Exploring Rest Advice in Fatigue Interventions in Rehabilitation Among Adults With Long-Term Conditions: A Systematic Scoping Review of the Reporting of Rest in Randomized Controlled Trials.

Abstract

To explore how rest is described or included as part of rest advice in fatigue interventions within rehabilitation for adults with long-term conditions (LTC). This scoping review identified fatigue interventions through PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and the Physiotherapy Evidence Database, from inception to July 2024. Two independent reviewers screened and selected the articles. Studies were included if they: (1) involved adults with LTC, (2) used nonpharmacological fatigue interventions, (3) had fatigue as the primary outcome, and (4) were randomized controlled trials. Only randomized controlled trials that include rest advice in the interventions were selected. Extracted data included the first author's name, year of publication, country, type of LTC, intervention category, specific interventions, and how rest was reported in all interventions. Furthermore, rest was reported using the frequency, intensity, time, and type principle, focusing on the frequency, intensity, duration, and type of rest in the exercise interventions and key conclusions. Results were summarized, tabulated, and reported descriptively. Out of 13,645 initial records, 56 studies were included in the review. Of the total interventions analyzed, 55.4% (31/56) were classified as physical activity interventions, 14.3% (8/56) as psychological interventions (eg, cognitive behavioral therapy), 12.5% (7/56) were identified as energy management strategies, 8.9% (5/56) as educational interventions, and 8.9% (5/56) as activity pacing strategies. A disparity was observed in the instruction of rest advice between exercise interventions and daily fatigue management strategies. Specifically, physical activity interventions tended to adopt a more prescriptive approach to rest, whereas rest in daily fatigue management strategies was primarily instructed through education on the importance of rest in daily life. Notably, the level of detail provided in reporting rest parameters was generally limited. This review found insufficient reporting of rest, highlighting a significant gap and indicating the need for improved documentation and standardization of rest in fatigue interventions. Future research is necessary to better understand the role of rest in the rehabilitation of LTC.