The Impact of Physical Exercise on Reduction of Fatigue in Patient with Guillain Barre Syndrome (GBS): A Systematic Review

Abstract

1.0 ABSTRACT Background: Guillain-Barre Syndrome (GBS) is a rare neuromuscular condition which is characterized by the body’s immunity attacking the peripheral nervous system (PNS). It affects three in every 100,000 people, with rates increasing with age, and men are more affected than women. Mortality rate is around 15% and about 20% of survivors have long-term disability. Symptoms include rapid onset of symmetrical and bilateral paraesthesia, paresis of extremities, hypo-areflexia, autonomic dysfunction, increased protein in cerebrospinal fluid (CSF), and pain. Some patients experience fatigue, chronic pain, and paresis. Fatigue can continue even after full neurological recovery. Various studies have explored the role of rehabilitation in treating fatigue in GBS patients. There is evidence in the studies that physical exercise has positive effects on fatigue in patients with GBS. Aim: The main purpose of the study was to explore the effect of physical exercise in reduction of fatigue in patients with GBS Methodology: The study was carried out in form of a systematic review, which is the standard for synthesis due to methodological rigor. The review was formulated of Randomized controlled trials, case controls, and quasi-experiments. The Review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A computerized search was carried out in five databases, MEDLINE, CINAHLPlus, AMED, Cochrane, and ScienceDirect. The study was limited to articles published in English language, primary studies, and human populations. The query included terms that described GBS, its treatment, fatigue, and the role of physical exercise in reducing fatigue in patients with GBS. Studies included were Randomized controlled trials (RCTs), Case reports, and quasi-experiments. The analysis of the included studies was conducted for content analysis. Results: A total of eight papers were included in the study (one RCT, two quasi-experiments, and 5 case reports/series), which met the inclusion criteria. The pooled sample size was 343 (170 female and 173 males). The outcome measures used in the studies demonstrated an improvement in fatigue scores in the GBS subjects who received the physical exercise therapy. However, the studies did not include physiological outcome measures to determine the exact impact on the nervous system and physical function. A small number of the included studies had healthy controls, and only one study compared the effect of low and high intensity exercise. For lack of randomization and blinding, the evidence in most of the studies was categorized as low to moderate. Conclusion: The systematic review provides moderate to low evidence for the effectiveness of physical exercise in reducing fatigue for patients with GBS. Lack of homogeneity in research designs, interventions, and outcome measures affect the evidence level of this review. As such, there is a need for future reviews to be conducted with higher quality studies to corroborate the findings of the present study. Keywords: Guillain-Barre Syndrome, fatigue, paraesthesia, paresis, hypo-areflexia, autonomic dysfunction, cerebrospinal fluid (CSF), rehabilitation, physical exercise, physical therapy