Purpose: The aim of the systematic review was to address whether psychological interventions were able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis. The empirical study aimed to evaluate the effectiveness of a CBT based self-help workbook at reducing perceived impact of fatigue in a clinical sample of MS patients. Methods: A systematic search of the literature was carried out between the years 1980 and February 2015 to review whether psychological interventions were effective for fatigue management in Multiple Sclerosis. A randomised controlled trial examined the effectiveness of a CBT-based self-help workbook for the reduction of fatigue impact in MS. Participants were randomly allocated to one of three groups treatment as usual (TAU), pure self-help (PSH) or guided self-help (GSH). Results: Eleven studies were included in the systematic review, which indicated that CBT based interventions aiming to reduce fatigue or depression were most effective at reducing the severity of fatigue. Impact of fatigue can be reduced through mindfulness, CBT, motivational interviewing and to a lesser extent acceptance and commitment therapy. The empirical study did not find any significant differences between groups, however satisfaction with the workbook was high. Conclusions: The review suggests that there is a clear role for psychological interventions in fatigue management in MS, although further robust research into different therapeutic modalities is needed. From the empirical study it appears that the low level CBT-based intervention for fatigue in MS was not effective at reducing the perceived impact of fatigue. This study reflects an inclusive, clinical sample, recruited from a specialist rehabilitation unit, with high levels of multidisciplinary input which may have diluted any potential effect of the workbook. Objectives: The aim of the systematic review was to address whether psychological interventions are able to reduce fatigue severity or the impact of fatigue in individuals with Multiple Sclerosis Data sources: A search was conducted of: Psychinfo, Medline, Embase, CINAHL between 1980 and February 2015. Review methods: All studies were evaluated against a set of quality criteria by author (KG) with a proportion of studies being independently reviewed by author (DP) to ensure reliability of ratings. Results: Eleven studies were included in the review. CBT based interventions with a focus on fatigue management and depression appear to significantly reduce fatigue severity with medium to large effect. Significant reductions in fatigue impact can be found from mindfulness groups, motivational interviewing and CBT. Effect sizes for CBT interventions ranged from negligible to medium. For the mindfulness and motivational interviewing interventions effect sizes were not able to be calculated. The acceptance and commitment therapy intervention did not find a significant reduction in fatigue but found a medium effect for the intervention. Conclusions: There is a clear role for psychological interventions in the reduction of fatigue management but more high quality research needs to be carried out.

La fatigue est l’un des symptômes les plus fréquents et persistants chez les victimes de commotion cérébrale. Au cours des dernières années, des signes d’altérations cognitives post-commotionnelles à la suite d’un effort aérobie, soit une forme de fatigue dont la cause est physique plus que cognitive, ont été trouvés à court et à long terme chez des athlètes étudiants. Or, puisque ces athlètes évoluent dans un contexte où ils doivent non seulement performer dans leur discipline sportive, mais aussi à l’école ou au travail, il convient de se demander si un effort mental soutenu n’aurait pas le même effet chez cette population. L’objectif de cette étude était donc de déterminer si des athlètes étudiants ayant subi une commotion cérébrale (groupe HC) se sentent plus fatigués ou ont davantage tendance à se fatiguer mentalement que ceux n’ayant jamais subi de commotion cérébrale (groupe ST). Les sujets devaient répondre à une série de questionnaires auto-rapportés. Ils devaient aussi compléter une tâche informatisée recrutant les fonctions exécutives avant et après avoir répondu à une épreuve de raisonnement, d’une durée d’une heure, visant à simuler un examen scolaire. Leur réaction physiologique à la tâche était mesurée via un appareil d’électroencéphalographie et un cardiofréquencemètre. Si dans l’ensemble les résultats n’appuient pas l’hypothèse initiale, les deux groupes ont montré des différences notables dans leur façon de répondre à la tâche. Nous avons notamment constaté l’absence d’un effet de pratique à la condition la plus facile ainsi qu’une variabilité de la performance généralement plus élevée chez les sujets avec un historique de commotion cérébrale. De plus, contrairement au groupe témoin, ceux qui rapportaient des symptômes plus importants de fatigue cognitive quotidienne, de somnolence et de dépression montraient également une moins bonne précision à la tâche après un effort cognitif soutenu. Ces résultats suggèrent que les commotions cérébrales pourraient avoir pour effet d’accroître la sensibilité de certains individus à l’effort cognitif. De futures études devraient se pencher sur cette relation afin de la confirmer et d’en comprendre les causes. / Fatigue is one of the most common and persistent symptoms in concussion victims. In recent years, signs of post-concussive cognitive impairment following aerobic exertion, a form of fatigue whose cause is more physical than cognitive, have been found in both shortand long-term in student athletes. However, since these athletes evolve in a context where they must not only perform in their sport, but also at school or at work, it is worth asking whether sustained mental effort would have the same effect in this population. The objective of this study was therefore to determine whether student athletes who have suffered a concussion (HC group) feel more tired or are more likely to become mentally fatigued than those who have never suffered a concussion (ST group). Subjects were asked to complete a series of self-report questionnaires. They were also required to complete a computerized task recruiting executive functions before and after completing a one-hour reasoning test meant to simulate a school examination. Their physiological response to the task was measured using electroencephalography and a heart rate monitor. While the results do not support the original hypothesis, the groups showed significant differences in the way they responded to the task. Particularly, we found the absence of a practice effect at the easiest condition as well as a generally higher performance variability in subjects with a history of concussion. In addition, unlike the control group, those who reported greater symptoms of daily cognitive fatigue, drowsiness and depression also showed poorer task accuracy after sustained cognitive effort. These results suggest that concussions may have the effect of increasing the sensitivity of some individuals to cognitive effort. Future studies should investigate this relationship in order to confirm it and understand its causes.

L’objectif général de ce travail doctoral était d’étudier les effets de la fatigue (physique et mentale) sur le contrôle postural. Tout d’abord, les effets de la fatigue musculaire du quadriceps fémoral induite par des contractions volontaires et des contractions électro-induites ont été comparés. Les résultats ont montré que des contractions volontaires altéraient davantage le contrôle postural que des contractions électro-induites pour une perte de force musculaire équivalente. Ceci s’expliquerait par la présence d’une fatigue centrale après les contractions volontaires, ainsi qu’une sollicitation différente des fibres musculaires entre les deux modalités de contraction. Des mécanismes compensatoires seraient mis en œuvre après ces deux modalités de contractions fatigantes, mais de façon plus prononcée pour les contractions volontaires. Concernant la fatigue mentale, les effets d’une tâche cognitive exigeante et prolongée sur ordinateur (induisant un état de fatigue mentale) et d’un visionnage de documentaire (tâche contrôle) sur le contrôle postural ont été comparés. De prime abord, la fatigue mentale affecterait le contrôle postural en condition de privation visuelle, en réduisant l’efficacité des stratégies d’attention associatives. De façon surprenante, visionner un documentaire conduirait également à une altération du contrôle postural, potentiellement en raison du maintien prolongé d’une posture assise affaissée. La posture assise pourrait ainsi constituer un facteur confondant dans les protocoles expérimentaux comportant une évaluation posturale. Une analyse statistique de classification en cluster hiérarchique a permis de mettre en évidence des sensibilités différentes au sein des individus à l’égard de la tâche mentalement fatigante. Le niveau de fatigue mentale serait associé au niveau de dégradation du contrôle postural sur un support stable avec les yeux ouverts. La réalisation d’une tâche cognitive prolongée exigeant une attention visuelle soutenue face à un écran d’ordinateur provoquerait une fatigue visuelle. Cette fatigue visuelle affecterait différemment les individus. Elle toucherait plus particulièrement les sujets les plus dépendants des informations visuelles, pour lesquels le contrôle postural se dégraderait davantage que les autres individus. / The overall objective of this doctoral work was to study the effects of fatigue (physical and mental) on postural control. First, the effects of femoral quadriceps muscle fatigue induced by voluntary contractions and electro-induced contractions were compared. The results showed that voluntary contractions affected postural control more than electro-induced contractions for an equivalent loss of muscle strength. This could be explained by the presence of central fatigue after voluntary contractions, as well as a different strain on muscle fibres between the two modes of contraction. Compensatory mechanisms would be implemented after these two modes of tiresome contractions, but more pronounced for voluntary contractions. With regard to mental fatigue, the effects of demanding and prolonged cognitive computer work (inducing mental fatigue) and documentary viewing (task control) on postural control were compared. At first glance, mental fatigue would affect postural control in conditions of visual deprivation, reducing the effectiveness of associative attention strategies. Surprisingly, viewing a documentary would also lead to an alteration in postural control, potentially due to the prolonged maintenance of a collapsed sitting posture. Sitting posture could thus be a confounding factor in experimental protocols involving postural evaluation. A statistical analysis of hierarchical cluster classification revealed different sensitivities within individuals towards the mentally demanding task. The level of mental fatigue would be associated with the level of degradation of postural control on a stable support with eyes open. Performing a prolonged cognitive task requiring sustained visual attention to a computer screen would cause visual fatigue. This visual fatigue would affect individuals differently. It would particularly affect the subjects most dependent on visual information, for which postural control would be more degraded than other individuals.