Non-exercise-Based Interventions
Non-exercise-based interventions that assessed fatigue outcomes in people with SCI included massage therapy interventions (such as Swedish massage [Lovas et al. 2017], broad compression massage [Chase et al. 2013], reflexology massage (Jorjafaki et al. 2022]), healing touch (Wardell et al. 2006), and neurofeedback (Jensen et al. 2013).
Discussion
In SCI, massage interventions have been poorly studied and are mainly focused on the management of pain, depression, functionality, muscle strength, and range of motion (Chase et al. 2013; Lovas et al. 2017; Norrbrink & Lundeberg 2011; Diego et al. 2002). The RCT by Jorjafaki et al. (2022) reported significant improvement in fatigue severity with reflexology massage performed on the palms for three 30-minute sessions per week for six weeks, in veterans with paraplegia. On the other hand, the other two RCTs which assessed fatigue (apart from pain) after a massage intervention both Swedish massage in the study of Lovas et al. 2017 and broad compression massage in the cross-over of Chase et al. 2013 did not improve fatigue in people with SCI. It is possible that the dose of massage in the included studies (30 minutes once a week over five consecutive weeks [Lovas et al. 2017] and 20 minutes three times a week over two weeks [Chase et al. 2013]) was insufficient.
In other populations, massage therapy has been recommended by larger systematic reviews such as in chronic fatigue syndrome (Li et al. 2024), people with kidney failure requiring dialysis (Natale et al. 2023), fibromyalgia (Yuan et al. 2015) or in multiple sclerosis (Salarvand et al. 2021; Zhang et al. 2022). However, fatigue may be different in people with multiple sclerosis than those with SCI, and the biological bases of fatigue have not been established in either population (Heine et al. 2015).
Other alternative non-exercise approaches, such as neurofeedback (Jensen et al. 2013) or healing touch (Wardell et al. 2006) have been studied with lower-quality studies in people with SCI and have provided non-positive results in the management of fatigue.
Conclusions
There is level 2 evidence (from one RCT: Pourjafari et al. 2022) that 6 weeks of 30-minute reflexology massage sessions, performed 3 times per week, decreases the fatigue severity (FSS) in veterans with paraplegia in a similar way to 6 weeks of 50-min upper limb virtual reality exercise sessions, performed 3 times per week, in comparison with a control condition.
There is level 2 evidence (from one RCT: Lovas et al. 2017) that 5 weeks of 30-min Swedish massage sessions, received once a week, decreases fatigue similarly to 5 weeks of 30-minute guided imagery relaxation sessions, received once a week, in people with chronic SCI.
There is level 2 evidence (from one RCT: Chase et al. 2013) that, during acute inpatient rehabilitation, 2 weeks of 20-min broad compression massage sessions, received 3 times per week, did not provide a change in fatigue severity, similar to 2 weeks of 20-minute light contact touch sessions, received 3 times per week, in people with acute SCI reporting any type of pain.
There is level 2 (from one prospective controlled trial: Wardell et al. 2006) that 6 weeks of healing touch sessions, received once a week, decreases (with a large variation) the fatigue scale of the POMS in people with SCI, chronic neurogenic pain, in comparison with guided progressive relaxation sessions.
