Evidence map›Paper›PMID 33876986›Full record

SynthesisMultiple sclerosis (Houndmills, Basingstoke, England)2021

Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis.

Anthony M Harrison, Reza Safari, Tom Mercer, Federica Picariello, Marietta L van der Linden, Claire White, Rona Moss-Morris, Sam Norton

Erratum issuedOpen access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Multiple sclerosis (Houndmills, Basingstoke, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 36 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 6 pooled it
8.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 6 syntheses or guidelines pooled it, 84 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Article
  13. Review
  14. Review
  15. Article
  16. Article
  17. Review
  18. Article
  19. Pediatric multiple sclerosis: Improving outcome through high-efficacy therapies.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Review
  20. Linking Pathogenesis to Fall Risk in Multiple Sclerosis.Archives of internal medicine research · 2025
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Anthony M HarrisonDepartment of Clinical and Health Psychology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK.
Reza SafariHealth and Social Care Research Centre, College of Health, Psychology and Social Care, University of Derby, Derby, UK.
Tom MercerCentre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK.
Federica PicarielloHealth Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Marietta L van der LindenCentre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK.
Claire WhiteSchool of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Rona Moss-MorrisHealth Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Sam NortonHealth Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
King's College London · GBQueen Margaret University · GBLeeds Teaching Hospitals NHS Trust · GBUniversity of Derby · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment.

objectiveThe aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions.

methodsNine electronic databases up to August 2018 were searched, and 113 trials (

resultsPairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect.

conclusionTreatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.

Indexed as

Multiple SclerosisExerciseExercise TherapyFatigueHumansbehavioural interventionsexercise interventionsFatiguemultiple sclerosisnetwork meta-analysisquasi-randomised controlled trialsrandomised controlled trialsTIDieR

Identifiers

PMID33876986
PMCPMC8474304
OpenAlexW3143531174

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.