title: Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis.
abstract: Fatigue is a frequently occurring symptom of multiple sclerosis (MS) that limits social participation.
  
  
  
  To systematically determine the short and long-term effects of cognitive behavioral therapy (CBT) for the treatment of MS-related fatigue.
  
  
  
  Pubmed, Cochrane, EMBASE, Psychology and Behavioral Sciences Collection, ERIC, PsychINFO, Cinahl, PsycARTICLES, and relevant trial registers were searched up to February 2016. In addition, references from retrieved articles were examined.
  
  
  
  Studies were included if participants had MS, fatigue was a primary outcome measure, the intervention was CBT, and the design was a randomized controlled trial. The search was performed by two independent reviewers, three CBT experts determined whether interventions were CBT.
  
  
  
  Data on patient and study characteristics and fatigue were systematically extracted using a standardized data extraction form. Two independent reviewers assessed risk of bias using the Cochrane Collaboration risk of bias tool. In the event of disagreement, a third reviewer was consulted.
  
  
  
  Of the 994 identified studies, 4 studies were included in the meta-analysis, comprising 193 CBT-treated patients and 210 patients who underwent a control treatment. Meta-analyses of these studies showed that CBT treatment had a positive short-term effect on fatigue (standardized mean difference [SMD]=-0.47; 95% confidence interval [CI]=-0.88; -0.06; I2=73%). In addition, three studies showed a long-term positive effect of CBT (SMD=-0.30; CI -0.51; -0.08; I2=0%).
  
  
  
  This review found that the use of CBT for the treatment of fatigue in patients with MS has a moderately positive short-term effect. However, this effect decreases with cessation of treatment.
authors: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands. Electronic address: l.vandenakker@vumc.nl.
authors: Lizanne Eva
authors: LE
authors: van den Akker
authors: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands.
authors: Heleen
authors: H
authors: Beckerman
authors: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Emma Hubertine
authors: EH
authors: Collette
authors: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands.
authors: Isaline Catharine Josephine Maria
authors: IC
authors: Eijssen
authors: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors: Joost
authors: J
authors: Dekker
authors: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands.
authors: Vincent
authors: V
authors: de Groot
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cognitive behavioral therapy; Fatigue; Multiple sclerosis; Systematic review and meta-analysis