Sanal-Hayes, Nilihan E.M. and Mclaughlin, Marie and Mair, Jacqueline L. and Ormerod, Jane and Carless, David and Meach, Rachel and Hilliard, Natalie and Ingram, Joanne and Sculthorpe, Nicholas F. and Hayes, Lawrence D. (2024) ‘Pacing’ for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) : a systematic review and meta-analysis. Fatigue: Biomedicine, Health Behavior. pp. 1-18. ISSN 2164-1846
Full text not available from this repository.Abstract
Background Pacing 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. Objective We aimed to undertake a PRISMA-accordant meta-analysis concerning the effect of pacing on ME/CFS patients’ symptoms. Data sources Six 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 selection Studies (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 methods Three separate meta-analyses were conducted on changes in symptoms using standardised mean differences (SMDs) and random-effects models. Results The 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). Conclusions Pacing 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.