Cryotherapy and self-reported fatigue in individuals with multiple sclerosis: A systematic review

Abstract

Background: Multiple Sclerosis (MS) is a degenerative neurological condition leading to central nervous system demyelination. Research shows that cryotherapy may increase function and decrease the symptoms of MS.

Objective: To evaluate the effects of cooling interventions compared to placebo/sham or no treatment on self-reported fatigue in individuals with MS.

Methods: The authors searched two databases (PubMed and EMBASE) in May 2019 using search terms related to cooling techniques and MS-related fatigue. Patients with comorbidities unrelated to MS were excluded. A risk of bias assessment was performed by two authors utilizing quality assessment tools related to the type of study including PEDro, NIH Quality Assessment for Case Series Studies (NIHQACSS), and the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group (NIHQATBASNCG).

Results: Eight studies were included for review. Six showed significant differences between groups in favor of the cooling group. Four showed significant effect sizes in favor of the cooling group within and between groups. Risk of bias results were as follows: PEDro scores for six studies ranged 4/10 to 6/10, an NIHQACSS score of 9/9, and an NIHQATBASNCG score of 9/12.

Conclusions: Three of the four studies that examined chronic cooling demonstrated large effect sizes favoring the cooling group. Three of the four studies that examined acute cooling demonstrated significant differences favoring the cooling group with the exception reporting a small, significant effect size that favored the cooling group. Seven of eight included studies revealed some benefit of cooling intervention on fatigue.

Keywords:

• multiple sclerosis
• cryotherapy
• fatigue

Acknowledgements

The authors would like to acknowledge and thank Tamara Nelson from the Rowland Medical Library at the University of Mississippi Medical Center for her assistance with the research for this study. The authors would also like to thank Jennifer Reneker for her guidance and instruction during the research process.

Disclosure statement

The authors have no current or future conflicts of interest to declare.

Additional information

Notes on contributors

Annie Campbell

Annie Campbell is a third year Doctorate of Physical Therapy Student at the University of Mississippi Medical Center. She received a bachelor’s degree in Kinesiology from Mississippi State University. Her current clinical interests include neurologic and pediatric physical therapy.

Benjamin Killen

Benjamin Killen is a third year Doctorate of Physical Therapy Student at the University of Mississippi Medical Center. He received a bachelor’s degree in exercise science from the University of Mississippi. His current clinical interests include neurologic and orthopedic physical therapy.

Steven Cialone

Steve Cialone is a third year Doctorate of Physical Therapy Student at the University of Mississippi Medical Center. He received a bachelor’s degree in exercise science from the University of Mississippi. His current clinical interests include neurologic and orthopedic physical therapy.

Marshall Scruggs

Marshall Scruggs is a third year Doctorate of Physical Therapy Student at the University of Mississippi Medical Center. He received a bachelor’s degree in biological sciences from Mississippi State University. His current clinical interests include neurologic and orthopedic physical therapy.

Melanie Lauderdale

Melanie Lauderdale is a full-time Associate Professor of Physical Therapy at the University of Mississippi Medical Center. She is a board certified clinical specialist in neurologic physical therapy. Her current area of clinical practice is an acute care hospital.