I’ve just had an email from a Professor of Nursing, with a quote under her signature, which I haven’t seen before:
“There is nothing so useless as doing something efficiently which should not be done at all.” (Peter Drucker)
In health research (as in life!) doing the right thing is critical. If research is to be useful, it’s really important that it sets out to answer the right questions, those that matter to people affected by the condition being investigated. That’s the starting point for the work of the James Lind Alliance (JLA). I’ve written here about one of their Priority Setting Partnerships, which bring together patients, health professionals and researchers to find the top priorities for research. The hope is that research funding will then be used to investigate the most important uncertainties.
Reducing fatigue – a top priority in MS research
Three years ago, the Multiple Sclerosis Society partnered with the JLA to find the top ten priorities for Multiple Sclerosis (MS) research. What emerged at number three was ‘which treatments are effective for fatigue in MS?’ There is no medicine that seems to help. Now, a new Cochrane review has been published, bringing together the best available evidence looking at whether exercise therapy is an effective and safe way of reducing fatigue in MS.
Exercise therapy: simple, safe and effective?
Exercise therapy is a relatively simple, accessible and non-invasive A treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. More with the potential to reduce fatigue, and its use by people with MS isn’t new. There have been lots of Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. More investigating it in recent years and the review team found 45 suitable trials with 2,250 adults with MS, most of whom had relapsing-remitting MS. The results from 36 of the trials could be added together.
What sort of exercise?
There were 69 different exercise interventions in five broad categories: endurance training, muscle power training, task-oriented training, mixed training (muscle power training and endurance training) and ‘other’ (such as yoga and tai-chi).
Here’s what they found
- Exercise had a better effect on fatigue than no exercise, particularly endurance training, mixed training and ‘other’
- There was no difference between exercise and non-exercise groups in the number of reported relapses
How reliable is this evidence?
Some of the methods used in the trials may mean they are less reliable than we would like. Most only had a small number of people, who may or may not have had fatigue, and reducing fatigue was not the main focus. There were problems with the way fatigue was assessed and a lot of variability in the way relapses were defined and reported.
Overall, this is rated as moderate quality evidence, so exercise is probably better than no exercise and probably does not increase the A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. More of relapse, but future research may change the results.
Where does this leave us?
The reviewers say that exercise therapy seems to be safe and moderately effective in treating fatigue in people with MS, but the current evidence does not enable us to be certain, nor to know which type is best. They also note that the effects may vary from person to person.
Clearly, there is more and better research to be done and the review includes a discussion of what that research needs to look like if it is to fill the gaps in the current evidence.
To return to where we started, if research is to be useful, it needs to be asking the right questions, but doing it efficiently is also essential if it is to have any hope of answering them.
More information and support for people with MS and their families can be found at healthtalk.org where you can watch videos of people sharing their experiences of MS and on the MS Society website.
Fatigue in people with MS: can exercise help? by Sarah Chapman is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Based on a work at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009956.pub2/abstract.
Permissions beyond the scope of this license may be available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009956.pub2/abstract. Images are not available for reuse as they were purchased for Evidently Cochrane from stock.com
Heine M, van de Port I, Rietberg MB, van Wegen EEH, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More 2015, Issue 9. Art. No.: CD009956. DOI: 10.1002/14651858.CD009956.pub2.
Plain language summary of this review: http://www.cochrane.org/CD009956/MS_exercise-therapy-fatigue-multiple-sclerosis