Review Non-pharmacological treatment options for fatigue: A systematic review of RCTs in adults, 2025, Steen

https://www.sciencedirect.com/science/article/pii/S0022399925000480


Journal of Psychosomatic Research
Available online 28 February 2025, 112084
In Press, Journal Pre-proof
Review article
Non-pharmacological treatment options for fatigue: A systematic review of RCTs in adults

Carlotta Steen, Anna Zalpur, Marissa Bentele, Stephan Zipfel, Andreas Stengel
a
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany
b
German Center for Mental Health (DZPG), site Tübingen
c
Clinic for Psychosomatic Medicine and Psychotherapy, Klinikum Stuttgart, Germany
Received 29 November 2024, Revised 7 January 2025, Accepted 26 February 2025, Available online 28 February 2025.


https://doi.org/10.1016/j.jpsychores.2025.112084
Open access

Highlights

• •
  The majority of fatigue research is related to cancer-related fatigue.
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  Cognitive behavioral therapy is the most common intervention for fatigue.
• •
  Multidimensional approaches and physical activity are promising.
• •
  Online interventions are useful for fatigue management.
• •
  A more transdiagnostic approach for fatigue is needed.

Abstract

Objective
Fatigue is a significant contributor to the burden experienced by patients with chronic disorders. The development of standardized treatments is challenging due to the lack of consensus concerning the etiology of fatigue. The aim of this systematic review is to provide an overview of non-pharmacological interventions for fatigue. The efficacy and differences in fatigue treatment across conditions will be explored.

Methods
A systematic literature search was conducted using the databases PubMed, Web of Science, PsycInfo and CINAHL.

Trials were eligible when (1) adult patients (≥ 18 years old) with disorders causing fatigue were included, (2) non-pharmacological interventions performed, (3) treatment was compared to standard care, placebo or active control group, (4) fatigue was the only primary outcome assessed with a multidimensional tool, and (5) a randomized controlled trial (RCT) design was applied.

Results
7592 papers were screened. 91 RCTs were eligible, with data reported in 95 papers. Specific fatigue interventions were present for a broad range of conditions. Findings demonstrated promising evidence for physical activity, CBT, online programs and multidimensional modules. Additional types of interventions were effective, but evidence was limited due to risk of bias and small sample sizes. Due to high heterogeneity concerning methodology, a meta-analysis was not possible.

Conclusion
Several non-pharmacological treatment options for fatigue are promising. No clear evidence was found that fatigue should be treated differently depending on the underlying condition. However, further research is necessary with a focus on a transdiagnostic approach to fatigue, high study quality and long-term follow-ups.

Keywords
Adults
Chronic disorders
Fatigue
Non-pharmacological
Systematic review
Treatment

 

I roughly note 4 for ME/CFS, 2 for "post-COVID", 1 for fibromyalgia, 1 for idiopathic chronic fatigue and 1 for Q fever, that have some relevance to us. PACE isn't included. I don't see any criteria that can explain why most of them are relatively recent, and why most trials have been excluded despite meeting their selection criteria. The fact that most of those trials routinely don't even get considered without anyone caring about this endless waste is really something.

Considering how many trials have actually been held, it's easily hundreds more, this is simply devastating. They have nothing, and the whole effort has been a huge waste of time and resources. But they write this as being promising. What an absurdly inefficient industry. A rare case where a thousand monkeys would actually manage to be just as effective, somehow just as much poop gets bring thrown around.

No. None of this is necessary, and high quality studies with long-term follow-ups literally never happen because it always weakens the evidence. Literally stop doing this entirely, stop this fake parasitic industry, it's a complete waste.

 

Just had a brief skim. Something that this does (inadvertently) demonstrate is just how poor a lot of fatigue research actually is. The authors were unable to perform a meta-analysis, opting instead for a narrative review, due to high heterogeneity in interventions, populations & instruments. Over half of the included trials did not report follow-up data after the intervention, and when follow-up was reported evidence of long-term efficacy was often inconclusive or absent. On the risk-of-bias assessments (Cochrane RoB2) they determined that most studies had "some concerns" or "high risk" of bias, particularly in the "selection of reported results" domain (often due to absent pre-specified analysis plans). Only about 25% of the included studies discussed effect sizes.