ABSTRACT
Background: Despite fatigue being a significant symptom among individuals with osteoarthritis (OA) and leading to a decline in functional status and quality of life, it has received very little attention. This project systematically reviewed the various non-pharmacological interventions that have been used to relieve fatigue in people suffering from upper and /or lower limb OA.
Aims: To identify fatigue interventions and to determine the effectiveness of these interventions in reducing fatigue immediately and overtime among individuals with OA.
Methods: Cochrane library, Allied and Complementary Medicine Database (AMED), Proquest, Web of science, Medline, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and African Journals Online (AJOL) databases were searched for studies on OA and fatigue symptom management. The reference lists of included articles were further checked for eligible studies. Inclusion criteria comprised studies with randomized controlled trials (RCTs), quasi-experimental and pre-post studies. Only papers written and published in English Language were used. Quality appraisal was conducted using the Cochrane Collaboration’s tool for assessing the risk of bias (ROB) for RCTs. Narrative synthesis was used to present findings, while a meta-analysis was conducted on homogenous studies.
Result: 31 RCTs studies were eligible from 2,586 studies identified from the search. 11 had low ROB, 11 moderate ROB and 9 had a high ROB. This study identified a total of 12 interventions, these included activity pacing, cognitive behavioural therapy (CBT), yoga, exercise / physical activity programmes, acupuncture, moxibustion, pain-coping skills training, BEMER therapy, use of modified shoes, massage /aroma therapy, education and thermotherapy. From the narrative synthesis, majority of the interventions had statistically significant reductive effect on fatigue in OA. The meta-analysis showed that exercise versus non-exercise interventions for fatigue in OA had statistically non-significant effects both immediately (-0.10 [-0.74, 0.54], p= 0.75) and overtime (-0.79 [-2.30, 0.73], p=0.31).
Conclusion: Activity pacing, CBT and yoga interventions showed beneficial effects on fatigue in OA. However, the pooled analysis showed that the effect of exercise on fatigue was not significant. Nonetheless, the pooled effect was in favour of the exercise group relative to other interventions.
Registration: A review protocol was developed and registered with the PROSPERO database, with the ID-CRD42020163730.
