10.3389/fpsyg.2012.00132

Vollständiger Abstract

Worum geht es in dieser Arbeit?

<h4>Background</h4>Fatigue is a prevalent and debilitating symptom among people undergoing maintenance hemodialysis (MHD). Pharmacological options for fatigue are limited, and treatment may be complicated by altered pharmacokinetics, polypharmacy, and adverse effects. Non-pharmacological interventions have therefore received increasing attention, but their comparative efficacy remains uncertain. This study aimed to compare and rank their efficacy for fatigue relief in people undergoing MHD.<h4>Methods</h4>PubMed, Embase, the Cochrane Library, CINAHL, and Web of Science were searched from inception to December 14, 2025. Randomized controlled trials of non-pharmacological interventions for fatigue were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Pairwise and frequentist random-effects network meta-analyses were performed. Treatment rankings were estimated using the surface under the cumulative ranking curve, and confidence in the evidence was evaluated using the Confidence in Network Meta-Analysis framework.<h4>Results</h4>Thirty-nine trials involving 2,943 participants evaluated eight active interventions, sham control, and usual care. Most trials were judged to have some concerns regarding risk of bias. Compared with usual care, brief behavioral intervention (SMD = -1.73, 95% CI: -2.46 to -0.99) and mind-body therapy (SMD = -1.66, 95% CI: -2.20 to -1.12) had the largest estimated reductions in fatigue and ranked first and second, respectively. Cognitive behavioral therapy, aromatherapy, exercise, acupoint stimulation, and manual therapy were also associated with lower fatigue, whereas estimates for sham control and non-invasive brain stimulation versus usual care were not statistically significant. There was no statistical evidence of global or local inconsistency. The direction of several estimates was maintained in sensitivity analyses, although small-study effects and estimate instability remained possible; exploratory meta-regression suggested that fatigue scale type may modify treatment effects. For comparisons with usual care, confidence was moderate for brief behavioral intervention, mind-body therapy, and aromatherapy, and low or very low for the remaining interventions.<h4>Conclusion</h4>Brief behavioral intervention and mind-body therapy appear to be the most promising options for reducing fatigue in people undergoing MHD, while aromatherapy was also supported by moderate-confidence evidence. However, these findings, particularly the treatment rankings, should be interpreted cautiously because of limited direct comparative evidence and uncertainty in the evidence base.<h4>Systematic review registration</h4>(https://www.crd.york.ac.uk/PROSPERO/view/CRD420261355908) PROSPERO (CRD420261355908).

Abstract: PubMed · Datensatz