Disability as a determinant of fatigue in MS patients

Toward unraveling the correlates of fatigue in glioma

BACKGROUND

Even though fatigue is one of the most prevalent and burdensome symptoms in patients with glioma, its etiology and determinants are still poorly understood. We aimed to identify which demographic, tumor- and treatment-related characteristics and patient-reported outcome measures (PROMs) are associated with or are predictors of fatigue in glioma.

METHODS

In this retrospective observational study, we included glioma patients with preoperative and postoperative assessments including PROMs on fatigue, depression, cognitive functioning, and health-related quality of life (HRQoL). Linear mixed models were used to identify which clinical factors and PROMs were associated with fatigue and linear multiple regression was used to detect predictors of postoperative fatigue.

RESULTS

In this study, 222 patients were included (78% grade II-III glioma, 22% grade IV). These patients had performed 333 assessments (193 preoperative and 116 one year postoperatively). Of all assessments, 39% was indicative of severe fatigue. Several HRQoL domains, depression, and right-sided tumors were significantly associated with fatigue (marginal R 2 = 0.63). Contrary to common expectations, tumor type, treatment-related factors, and timing of the assessment, were not associated with fatigue. In a subgroup of 70 patients with follow-up assessments, preoperative fatigue, and physical functioning were predictors of postoperative fatigue (adjusted R 2 = 0.31).

CONCLUSION

Fatigue is a complex symptom, which should not solely be attributed to the tumor or its treatment, but is instead related to different aspects of mood and HRQoL. These insights are important in understanding fatigue and could guide symptom management, especially in patients with lower-grade tumors.

Shiatsu-associated physical therapy on pain and fatigue on people with multiple sclerosis

Abstract Introduction: Pain and fatigue are common symptoms in multiple sclerosis (MS). Shiatsu, a technique that uses the pressure of fingers, associated with manual therapy, exercises and stretching can be used to control these symptoms. Objective: To evaluate the effect of Shiatsu associated with physical therapy on pain and fatigue on people with MS. Methods: Randomized clinical trial with people diagnosed with MS divided into two groups: intervention group (IG) - Shiatsu-associated physical therapy (n = 9), and control group (CG, n = 8). Participants were assessed before and after treatment by the Expanded Disability Status Scale (EDSS), Neuropathic Pain Questionnaire (DN4), Visual Analog Scale (VAS) and Fatigue Impact Scale (MFIS), and description of sociodemographic. Results: Seventeen people with MS (9 men) aged 45.18 ± 3.06 years participated in this study. In the total sample, the average of DN4 was 1.65 ± 20.02, VAS was 2.29 ± 2.80, MFIS was 39.47 ± 29.67, and 52.9 % had a score > 38 in the MFIS that corresponds to presence of fatigue. The values pre/post-intervention/grade of p, respectively in the IG were DN4: 2.78 ± 2.16/2.0 ± 2.12/0.432, EVA: 3.22 ± 3.27/0.33 ± 1.00/0.023, total MFIS: 44.44 ± 35.91/35 ± 31.70/0.068. In the CG the values were DN4 : 0.38 ± 0.744/2.25 ± 2.71/0.054, EVA : 1.25 ± 1.83/3.63 ± 2.38/0.043, and MFIS : 33.88 ± 21.68/25.13 ± 24.22/0.379. Conclusion: Shiatsu associated with Physiotherapy was effective in improving pain and fatigue in individuals with MS.

Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review

BACKGROUND

Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS).

METHODS

Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data.

RESULTS

The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS.

CONCLUSION

Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.

Effectiveness of Virtual Reality Rehabilitation in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Multiple Sclerosis (MS) is a chronic disease with physical, cognitive, and psychosocial impairments. Virtual Reality (VR) has been used as an innovative tool in neurological rehabilitation. There are promising new studies that have used commercial video games consoles for the rehabilitation of people with MS.

OBJECTIVES

The aim of this systematic review is to summarize the effectiveness of using VR on functional mobility, fatigue, quality of life and balance in people with MS, compared with conventional exercises or no intervention.

METHODS

Six databases (Scielo, Lilacs, Pubmed, Cochrane library, Embase and PEDro) were searched using some of following terms: "Virtual reality" AND "Multiple sclerosis" AND " randomized controlled trial". Two reviewers performed the search, selection, and extraction of data from the studies. The methodological quality of the articles was assessed using the PEDro scale and the risk of bias was independently assessed by two reviewers using the Cochrane Collaboration Risk of Bias tool. Mean differences and confidence intervals were combined and calculated in meta-analysis.

RESULTS

Nine randomized clinical trials were included, with a total sample of 424 participants. In general, functional mobility presented similar improvement between groups, while for fatigue, quality of life and balance, VR promoted improvement equal to or greater than the conventional exercises. The meta-analysis confirmed that for functional mobility, VR does not promote significant improvement, while for fatigue, quality of life and balance, VR promotes superior improvement.

CONCLUSION

This systematic review demonstrated a positive effect of using VR in people with MS in relation to fatigue, quality of life and balance, compared to the conventional exercises. For functional mobility, VR associated or not with conventional exercises does not seem to bring additional benefits. Larger and methodologically robust studies are need.

OTHER

There was no funding for this systematic review. PROSPERO Registration Number CRD42021226471.