A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions, 2024, Mulligan et al

Abstract

Purpose
Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions.

Methods
A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted.

Results
The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials.

Conclusion
This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.

Implications for rehabilitation

• Fatigue is a common and debilitating symptom of many long-term physical health conditions; however, many people do not receive treatment for fatigue.
  
  
• This mapping review found that very few clinical guidelines contain recommendations for managing fatigue, even where published evidence exists.
  
  
• It is essential that developers of clinical guidelines address this important neglected area.

Open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2024.2353855

 

"Guidelines were excluded if they related to LTCs resulting from accident or injury, rather than disease, mental health conditions or developmental disorders. Guidelines relating to cancer were excluded because a systematic review of clinical guidelines for the management of cancer-related fatigue has already been published [Citation30]. Guidelines for myalgic encephalomyelitis/chronic fatigue syndrome were also excluded as fatigue is the illness itself rather than an effect of a distinct LTC."

 

Just terrible all-around. Not the review itself, the evidence. It's all low-quality garbage. Medicine doesn't have a clue what fatigue is, how to define, how to identify it or what to do with it. In any condition. And that's in addition to the confusion over fatigue being the illness itself in ME/CFS, which is just... weird. And lazy. Can't be bothered to do the most minimal amount of research.

Really the state of knowledge is no more advanced than 5000 years ago. Lots more words are written about it, but it doesn't add up to a level of understanding beyond the most superficial. No modern practitioner is better informed or capable about it than at any point in the past, probably all the way back to our cave-dwelling ancestors.

The recommendations are all low quality, generic and even contradict each other. It's mostly either rest or activity. Which doesn't even make sense, a child's comically ignorant understanding of a complex problem. You get more realistic solutions from most children when they explain what laws would exist in the fantasy kingdom where they would rule.

And the same can be said of pain, but at least there is some medication for it, even though it has its own problems. The two most common problems in medicine, and they're stuck in antiquity-level of knowledge. The cutting edge of medical science keeps progressing, but the basics have been stagnant for a long time, and the profession seems to lack the self-reflection or motivation to do anything about it. Which is, ironically, a popular concept for a laziness-based model of fatigue, which completely misunderstands the problem.

What it all ends up is a bizarre reality where complete amateurs often really do know better than the professionals, and actually should tell them how to do their job, because they aren't doing it properly. A completely unique failure with no equivalent in any other profession.