PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials.
To select potential studies, 2 reviewers independently applied the inclusion criteria.
Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.
The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=−2.91; 95% confidence interval [CI], −4.32 to −1.50), physical (MD=−2.99; 95% CI, −4.47 to −1.52), and psychosocial (MD=−6.05; 95% CI, −8.72 to −3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69–24.84), social function (MD=6.91; 95% CI, 1.32–12.49), and mental health (MD=5.55; 95% CI, 2.27–8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results.
The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales—role physical, social function, and mental health—in fatigued patients with MS. More RCTs that also study long-term results are needed.