Non-exercise-Based Interventions
Non-exercise-based interventions that assessed fatigue outcomes in people with SCI were largely different types of massage therapy (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
Treatments for fatigue in people with SCI are mainly focused on the management of pain, depression, functionality, muscle strength, and range of motion, while effects on fatigue have mixed results (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. Conversely, two other RCTs that assessed fatigue after a massage intervention (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 to produce desired effects.
Results from larger systematic reviews show that massage therapy has positive effects on fatigue in other populations, such as people with chronic fatigue syndrome (Li et al. 2024), people with kidney failure requiring dialysis (Natale et al. 2023), people with fibromyalgia (Yuan et al. 2015) and people with multiple sclerosis (Salarvand et al. 2021; Zhang et al. 2022). However, fatigue may be different in people from these populations than in those with SCI. It is difficult to properly research fatigue in these populations as the biological bases of fatigue have not been established in MS nor in SCI (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 30-minute reflexology massage sessions or 50-min upper limb virtual reality exercise sessions, decreased fatigue severity (FSS) in veterans with paraplegia when performed 3 times per week for 6 weeks compared to the control condition.
There is level 2 evidence (from one RCT: Lovas et al. 2017) that 5 weeks of weekly 30-min Swedish massage sessions or guided imagery relaxation sessions decreased fatigue in people with chronic SCI.
There is level 2 evidence (from one RCT: Chase et al. 2013) that neither broad compression massage nor light contact touch sessions improved fatigue severity for people with acute SCI reporting pain.
There is level 2 evidence (from one prospective controlled trial: Wardell et al. 2006) that 6 weeks of healing touch sessions once a week decreased (with a large variation) fatigue scores on the POMS and chronic neurogenic pain compared to guided progressive relaxation sessions in people with SCI.
