Key Points

• In studies including people with SCI, fatigue has been defined as feelings of tiredness, lack of energy, low motivation, difficulty in concentrating, or an increased perception of effort disproportionate to attempted activities (Anton et al. 2017; Hammell et al. 2009).
• Despite fatigue affecting more than a half of people living with SCI (Fawkes-Kirby et al. 2008), only seven RCTs and ten lower-level quality studies have evaluated the effectiveness of interventions to address fatigue in this population.

Effect of Pharmacological Management of Fatigue

• According to one RCT (Wade et al. 2003), including only four patients with SCI, cannabis medicinal extracts (CME) should not be recommended, because of the lack of effectiveness in improving fatigue for people with SCI.
• Fatigue did not significantly differ between intrathecal and oral delivery methods of baclofen treatment in people (33% with SCI) after using the medication for one year (McCormick et al. 2016).
• Further research is needed to address whether baclofen and CME provide positive results in fatigue in people with SCI and in the case of baclofen, which delivery method is more effective, accounting also for adverse effects.

Effect of Exercise on Fatigue

• Exercise-based interventions (e.g., upper limb virtual reality exercise sessions, moderate-intensity home-based arm-crank exercise, hybrid high-intensity interval training [HIIT] program) may have a positive effect on fatigue in people with chronic SCI; however, there is no consensus on which type of exercise, or the dosage that will be more effective in reducing fatigue in people with SCI.
• Yoga or Tai Chi programs do not seem to provide any effects on fatigue in people with SCI.

Effect of Non-exercise Interventions on Fatigue

• There is conflicting evidence that non-exercise-based interventions, especially massage therapy, could improve fatigue outcomes in people with SCI.

Effect of Self-Management Interventions on Fatigue

• Fatigue self-management and behavioral interventions promoting an active lifestyle does not provide a significant improvement in fatigue in people with SCI.