Fatigue management in Parkinson’s disease: Evidence synthesis and a pilot randomised controlled trial of the ReFresh online intervention

Alageel, Sarah (2025) Fatigue management in Parkinson’s disease: Evidence synthesis and a pilot randomised controlled trial of the ReFresh online intervention. Doctoral thesis, University of East Anglia.

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Abstract

Fatigue is one of the most prevalent and disabling non-motor symptoms in Parkinson’s disease (PD), yet it remains poorly understood and inadequately treated. People with Parkinson’s consistently identify fatigue as among the most burdensome aspects of their condition, often with greater impact on daily functioning and quality of life than motor symptoms. Despite this, fatigue remains under-recognised in clinical care and there is limited evidence to guide effective management strategies.

This thesis aimed to advance the evidence base for non-pharmacological approaches to fatigue management in PD through a multi-stage research programme. First, a systematic review synthesised randomised controlled trials of non-pharmacological interventions for fatigue in PD. Findings highlighted the scarcity of available evidence, with only a small number of underpowered studies—predominantly exercise-based—providing modest indications of benefit but insufficient to establish robust conclusions. To broaden the perspective, a scoping review mapped fatigue management strategies across other neurodegenerative conditions, including multiple sclerosis and motor neurone disease. This review identified a wider range of interventions, such as cognitive behavioural therapy, energy management, psychoeducation, and self-management programmes, many of which demonstrated promise and provided transferable insights for PD.

Building on this evidence, a pilot randomised controlled trial evaluated the feasibility, acceptability, and preliminary outcomes of ReFresh, an online fatigue management programme for people with PD adapted from the Multiple Sclerosis-based FACETS programme. The pilot trial demonstrated good feasibility and acceptability, with encouraging short-term trends towards improved fatigue self-efficacy. However, challenges were noted in iii sustaining engagement and retention, highlighting the need for further adaptation and digital support strategies in future research.

Together, these studies contribute to understanding fatigue management in PD, emphasising the limited existing evidence, the value of cross-condition learning, and the potential of structured, patient-centred programmes. The findings support the case for further development and rigorous evaluation of non-pharmacological fatigue interventions in PD, with patient involvement central to design and implementation.

Protocol registrations: Systematic review — PROSPERO (CRD42023394180); Scoping review — OSF (DOI: 10.17605/OSF.IO/MJEYP; osf.io/r38sh); Pilot RCT — ISRCTN (ISRCTN62114944).

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User:	Jennifer Whitaker
Date Deposited:	01 May 2026 14:11
Last Modified:	01 May 2026 14:11
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102881
DOI:

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