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Research output: Contribution to Journal/Magazine › Review article › peer-review
Research output: Contribution to Journal/Magazine › Review article › peer-review
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TY - JOUR
T1 - ‘Pacing’ for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
T2 - a systematic review and meta-analysis
AU - Sanal-Hayes, Nilihan E.M.
AU - Mclaughlin, Marie
AU - Mair, Jacqueline L.
AU - Ormerod, Jane
AU - Carless, David
AU - Meach, Rachel
AU - Hilliard, Natalie
AU - Ingram, Joanne
AU - Sculthorpe, Nicholas F.
AU - Hayes, Lawrence D.
PY - 2025/1/31
Y1 - 2025/1/31
N2 - BackgroundPacing typically comprises regulating activity to avoid post-exertional neuroimmune exhaustion, the worsening of symptoms after an activity. Yet, the efficacy of pacing to improve symptomology is unclear.ObjectiveWe aimed to undertake a PRISMA-accordant meta-analysis concerning the effect of pacing on ME/CFS patients’ symptoms.Data sourcesSix electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature.Study selectionStudies (k = 5) selected from the 210 identified included randomised controlled trials (RCTs; k = 2), uncontrolled trials (UCTs; k = 1), intervention case series (k = 1), and sub-analysis of the PACE trial (k = 1), all of which had a pacing component, and an outcome measure reported pre- and post-pacing.Study appraisal and methodsThree separate meta-analyses were conducted on changes in symptoms using standardised mean differences (SMDs) and random-effects models.ResultsThe overall SMD showed pacing improved physical function (k = 4, SMD = 0.15 [95% CI = −0.39, 0.68], p = 0.5951). Pacing improved pain (k = 4, SMD = −0.11 [95% CI = −0.32, 0.10], p = 0.3090). Pacing improved fatigue (k = 4, SMD = −1.09 [95% CI = −2.38, 0.21], p = 0.0998).ConclusionsPacing exerted a trivial beneficial effect on physical function and pain. Fatigue was improved with a large effect, which did reach the p < 0.05 level. We cautiously conclude pacing likely exerts some beneficial effects on symptomology, particularly, fatigue, in people with ME/CFS. However, the level of empirical research is insufficient, and more high-quality RCTs are essential to support the NICE guidelines.
AB - BackgroundPacing typically comprises regulating activity to avoid post-exertional neuroimmune exhaustion, the worsening of symptoms after an activity. Yet, the efficacy of pacing to improve symptomology is unclear.ObjectiveWe aimed to undertake a PRISMA-accordant meta-analysis concerning the effect of pacing on ME/CFS patients’ symptoms.Data sourcesSix electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature.Study selectionStudies (k = 5) selected from the 210 identified included randomised controlled trials (RCTs; k = 2), uncontrolled trials (UCTs; k = 1), intervention case series (k = 1), and sub-analysis of the PACE trial (k = 1), all of which had a pacing component, and an outcome measure reported pre- and post-pacing.Study appraisal and methodsThree separate meta-analyses were conducted on changes in symptoms using standardised mean differences (SMDs) and random-effects models.ResultsThe overall SMD showed pacing improved physical function (k = 4, SMD = 0.15 [95% CI = −0.39, 0.68], p = 0.5951). Pacing improved pain (k = 4, SMD = −0.11 [95% CI = −0.32, 0.10], p = 0.3090). Pacing improved fatigue (k = 4, SMD = −1.09 [95% CI = −2.38, 0.21], p = 0.0998).ConclusionsPacing exerted a trivial beneficial effect on physical function and pain. Fatigue was improved with a large effect, which did reach the p < 0.05 level. We cautiously conclude pacing likely exerts some beneficial effects on symptomology, particularly, fatigue, in people with ME/CFS. However, the level of empirical research is insufficient, and more high-quality RCTs are essential to support the NICE guidelines.
KW - chronic fatigue syndrome
KW - myalgic encephalomyelitis
KW - Pacing
KW - pain
KW - fatigue
KW - physical function
U2 - 10.1080/21641846.2024.2433390
DO - 10.1080/21641846.2024.2433390
M3 - Review article
VL - 13
SP - 36
EP - 53
JO - Fatigue: Biomedicine, Health Behavior
JF - Fatigue: Biomedicine, Health Behavior
SN - 2164-1846
IS - 1
ER -