Poster presentation for the PsyPAG 2021 Conferenc

Cooper, Kate

Dunn, Barney

Higson-Sweeney, Nina

Loades, Maria

English

Nina Higson-Sweeney

Barney Dunn

Kate Cooper

Maria Loades

OSF Preprints

What nonpharmacological interventions are effective for treating fatigue in adolescents? A systematic review of randomised controlled trials

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        Citation for published version:Higson-Sweeney, N, Loades, M, Dunn, B & Cooper, K 2021, 'What nonpharmacological interventions areeffective for treating fatigue in adolescents? A systematic review of randomised controlled trials'.Publication date:2021Document VersionPeer reviewed versionLink to publicationUniversity of BathAlternative formatsIf you require this document in an alternative format, please contact:openaccess@bath.ac.ukGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Download date: 21. Oct. 2021What nonpharmacological interventions are effective for treating fatigue in adolescents? A systematic review of randomised controlled trialsNina Higson-Sweeney, Dr Maria Loades, Professor Barney Dunn, & Dr Kate CooperIntroductionFatigue refers to an extreme state of physical and/or mental exhaustion and is assumed to be a "normal" part of adolescence [1]. However, prolonged fatigue can be highly disabling and has been associated with poor outcomes in adolescents, like school absenteeism and impaired social development [2, 3]. To prevent these adverse outcomes, fatigue is an important symptom to be identified and address.A range of nonpharmacological interventions are available for fatigue. In the context of adolescents, research has focused on interventions within specific populations, such as cancer and CFS/ME [4, 5]. However, this potentially results in a segregated evidence-base, with evidence only being available for specific populations, despite fatigue being transdiagnostic and common [6, 7]. Without an integrated evidence-base, we do not know which interventions are most effective for adolescents as a whole and should be used as the basis for decisions regarding policy and practice.MethodsAimsThe aim of this systematic review is to identify, synthesise and evaluate randomised controlled trials (RCTs) of nonpharmacological interventions for treating fatigue in adolescents. We want to learn which interventions are effective and what the active ingredients of these interventions are.Search strategy(1) Adolescents aged 10-19 years(2) Fatigue(3) Nonpharmacological interventions(4) RCTsInclusion criteriaPopulation: Adolescents, sample mean age > 10 and < 19 yearsIntervention: Includes a nonpharmacological treatment armComparison: Standard care, waiting list, alternative treatmentOutcome: Change in self-reported fatigue on a validated measure, as a primary or secondary outcome, measured pre- and post-interventionStudy design: RCTs, peer-reviewed, available in Englishhttps://doi.org/10.17605/OSF.IO/ND4WF5,626 abstracts120 full texts22 articles / 17 RCTsResultsFirst author (Year) True randomisation?Allocation concealment?Similar baseline?Participants blinded?Providers blinded?Assessors blinded?Identical treatment?Complete follow-up?Intention-to-treat?Measured similarly?Measured reliably?Appropriate statistics?Appropriate design?Al-Haggar (2006)Akel (2019)Bakker (2011) NAChalder (2010)Crawley (2018)Evans (2014)Gradisar (2011)Lam (2018)Li (2018)Malik (2020)Nijhof (2012)Renaud (2020)Richardson (2018)Stössel (2020)Stulemeijer (2005)Van Brussel (2008)Van Dijk-Lokkart (2016)Published 2005-2020Total sampleN = 1,420Intervention groupn = 727Control groupn = 693Sample age range6 – 26Sample Mage range10.51 – 197 interventions included physical activity6 interventions included CBT7 interventions included psychoeducation9 interventions incorporated additional componentsInitial Discussion• Effective interventions for fatigue often include elements of physical activity, CBT, or psychoeducation• Interventions for fatigue are also often multimodal, incorporating multiple approaches into one• A range of BCTs used, but predominantly shaping knowledge and repetition and substitution• BCTs involving reward and punishments least used• Mixed quality studies – particular issues with blinding, evidencing measurement reliability, and providing sufficient reasons for loss to follow-up• Difficult to be conclusive – mixed findings, small number of studies, often small sample sizesBehaviour Change TechniquesShaping knowledge (15/17)Repetition and substitution(14/17)Goals and planning(11/17)Social support(11/17)Feedback and monitoring(9/17)Natural consequences(9/17)References1. Viner, R., & Christie, D. (2005). Fatigue and somatic symptoms. BMJ, 330(7498), 1012-1015.2. Bakker, R. J., van de Putte, E. M., Kuis, W., & Sinnema, G. (2009). Risk factors for persistent fatigue with significant school absence in children and adolescents. Pediatrics, 124(1), 89-95.3. Farmer, A., Fowler, T., Scourfield, J., & Thapar, A. (2004). Prevalence of chronic disabling fatigue in children and adolescents. The British Journal of Psychiatry, 184(6), 477-481.4. Chang, C. W., Mu, P. F., Jou, S. T., Wong, T. T., & Chen, Y. C. (2013). Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer. Worldviews on Evidence-Based Nursing, 10(4), 208-217.5. Knight, S. J., Scheinberg, A., & Harvey, A. R. (2013). Interventions in pediatric chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. Journal of Adolescent Health, 53(2), 154-165.6. McCallum, S. M., Batterham, P. J., Calear, A. L., Sunderland, M., Carragher, N., & Kazan, D. (2019). Associations of fatigue and sleep disturbance with nine common mental disorders. Journal of Psychosomatic Research, 123.7. Menting, J., Tack, C. J., Bleijenberg, G., Donders, R., Droogleever Fortuyn, H. A., Fransen, J., ... & Knoop, H. (2018). Is fatigue a disease-specific or generic symptom in chronic medical conditions?. Health Psychology, 37(6), 530-543.nhs35@bath.ac.uk @n_higsonsweeney

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What nonpharmacological interventions are effective for treating fatigue in adolescents? A systematic review of randomised controlled trials

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