimated using the published graphical data presented in the article; CBT: cognitive behavioral therapy; MFIS: Modified Fatigue Impact Scale; FSS: Fatigue Severity Scale; MFI: Multidimensional Fatigue Inventory; FIS: Fatigue Impact Scale; FS: Fatigue Scale; FAI: Fatigue Assessment Instrument.