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Results support the efficacy and effectiveness of the energy conservation course to decrease fatigue impact, and to increase self-efficacy and some aspects of quality of life.

The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom.

Fatigue is a common symptom of multiple sclerosis (MS) with negative impacts extending from general functioning to quality of life. Both the cause and consequences of MS fatigue are considered multidimensional and necessitate multidisciplinary treatment for successful symptom management. Clinical practice guidelines suggest medication and rehabilitation for managing fatigue. This review summarized available research literature about three types of fatigue management interventions (exercise, education, and medication) to provide comprehensive perspective on treatment options and facilitate a comparison of their effectiveness. We researched PubMed, Embase, and CINAHL (August 2013). Search terms included multiple sclerosis, fatigue, energy conservation, Amantadine, Modafinil, and randomized controlled trial. The search identified 230 citations. After the full-text review, 18 rehabilitation and 7 pharmacological trials targeting fatigue were selected. Rehabilitation interventions appeared to have stronger and more significant effects on reducing the impact or severity of patient-reported fatigue compared to medication. Pharmacological agents, including fatigue medication, are important but often do not enable people with MS to cope with their existing disabilities. MS fatigue affects various components of one's health and wellbeing. People with MS experiencing fatigue and their healthcare providers should consider a full spectrum of effective fatigue management interventions, from exercise to educational strategies in conjunction with medication.

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45-90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45-90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating.

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