{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:41:50Z","timestamp":1778200910770,"version":"3.51.4"},"reference-count":123,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T00:00:00Z","timestamp":1692403200000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"European Alliance of Associations for Rheumatology","award":["HPR052"],"award-info":[{"award-number":["HPR052"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,7,28]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=\u22120.23, 95% CI=\u22120.37\u2009to \u22120.1), systemic lupus erythematosus (SLE) (SMD=\u22120.54, 95% CI=\u22121.07\u2009to \u22120.01) and spondyloarthritis (SMD=\u22120.94, 95% CI=\u22121.23\u2009to \u22120.66); reduction of fatigue was not significant in Sj\u00f6gren\u2019s syndrome (SMD=\u22120.83, 95% CI=\u22122.13\u2009to 0.47) and systemic sclerosis (SMD=\u22120.66, 95% CI=\u22121.33\u2009to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=\u22120.32, 95% CI=\u22120.48\u2009to \u22120.16), but not in SLE (SMD=\u22120.19, 95% CI=\u22120.46\u2009to 0.09). Follow-up models in consultations (SMD=\u22120.05, 95% CI=\u22120.29\u2009to 0.20) and multicomponent interventions (SMD=\u22120.20, 95% CI=\u22120.53\u2009to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Physical activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003350","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T12:35:30Z","timestamp":1692621330000},"page":"e003350","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-2377","authenticated-orcid":false,"given":"Eduardo Jos\u00e9 Ferreira","family":"Santos","sequence":"first","affiliation":[{"name":"School of Health, Polytechnic University, Viseu, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal"}]},{"given":"Bayram","family":"Farisogullari","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-8607","authenticated-orcid":false,"given":"Emma","family":"Dures","sequence":"additional","affiliation":[{"name":"Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK"},{"name":"School of Health and Social Wellbeing, University of the West of England, Bristol, UK"}]},{"given":"Rinie","family":"Geenen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Utrecht University, Utrecht, Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-7972","authenticated-orcid":false,"given":"Pedro M","family":"Machado","sequence":"additional","affiliation":[{"name":"Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK"},{"name":"National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK"}]}],"member":"239","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"2025090312280377000_9.3.e003350.1","unstructured":"WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium . 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