This evidence map provides an overview of the amount of evidence and types of studies that are available for evaluating different interventions for fatigue in people with multiple sclerosis (MS). Read more about Using This Map and overarching Research Insights gained from this map. For the best map interaction experience, we recommend viewing this evidence map on desktop-sized devices in a Chrome, Safari, or Firefox browser.

The ECRI Institute-Penn Medicine Evidence-based Practice Center developed this map for PCORI.
 

Using This Map

This map summarizes 282 study abstracts of interventions that are categorized by overall treatment type and study design (randomized trial, nonrandomized controlled study, or case series).

Axes: The x-axis (horizontal line) lists the major categories of available interventions (e.g., pharmacologic, complementary and alternative medicine [CAM]), and the y-axis represents the number of studies identified for a given intervention class.

Bubbles: The colored bubbles represent the specific type of study design (e.g., randomized controlled trial [RCT]) for each intervention category. Bubbles represent specific interventions with bubble height corresponding to the number of studies investigating a treatment type. Bubble size represents the total number of patients enrolled in studies of that treatment type (including patients receiving inactive treatments such as placebo or sham, and those on a waiting list).

Hovering over a given bubble provides more detailed information about the evidence available for that particular intervention category. For example, the blue bubble representing exercise shows 78 RCTs of exercise for fatigue in MS encompassing a total of 3,734 patients.

Filters: Filters allow for customization of the presented data by the country in which the study was conducted, the year the study was conducted, and the type of study design. It also permits a more granular view within each bubble. For instance, checking “specific interventions” within the RCT category allows for the visualization of packed bubbles (e.g., darker blue bubbles within a lighter blue circle), which describe the specific type of intervention and the number of patient studies within that larger category (for example, one specific exercise intervention is balance training, which had 186 patients).

Research Insights

• Research has focused on exercise (119 studies), behavioral/education (76 studies), and pharmacologic interventions (57 studies), with particular increased attention on exercise and behavioral/education intervention studies in recent years (i.e., since 2001).
• The map reveals a high proportion of randomized trials, compared to other study designs. In most areas of medicine, randomized trials are less frequent than case series and nonrandomized controlled trials. By contrast, for interventions for fatigue in MS, randomized trials were the most frequent study design for all categories except combination treatment.
• A relative change in the types of treatments under investigation has occurred over time. Studies of exercise and behavioral/educational interventions have increased since 2011. By contrast, studies of pharmacologic and CAM interventions have decreased.

Posted: March 6, 2019