title: Effectiveness of Nonpharmacologic Interventions for Decreasing Fatigue in Adults With Systemic Lupus Erythematosus: A Systematic Review.
abstract: OBJECTIVE
  Survival of patients with systemic lupus erythematosus (SLE) has significantly improved over the past decades. As SLE patients live longer they inevitably experience a range of clinical manifestations and somatic symptoms. Quality of life may also be impacted through a range of subjective indicators. Among these parameters, fatigue is the most prevalent complaint. Nonpharmacologic strategies seem regularly utilized for fatigue management in SLE; however, their real effects are not known.
  
  
  METHODS
  A systematic review was conducted to analyze the effectiveness of nonpharmacologic interventions to reduce fatigue in SLE patients. Medline/PreMedline, Embase, PsycINFO, SCI-EXPANDED, Social Sciences Citation Index, and the Cochrane Library were searched (June 2014). Studies were included and assessed for quality if they fulfilled prespecified criteria.
  
  
  RESULTS
  A total of 12 studies were finally included (n = 549): 7 randomized trials, 1 nonrandomized trial, and 4 prospective observational studies. They assessed 5 main intervention categories: exercise, behavioral and psychological approaches, diets, acupuncture, and phototherapy. All interventions produced reductions in fatigue, as measured using at least 1 instrument. Aerobic exercise was found to be effective and suitable for reducing fatigue, but results were not always consistent across instruments used. The diversity of psychological interventions limits the significance of the results; however, data point to a positive impact on fatigue. There are still few data on the effect of acupuncture, diets, and ultraviolet A radiation.
  
  
  CONCLUSIONS
  Studies are few and heterogeneous; however, nonpharmacologic interventions applied to SLE patients can be effective in reducing fatigue.
authors.affiliation: Canary Foundation of Health Research (FUNCANIS), Canary Islands, Spain.
authors.forename: Tasmania
authors.initials: T
authors.lastname: del Pino-Sedeño
authors.affiliation: Canary Foundation of Health Research (FUNCANIS) and Center for Biomedical Research of the Canary Islands (CIBICAN), Canary Islands, Spain, and Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain.
authors.forename: María M
authors.initials: MM
authors.lastname: Trujillo-Martín
authors.affiliation: Hospital Universitario Cruces, Basque Country, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Canary Foundation of Health Research (FUNCANIS), Canary Islands, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Cuellar-Pompa
authors.affiliation: Evaluation Service of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: de Pascual-Medina
authors.affiliation: Evaluation Service of the Canary Islands Health Service (SESCS) and Center for Biomedical Research of the Canary Islands (CIBICAN), Canary Islands, Spain, and Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Serrano-Aguilar
mesh_terms: D005221:Fatigue / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome