Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Objectives This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS).

Methods Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS.

Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value.

Meta-analysis was conducted using RStudio's "meta" package with a random-effects model.

Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates.

Results Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis.

The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%).

Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively.

Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean ( P  = 0.02).

The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS.

Conclusion Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.