Title:
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Cognitive fatigue in MS : an investigation of 'pacing' as a fatigue management strategy
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Fatigue is a disabling symptom in Multiple Sclerosis (MS), but fatigue management
strategies have not been systematically evaluated. The objective of this study was to
investigate the effects of 'Pacing', on the experience of fatigue measured by self-report
ratings and cognitive performance decrement. Using an experimental design, 29 MS
participants and 31 matched healthy control participants were separately randomised to
one of three conditions: continuous verbal list learning, alternating verbal list and visual
memory tasks, or verbal list learning alternating with rest ("pacing"). Participants were
assessed on parallel forms of the Brief Repeatable Neuropsychological Battery (BRB-N)
before and after the intervention. Baseline depression (CES-D) and fatigue (FSS)
questionnaires and 4 Fatigue Visual Analog Scale (FVAS) ratings spaced through the 90-
minute schedule were completed. Results revealed the MS group had significantly higher
baseline depression and fatigue scores. A mixed ANOV A (group x condition x cognition
time I, time 2) for cognitive performance revealed: the MS group's performance was
worse than the healthy control group's (p<.OOI); both groups' performance was worse
after the mental effort (p<.OOI) required by the intervention, whilst experimental
condition had no effect upon cognitive performance. A mixed ANOV A (group x
condition x self-reported fatigue at 4 time points) for FVAS ratings revealed both groups
reported increased fatigue over time (p<.OOI) yet fatigue did not differ significantly
between groups or conditions. The conclusion drawn was effortful mental tasks increased
self-reported fatigue and reduced cognitive performance equally in both MS and healthy
participants. This supports cognitive fatigue as an inducible and measurable construct. In
this study, ' Pacing' had no effect on cognitive performance decrement or self-reported
fatigue. With direct clinical implications for MS fatigue management courses that
incorporate these strategies further systematic evaluation is warranted.
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