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Non-pharmacological interventions for fatigue in rheumatoid arthritis

Cramp, Fiona; Cramp, Fiona (Alice); Hewlett, Sarah; Almeida, Celia; Kirwan, John R.; Choy, Ernest H.S.; Chalder, Trudie; Pollock, Jon; Christensen, Robin

Authors

Fiona Cramp

Fiona Cramp Fiona.Cramp@uwe.ac.uk
Professor in Long Term Conditions

John R. Kirwan

Ernest H.S. Choy

Trudie Chalder

Jon Pollock Jon.Pollock@uwe.ac.uk
Associate Professor in Epidemiology

Robin Christensen



Abstract

© 2013 The Cochrane Collaboration. Background: Fatigue is a common and potentially distressing symptom for people with rheumatoid arthritis with no accepted evidence based management guidelines. Non-pharmacological interventions, such as physical activity and psychosocial interventions, have been shown to help people with a range of other long-term conditions to manage subjective fatigue. Objectives: To evaluate the benefit and harm of non-pharmacological interventions for the management of fatigue in people with rheumatoid arthritis. This included any intervention that was not classified as pharmacological in accordance with European Union (EU) Directive 2001/83/EEC. Search methods: The following electronic databases were searched up to October 2012, Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database. In addition, reference lists of articles identified for inclusion were checked for additional studies and key authors were contacted. Selection criteria: Randomised controlled trials were included if they evaluated a non-pharmacological intervention in people with rheumatoid arthritis with self-reported fatigue as an outcome measure. Data collection and analysis: Two review authors selected relevant trials, assessed risk of bias and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model. Main results: Twenty-four studies met the inclusion criteria, with a total of 2882 participants with rheumatoid arthritis. Included studies investigated physical activity interventions (n = 6 studies; 388 participants), psychosocial interventions (n = 13 studies; 1579 participants), herbal medicine (n = 1 study; 58 participants), omega-3 fatty acid supplementation (n = 1 study; 81 participants), Mediterranean diet (n = 1 study; 51 participants), reflexology (n = 1 study; 11 participants) and the provision of Health Tracker information (n = 1 study; 714 participants). Physical activity was statistically significantly more effective than the control at the end of the intervention period (standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.62 to -0.10; back translated to mean difference of 14.4 points lower, 95% CI -4.0 to -24.8 on a 100 point scale where a lower score means less fatigue; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 4 to 26) demonstrating a small beneficial effect upon fatigue. Psychosocial intervention was statistically significantly more effective than the control at the end of the intervention period (SMD -0.24, 95% CI -0.40 to -0.07; back translated to mean difference of 9.6 points lower, 95% CI -2.8 to -16.0 on a 100 point scale, lower score means less fatigue; NNTB 10, 95% CI 6 to 33) demonstrating a small beneficial effect upon fatigue. For the remaining interventions meta-analysis was not possible and there was either no statistically significant difference between trial arms or findings were not reported. Only three studies reported any adverse events and none of these were serious, however, it is possible that the low incidence was in part due to poor reporting. The quality of the evidence ranged from moderate quality for physical activity interventions and Mediterranean diet to low quality for psychosocial interventions and all other interventions. Authors' conclusions: This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue in adults with rheumatoid arthritis. There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions.

Citation

Cramp, F., Cramp, F. (., Hewlett, S., Almeida, C., Kirwan, J. R., Choy, E. H., …Christensen, R. (2013). Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systematic Reviews, 2013(8), https://doi.org/10.1002/14651858.CD008322.pub2

Journal Article Type Review
Publication Date Aug 23, 2013
Deposit Date Sep 13, 2013
Journal Cochrane Database of Systematic Reviews
Electronic ISSN 1469-493X
Publisher Cochrane Collaboration
Peer Reviewed Peer Reviewed
Volume 2013
Issue 8
DOI https://doi.org/10.1002/14651858.CD008322.pub2
Keywords rheumatoid arthritis, fatigue, randomised controlled trial, non-pharmacological, psychsocial, exercise
Public URL https://uwe-repository.worktribe.com/output/928793
Publisher URL http://dx.doi.org/10.1002/14651858.CD008322.pub2