Multiple Sclerosis Journal - October 2017 - 1527

702751
research-article2017

MSJ0010.1177/1352458517702751Multiple Sclerosis JournalLJM Blikman, J van Meeteren

MULTIPLE
SCLEROSIS
JOURNAL

MSJ

Original Research Paper

Effectiveness of energy conservation
management on fatigue and participation
in multiple sclerosis: A randomized
controlled trial

Multiple Sclerosis Journal
2017, Vol. 23(11) 1527-1541
DOI: 10.1177/
https://doi.org/10.1177/1352458517702751
1352458517702751
https://doi.org/10.1177/1352458517702751
© The Author(s), 2017.
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Lyan JM Blikman, Jetty van Meeteren, Jos WR Twisk, Fred AJ de Laat,
Vincent de Groot, Heleen Beckerman, Henk J Stam and Johannes BJ Bussmann;
TREFAMS-ACE study group

Abstract
Background: Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS).
Objective: To investigate the effectiveness of an individual energy conservation management (ECM)
intervention on fatigue and participation in persons with primary MS-related fatigue.
Methods: A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were
randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out
at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue
subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA).
Results: Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS
nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the
groups = −0.81; 95% confidence interval (CI), −3.71 to 2.11) or for four out of five IPA domains. An
overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference
between the groups = 0.19; 95% CI, 0.03 to 0.35).
Conclusion: The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.
Keywords: Energy conservation, fatigue management, multiple sclerosis, rehabilitation medicine,
fatigue, participation, randomized controlled trial
Date received: 13 November 2016; revised: 8 March 2017; accepted: 11 March 2017

Introduction
Multiple sclerosis (MS) is a chronic progressive neurological disease, with onset generally occurring in
relatively young adults. MS causes a variety of clinical symptoms: neurological impairments, fatigue and
depression.1 Fatigue is the most frequently reported
and disabling symptom of MS. However, the exact
pathophysiological mechanism is still not completely
understood.2 MS-related fatigue has been defined by
the Multiple Sclerosis Council for Clinical Practice
Guidelines as 'a subjective lack of physical and/or
mental energy that is perceived by the individual (or

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Correspondence to:
J van Meeteren
Department of Rehabilitation
Medicine, Erasmus MC
- University Medical Center
Rotterdam, PO Box 2040,
3000 CA Rotterdam, The
Netherlands.
j.vanmeeteren@
erasmusmc.nl
Lyan JM Blikman
Jetty van Meeteren
Henk J Stam
Johannes BJ Bussmann
Department of Rehabilitation
Medicine, Erasmus MC
- University Medical Center
Rotterdam, Rotterdam, The
Netherlands
Jos WR Twisk
Department of Epidemiology
and Biostatistics, VU
University Medical Center,
Amsterdam, The Netherlands
Fred AJ de Laat
Libra Rehabilitation
Medicine and Audiology,
Tilburg, The Netherlands
Vincent de Groot
Heleen Beckerman
Department of Rehabilitation
Medicine, VUmc MS Center
and EMGO Insitute for
Health and Care Research,
VU University Medical
Center, Amsterdam, The
Netherlands

caregiver) to interfere with usual and desired activities'.3 Fatigue severely limits a person's daily activities and restricts societal participation.4
Reducing limitations of activities in daily life is an
important rehabilitation treatment goal. Fatigue is
multidimensional and can be managed using multiple
approaches, including pharmacological therapies
(such as Amantadine, Modafinil) and non-pharmacological therapies such as aerobic training, cognitive
behavioural therapy, energy management, mindfulness or multidisciplinary treatment. At this time, there

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