Review What is the effect of education on fatigue in adults with neurological conditions? A systematic review and meta-analysis 2025 Simpson et al

[Andy]

Abstract​

Objective​

To determine the effect of education programs on fatigue outcomes in people with neurological conditions.

Data sources​

MEDLINE, CINAHL, EMBASE, PEDRO until May 2025, according to PRISMA guidelines.

Review methods​

Systematic review with meta-analysis of randomised controlled trials comparing education versus no education/other intervention on the outcome of fatigue for people with neurological conditions. Methodological quality and risk of bias were assessed using the Cochrane Risk of Bias Tool. Pooled effects were calculated using standard mean difference (SMD).

Results​

We included 19 clinical trials of education for fatigue (n = 1970 participants) in five different neurological conditions. Education duration ranged from 4 to 12 weeks, 79% (n = 15) of trials included people with multiple sclerosis and 18% (n = 3) included people with stroke. Most education (11 trials, 58%) was delivered in a group setting. Education reduced fatigue compared with usual care by a SMD −0.28, 95% CI [−0.45 to −0.11]. Greater benefits for fatigue were observed when education was delivered one-to-one (SMD −0.44, 95% CI [−0.77 to −0.12]) than in group sessions (SMD −0.17, 95% CI [−0.36 to 0.01]). Mode of delivery (in-person versus telehealth) did not appear to influence the effect of education for fatigue.

Conclusions​

Fatigue education programs may improve fatigue for people with neurological conditions. One-to-one delivered sessions may have greater benefits than group programs and remote delivery could improve accessibility for people living in regional and rural locations.

Open access

 

[Andy]

Health-related education is designed to improve knowledge, health literacy and influence motivation. Active education interventions use a variety of behaviour science methods however techniques are challenging to define, differentiate and are often poorly reported in clinical trials.

The experimental intervention was fatigue education programs. All trials included some form of behaviour change strategy, such as cognitive behavioural therapy principles and/or self-management principles. Similarly, all trials provided education on energy conservation principles and/or general fatigue management strategies.

So, yet again, the effect is most likely to be in how much the 'education' manages to change how people answer questionnaires.

 

[SNT Gatchaman]

Unfortunately for many neurological conditions, fatigue research is either in its infancy, possibly because of the complexity of the phenomenon and lack of mechanistic understanding. Consequently, it is challenging for health professionals to know what to offer patients.

Indeed. Hence "education".

 

[Turtle]

Why would patients need education on fatigue, they are the experts with lived experience.
Pure hybris from professionals. We don't know anything, but we can educate others with ........????????
Listening to the patients would be a good place to start.

 

[Snow Leopard]

I've never met a medical practitioner who understands fatigue at all.

 

[NelliePledge]

“reeducation”

 

[Utsikt]

Figure 2 presents the results of the risk of bias assessment for each included trial, and Table 2presents summary of findings and GRADE quality of evidence. The majority of trials (89%) reported appropriate randomisation, allocation concealment (74%) and completeness of outcome data (63%). Due to the nature of the intervention, all trials presented high risk of bias for blinding of participants and personnel. Fifty-three percent of the trials did not clearly report outcome assessor blinding. Other biases included inadequate (42%), or no reporting of statistical power (16%).

Spoiler: Figure 2 on bias

Our review has strengths and limitations. The strengths of our review included the rigorous systematic review methodology, use of the GRADE criteria to describe the certainty of evidence and the exclusive inclusion of RCTs with a primary focus of education for fatigue management.

I have no idea why they believe that RCTs make much of a difference if all of them are unblinded. And using GRADE isn’t much to brag about.

The quality assessment of the 19 trials included in this review resulted in low certainty of the overall small effect of education for fatigue across neurological conditions.

Yet they failed to include any mention of the certainty in the abstract.

A major source of bias in the included trials was lack of, or unclear blinding of outcome assessors. The certainty of evidence was also downgraded due to heterogeneity across trial results for the main results, and most subgroup analyses.

I’d say that the lack of blinding for the participants is even more important when paired with subjective outcomes.

On the other hand, the balance in published trials reporting both positive and equivocal benefits means that publication bias is unlikely, however, we did not formally assess publication bias using a funnel plot or Egger's test.

It would have been pretty easy to do this..