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  • Review Article
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Treatments of fatigue after spinal cord injury: a systematic review and meta-analysis

Spinal Cord volume 63, pages 149–158 (2025)Cite this article

Subjects

Abstract

Study design

Systematic Review and Meta-analysis.

Setting

Canada.

Objectives

Fatigue is one of the most common consequences of spinal cord injury (SCI). In this systematic review and meta-analysis, we examined interventions for fatigue in SCI and evaluated their effectiveness.

Methods

MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched up to January 2024 inclusive. Randomized controlled trials (RCTs) that assessed any intervention for at least one fatigue outcome in people with SCI were included. Study quality was assessed using the Cochrane Risk of Bias Tool.

Results

Initial screening identified 282 studies from which six RCTs were included in the review (N = 249). One study found that moderate-intensity arm-crank exercise significantly improved fatigue compared to a control group (p = 0.036) with a large effect size (standard mean difference [SMD] = 1.05; 95% confidence interval [CI], 0.10–2.00). Two studies assessing behavioral interventions found a moderate effect on fatigue (SMD = 0.46; 95% CI, −0.00–0.92; p = 0.05). Two studies did not find an effect of massage therapy on fatigue (SMD = 0.06; 95% CI, −0.38–0.50; p = 0.80). The risk of bias was classified as High for all but two of the RCTs.

Conclusions

These findings suggest that exercise and behavioral interventions promoting an active lifestyle may have a positive effect on fatigue. More research with larger sample sizes, including controls for co-morbid conditions like pain and depression, is needed to establish evidence-based treatments for reducing fatigue in people with SCI.

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Fig. 1
Fig. 2: Meta-analysis forest plots of behavioral (2.1.1), massage therapy (2.1.2), and exercise (2.1.3) interventions; and the combination of all meta-analysis (total).
Fig. 3: Risk-of-Bias diagram for fatigue intervention RCTs after spinal cord injury.

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Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Acknowledgements

We thank Paul Mackie for providing valuable feedback during the preparation of the draft of this manuscript.

Funding

The authors disclose receipt of financial support for the research, authorship, and publication of this article: Praxis Spinal Cord Institute [Praxis Grant # G2023-22-A1].

Author information

Author notes

  1. A full list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada

    Carlos Leonardo Cano-Herrera, Matthew Querée & Janice J. Eng

  2. Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Carlos Leonardo Cano-Herrera, Matthew Querée, William C. Miller, W. Ben Mortenson, Andrea Townson & Janice J. Eng

  3. Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada

    Gita Manhas

  4. GGZ inGeest Mental Healthcare Services, Amsterdam, Netherlands

    Bob Hoogenes

  5. Department of Psychiatry, Faculty of Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands

    Bob Hoogenes

  6. Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada

    Emma A. Bateman & Eldon Loh

  7. Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada

    Emma A. Bateman & Eldon Loh

  8. Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    William C. Miller & W. Ben Mortenson

  9. International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada

    William C. Miller, W. Ben Mortenson & Janice J. Eng

  10. Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Andrea Townson

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Consortia

the SCIRE Research Team

  • Carlos Leonardo Cano-Herrera
  • , Matthew Querée
  • , Emma A. Bateman
  • , Eldon Loh
  • , William C. Miller
  • , W. Ben Mortenson
  • , Andrea Townson
  •  & Janice J. Eng

Contributions

GM, MQ, and JE were responsible for the conceptualization and design of the study. JE is responsible for the overall content as guarantor. GM and CLCH were responsible for the selection of articles and data extraction. GM, CLCH, and MQ were responsible for further data extraction and risk of bias assessment with justification. GM, MQ, JE, and CLCH were responsible for assessing study methodologies. CLCH and MQ were responsible for preparing the tables. CLCH and JE were responsible for the meta-analysis. CLCH, GM, MQ, BH, EAB, EL, WCM, WBM, AT, and JE were responsible for writing and editing the manuscript. All authors approved the final manuscript.

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Correspondence to Janice J. Eng.

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Cano-Herrera, C.L., Manhas, G., Querée, M. et al. Treatments of fatigue after spinal cord injury: a systematic review and meta-analysis. Spinal Cord 63, 149–158 (2025). https://doi.org/10.1038/s41393-025-01067-z

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