¥_°Ï(¤G)The effectiveness of non-pharmacological interventions on fatigue in children and...

1

Systematic Review

The effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer a systematic review

First Reviewer

Chi-Wen Chang RN PhD candidate School of Nursing National Yang-Ming University and Instructor School of Nursing Chang Gung University Taipei Taiwan R OC Taiwan A collaborating centre of the Joanna Briggs Institute Email cwchangmailcguedutw Second Reviewer Pei-Fan Mu RN PhD Professor and Deputy Academic Dean School of Nursing National Yang-Ming University Taipei Taiwan R OC Taiwan Joanna Briggs Institute Collaborating Centre

Third Reviewer Shiann-Tarng Jou Assistant professor Visiting Staff Department of Pediatrics National Taiwan University Hospital Taipei Taiwan R OC

Fourth Reviewer Tai-Ting Wong Division of Pediatric Neurosurgery Department of Neurosurgery Neurological Institute Veterans General Hospital Taipei Taiwan R OC

Fifth Reviewer Yu-Chih Chen RN PhD Director Department of Nursing Taipei Veterans General Hospital amp Adjunct Associate Professor School of Nursing National Taipei University of Nursing and Health Sciences Taipei Medical University and National Defense Medical Center

Contact Reviewer Pei-Fan Mu RN PhD Professor and Deputy Academic Dean School of Nursing National Yang-Ming University Taipei Taiwan R OC Taiwan Joanna Briggs Institute Collaborating Centre

Executive Summary Background Fatigue is one of the most distressing and prevalent symptoms reported by

pediatric oncology patients With the increase in cancer survival rate how to control

childrenrsquos cancer-related fatigue during treatments or the coexisting period with the

disease to further increase their quality of life has become the focus of medical teams

who provide care to children with cancer

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2

Objectives The objective of this systematic review was to determine the best available

evidence concerning the effectiveness of non-pharmacological interventions on fatigue in

children and adolescents with cancer

Search strategy The search strategy aimed to find studies published between 1960 and

2010 in either the English or Chinese languages Reference lists of studies that met the

inclusion criteria were also searched for additional studies

Types of studies This review included randomised controlled trials and

quasi-experimental studies that examined the effectiveness of non-pharmacological

interventions for fatigue in children and adolescents with cancer

Types of participants Children and adolescents aged from 1 to 18 years old with

cancer either during or after the chemotherapy The types of cancer included were Acute

lymphoblastic leukemia Acute myeloid leukemia lymphoma and solid tumors

Types of interventions This review considered studies that examine

non-pharmacological interventions on fatigue for children and adolescents with cancer

including activity enhancement (exercise physical activity) psychosocial interventions

cognitive behavioral therapy stress management relaxation nutrition consultation

massage and educational interventions The intervention descriptions included the length

frequency setting and intervention providers

Types of outcome measures The outcome measures considered fatigue scores

assessment

Types of setting The review focused on studies that conducted either in a hospital or a

community setting

Data collection and synthesisThe data were extracted using the standardised data

635

3

extraction tool from the Joanna Briggs Institute-Meta-Analysis of Statistics Assessment

and Review Instrument

Results

The review included a total of six studies - five English-language papers and one

Chinese-language paper Meta-analysis did not show statistically significant impact on

the effectiveness of exercise interventions in reducing fatigue in children and adolescents

with cancer The impact of the exercise interventions on general fatigue did however

indicate a statistically significant difference (p = 001 95 Confidence Interval -135 to

-017)

Conclusions

The results of this systematic review show that exercise interventions can effectively

reduce the level of general fatigue of children six to 18 years No strong conclusions

can be made for the use of massage therapy or health education measures as there

was only one article for each of these interventions

Implications for practice The review provides an evidenced-based guide to future priorities for clinical practice

Exercise intervention could reduce the level of general fatigue of children who ages are

six to 18 In particular exercise intervention for fatigue are feasible and safe

Implications for research There is still a lack of rigorous research on this specific topic Further research requires

more rigorous study design and reporting of menthdologic issues such as randomized

controlled trials using concealment of allocation Other non-pharmacological

interventions should be also examined including cognitive behavioral therapy stress

management relaxation support groups massage therapy in this area

636

4

Keywords non-pharmacological intervention fatigue children adolescents cancer

exercise cognitive systematic review

BACKGROUND

The Clinical Practice Guidelines in Oncology of the National Comprehensive Cancer

Network (NCCN) in the USA define cancer-related fatigue as ldquoa distressing persistent

subjective sense of physical emotional andor cognitive tiredness or exhaustion related

to cancer or cancer treatments that is not proportional to recent activity and interferes

with daily functionrdquo(pFT-1)1 When children suffer from cancer fatigue is not only the most

consistently reported symptom by children with cancer but also one of the most

persistent and uncomfortable symptoms 2

The incidence of cancer in children is high across the world As an example the

incidence in the USA for children aged 0-14 years is approximately 129 per million with

an estimated projection of 8200 newly diagnosed cases per year3 In Taiwan

approximately 550-600 children are diagnosed with cancer every year4 According to the

estimation of group proportions the incidence of childhood cancer in Taiwan and the

United States are similar 5 In addition malignant tumor has become the second leading

causes of death for children and adolescents aged 1-14 years in Taiwan3 and US6

Although cancer has been one of the major illnesses threatening the life of children the

progress made in medical technology has led to a significant improvement in the

treatment of children and adolescents with cancer over the past three decades7

especially the increase in their survival rate Statistics have indicated that the five-year

637

5

survival rate of children with cancer has exceeded 756 however the treatments of

cancer tend to rely on aggressive chemotherapies which force children to face a long

treatment process as well as various physical and mental symptoms8 Fatigue is one of

the common symptoms affecting children during treatments Children may feel persistent

fatigue even after they complete cancer treatments9

To date the causes and mechanism of cancer-related fatigue are still unclear However

the theories concerning the causes of fatigue have been proposed Common theories

include Integrated Fatigue Model10 Psychobiological Entropy Model11 Energy Analysis

Model12

Piper et al (1987) 10 proposed the Integrated Fatigue Model which is one of the most

frequently cited fatigue models at present They suggest that fatigue is the tiredness felt

by individuals as a result of the influence of body rhythm which makes individuals

experience different degrees of discomfort In this model fatigue can be measured by

biochemical indicators such as cytokines interferon and tumor necrosis factors as well

as with a self-report fatigue scale

The term ldquoIntegratedrdquo refers to a combination of features including perception physics

biochemistry and behavior all of which affect level of fatigue and in turn influence

fatigue patterns including diseases treatments activitiesrests environment symptoms

social activities life events individual internal factors and other aspects of the patients

life

The second theory is the Psychobiological Entropy Model11 is the most complete fatigue

638

6

theory at present This model suggests that the main cause of fatigue is a lack of energy

The physical ability of patients is reduced because of the symptoms caused by diseases

or treatments and thus patients experience emotion-related fatigue and the reduction in

functional status as a result In addition the symptoms caused by reoccurring diseases

or treatments may be harmful to physical conditions even more and lead to disability

eventually In this model any treatment program that can address the decline in activity

can alleviate fatigue symptoms is said to improve fatigue Therefore Psychobiological

Entropy Model not only provides a more direct detection of clinical patterns but also for

providing measures of care within a fatigue model

The third model is the Energy Analysis Model12 which suggests that the pathological

change of individual physical status becomes the barrier of energy conversion When the

supply of energy in individuals is low or the demand is high a lack of energy results and

the individuals feel fatigue Energy is generated by the oxygenation in blood The

correction factors of energy reaction are cancer treatments symptom distress and

emotional disorders Concepts in the fatigue model include energy sources energy

transformations energy expenditures and energy response modifiers The relationships

among these concepts are dynamic and intercorrelated with each other From the Energy

Analysis Mode point of view the physiological mechanism of fatigue includes some

objective indicators such as body weight and hemglobulin

In terms of the causes of fatigue Ekti Genc amp Conk (2008) 2 indicated that illnesses

treatments and stage of disease can cause fatigue NCCN (2011) 1 points out that many

conditions are related to fatigue including pain emotional pain anaemia sleep disorders

639

7

nutritional deficiencies activity reduction side effects of drugs (antihistamine drugs

anti-vomiting drugs and anti-anxiety drugs) and others In a study on children

adolescents parents and relevant medical and nursing staffs Hinds and

Hockenberry-Eaton (2001) 13 proposed four factors causing the fatigue of children with

cancer which are 1) environmental factors treatment setting events or situations that

place demands on the patient such as appointments inpatient stay long waiting time

altered routines that lack clear beginnings and endings of each day and decision making

and information exchange 2) personalbehavioral factors the negative faith of children

with illness 3) culturalfamilyother factors emotions concerns the hope of friends and

family ability to participate in activities and restricted activities 4) treatment-related

factors the invasive inspections experienced by children with illness insufficient time for

physical strength recovery between the repeated courses of treatments or the side

effects caused by treatments (infection pain and decrease in complete blood count) It

can be inferred that the causes of fatigue are complicated and multifaceted

Fatigue is a complex and multidimensional condition 10 therefore fatigue is subject to

different definitions and there are different measurement tools Aaronson et alrsquos14

review the literature of fatigue summarised the characteristics of fatigue measurement

including the following(1) Subjective quantification of fatigue can be determined with the

Lee and colleagues (1991) Visual Analog Scale for Fatigue (VASF)(2) Subjective

distress This item simply asks the rater to report to what degree fatigue has caused

distress (3) The effect of fatigue on activities of daily living (4) Correlates of fatigue

such as sleep and depression to assess when measuring fatigue (5) key biological

parameters such as cytokines interferon and tumor necrosis factor

640

8

Fatigue can be also measured with unidimensional or multidimensional scales The first

type of fatigue scale is not suitable for studies focusing on fatigue because they are too

long if the aim is to only assess fatigue Furthermore they only allow for a limited number

of possible responses Unidimensional scales also are not suitable for the in-depth study

of fatigue because they assess only one aspect of fatigue15

In recent years fatigue in children with cancer has received some attention and

measurement tools have gradually been developed - such as1) Checklist individual

strength (CIS) The items are scored on 7-point Likert scales (with 1 indicating best and

7 worst function) 2) The Child Fatigue Scale (CFS) is a 2-part questionnaire that asks for

a yes or no (frequency) response and a 5-point rating of the intensity of any yes

responses ranging from not at all to a lot The Fatigue Scale for 7-12 year Olds (FS-C)

is provide a fatigue intensity score higher scores indicating higher fatigue The Fatigue

Scale for 13-18 year Olds (FS-A) measure adolescent cancer patientsrsquo perceptions of

the intensity of their fatigue on a daily or weekly basis higher scores indicating higher

fatigue 3) The Fatigue Scale Parent Version (FS-P) measures the parentsrsquo perception

of their childrsquos fatigue intensity on a five-point Likert-type scale higher scores indicating

higher fatigue 4) The Fatigue Scale Staff Version (FS-S ) measures the staffrsquos

perceptions of the patientrsquos fatigue intensity during the past 24 hours Intensity ratings are

on a four-point Likert-type scale with higher scores indicating more intense fatigue

symptoms 5) The Pediatric Quality of life Multidimensional Fatigue Scale (Peds

QL-MFS)Higher scores (0 to 100) indicate less fatigue( Appendix IV)

Besides disturbing physical and mental functions and status fatigue also affects the

641

9

quality of life 15 of children with cancer and impacts their daily life16 among all different

types of cancer progress and childrsquos ages However as opposed to the fatigue of adults

the fatigue of children tends to be neglected and left untreated17 by medical and nursing

staffs

In terms of the management approach to cancer-related fatigue Ekti Gene (2008) 2

suggests that strategies could include pharmacologic and non-pharmacologic measures

NCCN (2011) 1 indicated in the Clinical Practice Guidelines in Oncology that during

aggressive treatments during long-term follow-up treatments or in the terminal phase of

cancer the intervening measures for cancer-related fatigue can be divided into

pharmacologic and non-pharmacologic measures Non-pharmacologic measures include

activity enhancement psychosocial interventions (eg cognitive behavioral therapy

(CBT) stress management relaxation support groups) attention-restoring therapy and

nutrition consultation As for the effectiveness of pharmacological measures the

effectiveness is still uncertain However there is evidence to suggest that

methylphenidate may be effective in treating cancer-related fatigue1 Whiting et al

(2001)18 included 36 randomized controlled trials and 8 controlled trails to assess the

effectiveness of the pharmacological and non-pharmacological interventions used in the

treatment or management of chronic fatigue syndrome in adults or children Results

showed insufficient evidence on the effectiveness of the pharmacological supplements

complementaryalternative and other interventions In addition the evidence of

pharmacological treatments of immunoglobulin and hydrocortisone were also

inconclusive However interventions such as cognitive behavioral therapy and graded

exercise therapy have shown promising results

642

10

The efficacy of pharmacological treatments for cancer-related fatigue has not been

established6 therefore there is a need to provide evidence-based findings of the

effectiveness of non-pharmacological interventions to support nursing intervention to

release the childrsquos cancer-related fatigue To date most studies have investigated the

effectiveness of non-pharmacological treatments on cancer-related fatigue of

adults20and to date there is no systematic review in relation to cancer-related fatigue of

children However as children are not a smaller version of adults it is inappropriate to

extrapolate the results of adults onto children Therefore there is a need to establish the

effectiveness of non-pharmacological intervention on the cancer-related fatigue of

children

Given the increase in childhood cancer survival rate the importance of decreasing

childrenrsquos cancer-related fatigue during treatments and so increase their quality of life has

become a focus of their medical teams The role of nurses during care intervention is to

confirm the major symptoms of children with illness and effectively treat each symptom to

increase the childrenrsquos quality of life21 Moreover the USA based NCCN also indicated in

the Care Standard for the Treatment of Cancer-related Fatigue of Children and

Adolescents that treatments for fatigue should be included in the health care teams and

the children and their family should be informed of relevant information The definition of

non-pharmacological interventions for childrenrsquos cancer ndashrelated fatigue include activity

enhancement (exercise physical activity) psychosocial interventions cognitive

behavioral therapy (CBT) stress management relaxation nutrition consultation

massage and educational interventions

643

11

The Cochrane Library of Systematic Reviews and The Joanna Briggs Institute Library of

Systematic Reviews were initially searched to ensure that systematic reviews on this

subject were not already published or being undertaken This initial search prior to the

commencement of the review did not yield any results

This systematic review has examined the effectiveness of non-pharmacologic

interventions on the cancer-related fatigue of children in hope of finding scientific

evidence that can support or refute such measures on children The results of this study

may serve as a reference for professional caregivers children with cancer and their

families or to be put into practice during the clinical care of children with cancer

Definition of terms

FatigueFatigue as a distressing persistent subjective sense of physical emotional

andor cognitive tiredness or exhaustion related to cancer or cancer treatments

that is not proportional to recent activity and interferes with daily function1 There

are various scales and measurements of the degree of fatiguewe have elected to

use the study authors own definitions of fatigue rather than applying a single

pre-set definition of the condition

Non-pharmacological interventionsReferring to reduce fatigue that does not involve

drugsNon-pharmacologic measures include activity enhancement psychosocial

interventions (eg cognitive behavioral therapy stress management relaxation

support groups) attention-restoring therapy and nutrition consultation1

ChemotherapyTreatment with drugs that kill cancer cells 1

644

12

Review QuestionsObjectives

Review Objective

The objective of this systematic review was to critically appraise synthesize and

present the best available evidence concerning the effects of non-pharmacological

interventions fatigue in children and adolescents with cancer

Review Question

The following specific question was addressed in this review

What is the effectiveness of non-pharmacological interventions on fatigue in

children and adolescents with cancer aged from one to 18 years

Criteria for Considering Studies for this Review

Types of studies

This review included randomised controlled trials (RCTs) and quasi-experimental

studies that examine the effectiveness of non-pharmacological intervention for fatigue in


Types of participants

Children and adolescents aged from one to 18 years old experiencing fatigue

associated with cancer either during or after the chemotherapy or maintenance stage of

chemotherapy or survive stage The types of cancer to be included in this systematic

review will be ALL (Acute lymphoblastic leukemia) AML (Acute myeloid leukemia)

lymphoma and solid tumors

Exclusion criteria for Types of participants

645

13

newborn infants under 1 years of age

participants who do not have a specific diagnosis of cancer

participants who have received immunoglobulin or hydrocortisone

treatment

If participants have received immunoglobulin or hydrocortisone treatment may

inference the effectiveness of non-pharmacological interventions on fatigue

Types of intervention

This review considered studies that examine non-pharmacological interventions on

fatigue for children and adolescents with cancer including activity enhancement

(exercise physical activity) psychosocial interventions CBT stress management

relaxation nutrition consultation massage and educational interventions The

interventions descriptive included the length frequency setting and intervention

providers eg Nurse Psychologist Dietician

Exclusion criteria for types of interventions only pharmacological interventions were

tested

Types of outcome measures

The outcome measures considered were fatigue scores The literature demonstrates that

differences of opinion exist regarding the most valid and reliable method of measuring

cancer-related fatigue Therefore studies that used any validated scale for

cancer-related fatigue were considered for inclusion Currently commonly used scales to

measure fatigue include Checklist Individual Strength (CIS) Child Fatigue Scale (CFS)

The Fatigue Scale for 7-12 year Olds (FS-C) The Fatigue Scale for 13-18 year Olds

646

14

(FS-A)and Pediatric Quality of life Multidimensional Fatigue Scale (Peds QL-MFS)

Types of settings

Both hospital and community settings

Search Strategy

Before undertaking this systematic review the Cochrane Library Joanna Briggs Institute

Library of Systematic Reviews and CINAHL were searched and no systematic reviews on

this topic were found or identified as underway

The search strategy aimed to find both published and unpublished studies

A three-step search strategy was utilized in each component of this review An initial

limited search of CINAHL and MEDLINE was undertaken followed by an analysis of the

text words contained in the title and abstract and of the index terms used to describe the

article A second search using all identified keywords and index terms was undertaken

Lastly the reference lists of all identified reports and articles were searched for additional

studies

Types of languages

1 English

2 Chinese

The following databases were searched to identify keywords contained in the title and

abstract and relevant MeSH headings and descriptor terms

The Cochrane Library PsycINFO 1990 ndash 2010

647

15

Ovid MEDLINE 1966 ndash 2010 CINAHL Plus with Full Text 1960 ndash2010 EMBASE ProQuest Dissertations amp theses 1990-2010 Electronic theses and dissertations system 1956(abstract)1990(full text)-2010 MEDNAR Index to Taiwan periodical literature 1970-2010 Electronic thesis and dissertation system (Chinese) 1990-2010

Keyword search terms

1Types of studies experimental study random quasi-experimental study實驗性研究隨

機類實驗性研究

2 Types of participants childchildren adolescents pediatric cancer and oncology兒童

青少年兒科癌症腫瘤

3 Types of interventions non-pharmacological interventions massage exercise fitness

physical activity cognitive behavioral stress management energy conservation

sleep therapy relaxation distraction and psycho-education非藥物性處置按摩運動

身體活動認知行為壓力處置能量保存睡眠治療放鬆轉移注意力衛教

4 Types of outcome measures fatigue cancer-related fatigue loss of energy levels of

tiredness tired side effect symptoms疲憊癌性疲憊疲倦合併症症狀

Methods of the Review

Assessment of methodological quality Papers selected for retrieval were assessed by two independent reviewers for

methodological validity prior to inclusion in the review using the standardised critical

appraisal instruments (Appendix I) from the JBI-SUMARI (Joanna Briggs Institute

Systems for the Unified Management Assessment and Review of Information package)

Any disagreements that arise between the reviewers were resolved through discussion

648

16

with a third reviewer

Data extraction Data was extracted from papers included in the review using standardised data

extraction tool (Appendix II) from the JBI-SUMARI Details of eligible studies were

extracted and summarised independently by two reviewers

Data Synthesis

All data analysissynthesis were made using the JBI-SUMARI The studies were

assessed for clinical heterogeneity by considering the settings populations interventions

and outcomes Where possible these binary outcomes were analyzed by calculation of

the Odds Ratio with the 95 CI The weighted mean difference was calculated if the

pooled studies have used the same scale for continuous data The standardized mean

difference was calculated for continuous data measuring the same outcome on a

different scale In studies where statistical pooling of results was inappropriate the

findings were considered for inclusion as a narrative summary

Results The findings from the systematic review are presented first Followed by the results from

the meta-analysis component of this review

Description of studies From database search and hand search a total of 76 papers were identified Thirty

papers were then excluded because they did not meet the inclusion criteria Forty-six

full text were retrieved for further consideration for inclusion Of the 30 excluded reasons

for exclusion were follows 11articles were duplicated eight articles did not meet

649

17

participant inclusion criteria eight articles did not meet outcome criteria and nine articles

were correlation studies or discussion papers others articles were unclear reporting In

total after sorting six papers have been included in this article Figure 1 displays the

process used to identify relevant articles for inclusion in the systematic review

Figure 1 Stages of searching and inclusionexclusion of references for the review

Potentially relevant English-language and Chinese- language Studies Identified

Electronically and hand search (n=76)

Duplicate (n= 11) Papers excluded after evaluation of abstract (n=19)

Papers retrieved for detailed examination (N=46)

Papers excluded after review of full paper

(n=40)

Papers assessed for methodological

quality (n=6)

Papers included in systematic review

(n=6)

Methodological Quality

Of the six included articles 2722232425 two articles were RCT design224 with score 7 out

of 10 each paper from Critical Appraisal Checklist and four articles used

650

18

quasi-experimental design7222425 with socre 5 to 6 out of 10 because the quality of

the whole papers is still acceptable therefore these six articles were accepted after

primary reviewer and secondary reviewerrsquos decision

Randomisation

In two RCT articles224 one study24 used to a computer-generated program operated by

the St Jude Protocol and Data Management System to randomize the sample Another

study2 didnrsquot address how randomization was done

Allocation concealment

No studies reported allocation concealment

Intention-to-treat analysis

One quasi-experimental design7 stated Intention-to-treat analysis

Adequate follow up

The follow-up periods included 2or 3 days24 7 days2 4 week7 one month25 6 week25 12

week2216 week23 and 1 year23

Baseline comparability of groups

Three 22425 of six studies had baseline comparability in terms of age sex diagnosis

race institution duration of illness

Blinded outcome assessment

No studies used blinded outcome assessment The researchers including study team

patients staff and families were not blinded to the patientrsquos group assignment

Characteristics of included studies

651

19

There were six studies related to interventions designed to cancer-related fatigue for

pediatric patients than there are for adults There are a total of six including five

English-language papers 27222324 and one Chinese-language paper 25 ranging in year of

publication from 2007 to 2009

Patient characteristics

The research subjects of four papers included both school-aged children and

adolescents 7222324 one papers involved mainly adolescents25 and one paper sampled

only school-aged children 2 the range in ages was between six-18 years The number of

patients included in the samples ranged from nine to 60 The sources of case data were

from both outpatients and hospitalized children The types of cancer included acute

lymphoblastic leukemia (ALL) solid tumors acute myeloid leukemia (AML) and

lymphoma Overall ALL was the most commonly studied cancer type The stage of the

disease varied in these reports some patients were in the maintenance stage of

chemotherapy25 some had just received their first round of chemotherapy224 some had

completed two courses of treatments lasting 4-8 weeks each 7 and some had entered

the survivor stage 2223

Countries

Two RCTrsquos 2 24 were conducted in the USA There were four quasi-experimental design

studiesThree studies conducted in the USA7 22 23 and one in Taiwan25

Intervention types

652

20

The interventions included exercise training programs 2225 physical activity 2324

massage therapy 7 and health education 223 exercise training and physical activity as

an intervention method given in three different settings home 22 25 community 23 or

hospital 24 The studies used different types of exercise interventions including

home-based aerobic exercise use a Video Compact Disc 25 use of a bicycle-style

exerciser 24 aerobics2223 and various types of physical activities2 and strength-building

exercises 2223 The intensity of the exercise varied and often included gradual warm-up

exercises a period of main exercise and a cool down period For these studies2023 the

target exercise intensity was a heart rate of gt90 of the maximum heart rate (HR max) or

the increase in the percentage of heart rate reserve ( HRR) of 40-60

The number of weeks for the exercisephysical activity interventions duration including

2-4 days 24 6 weeks25 12 weeks22 and 16 weeks23 The frequency of exercise ranged

from 2-3 times per week to twice a day Typical duration of exercise ranged from 10 to 45

minutes There are three papers using exercise interventions based on ACSM (American

College of Sports Medicine) 2225 recommendations and one of these used an Activity

pyramid from the ACSM to determine intensity 24

One article did not clarify the type of exercise intervention or the reasons for their choices

23 In addition there was an article focusing on massage therapy 7 as an intervention in

this study the experimental group received four weeks of massage therapy either in the

clinic or in the patientrsquos room the therapy was applied by a professional masseur and

targeted the back legs arms chest stomach and face of the children However the

frequency of massage sessions per week and the duration of the massages were not

653

21

given There is another article about intervention measures combine health education

and physical activity 2 In this study patients were informed about the following (1) health

education patients received daily education about chemotherapy-related fatigue and

information from a health education manual written by the author (2) encouragement for

children to engage in activities such as listening to music drawing and reading and (3)

physical activity which involved walking along the corridors of the ward for 10-15 minutes

These health education measures were presented for 45-60 minutes a day for a total of

seven days The study design for non-pharmacological interventions used control groups

that included primarily people who had received standard treatment or people who did

not receive an exercise intervention

Outcome measures

Five measurement tools were used in this group of seven papers concerning childrenrsquos

fatigue (Appendix IV) Because those studies included both school-age children and

adolescents the following descriptions will be differentiated by age Fatigue

measurements for school-aged children with cancer include the following the Child

Fatigue Scale (CFS) 7 a scale that measures the frequency and intensity of fatigue and

the Fatigue Scale for 7-12 year Olds (FS-C) 224 a scale that can be used to evaluate the

intensity of fatigue On the other hand fatigue measurements for adolescent cancer

patients include the following the Fatigue Scale for 13-18-year-olds (FS-A) 24 a measure

that can help evaluate fatigue levels the Pediatric Quality of Life Multidimensional

Fatigue Scale (Peds QL-MFS) 2325 a tool that can be divided into three sub-scales to

understand the general cognitive and sleep rest components of fatigue and finally the

CIS-20 for school-age children and adolescents 22 a scale that measures four levels of

654

22

fatigue namely subjective experience attention motivation and physical activity Two

studies used the Peds QL-MFS scale to measure fatigue2325

Meta-analysis results Two studies of the included papers failed to provide sufficient raw data they could not be

included in the meta-analysis Hinds et al 24 did not include post-test data Genc et al 2

provided no pre-test data PostWhite et al7 reported that fatigue after the health

education intervention was not statistically different but they presented the results

without presenting fatigue-related data Therefore the meta-analysis included three

studies 222325

The heterogeneity of studies was analyzed with Chi square statistics and no statistical

significance was found Therefore the data was combined in meta-analysis according to

exercise intervention on fatigue In addition there were three articles using the Peds

QL-MFS as a research tool to examine childrenrsquos improvements in fatigue Among these

Keats 22 and Chiang 24 present the effectiveness of exercise interventions using three

subscales Therefore the meta-analysis also analysis of the effects of these exercise

intervention measures on three subscales of Peds QL-MFS general fatigue sleep rest

fatigue and cognitive fatigue

The effectiveness of exercise intervention for fatigue We analyzed the exercise intervention effect on fatigue A total of 2 studies 22 23 were

included Takken et al 22 used community-based exercise training program to reduce

fatigue of children 6 to 14 years (mean 93y) of age who survived ALL Fatigue

measurement by Checklist Individual Strength (CIS) after 12-week of training fatigue

655

23

show no significant differences between pre (meanplusmnSD 415plusmn147) and post training

(meanplusmnSD368plusmn217) but fatigue change from baseline mean reduction of 11

Keats et al23 although used community-based physical activity program to reduce fatigue

for adolescents 14 to 18 years of age (mean162 y) with cancer (Lymphoma leukemia CNS

tumor germ cell tumor) Studies used fatigue by PedsQLMFS Results show general fatigue

from baseline to 8 weeks and to 3 months follow up significantly improves General

fatigue sleeprest fatigue and total fatigue from baseline to 3 months follow up showed

significant improvements Sleeprest fatigue and total fatigue at 1 years followed up were

significant improvements

Figure 2 shows the overall effect of exercise intervention in children and adolescents with

cancers with a focus on improving fatigue Due to the lower heterogeneity (p＞005) the

fixed effects model was used to pool the data for meta-analysis (Overall effect size=

-006 95 Confidence Interval (CI) -070 to 058) A result did not indicate a statistically

significant difference (p = 087)

656

24

Figure2 Meta-analysis results of exercise intervention on fatigue

In addition Keats23 and Chiang25 used the three sub-scales of Peds QL-MFS to

determine the general cognitive and sleep rest components of fatigue The following

present the effectiveness of exercise interventions using three subscales including

general fatigue sleep rest fatigue and cognitive fatigue 2325

Chiang et al 25 used a 6- week home-based aerobic exercise intervention to reduce

fatigue of children 7 to 18 years (mean age at experimental group was 1088 y in control

group was 1247 y) of age who with acute lymphoblastic leukemia Fatigue measurement

by Peds QL-MFS after training For intent-to ndash treat analysis the findings indicated that

there are no intervention effects and time differences by any items on the subscale of

fatigue For per-protocol analysis general fatigue( meanplusmnSD 422plusmn402) was the only

subscale that was significantly lower for children who received the exercise intervention

than those in control group at follow-up assessment (one month after the completion of

intervention)


for adolescents 14 to 18 years of age (mean162 y) with cancer (Lymphoma leukemia

CNS tumor germ cell tumor) Both studies used fatigue by PedsQLMFS Results show

general fatigue from baseline to 8 weeks and to 3 months follow up significantly improves

657

25

General fatigue sleeprest fatigue and total fatigue from baseline to 3 months follow up

showed significant improvements Sleeprest fatigue and total fatigue at 1 years followed

up were significant improvements

The effectiveness of exercise intervention for general fatigue

The impact of the exercise interventions upon levels of general fatigue was also analysed

The heterogeneity was low (p＞005) Therefore the fixed effects model was used to

examine the effectiveness The effect size is -076 indicating a statistically significant

difference (p = 001 95 CI -135 to -017 Fig 3) The evidence suggests that exercise

intervention can reduce general fatigue in children with cancer

Fig 3 Meta-analysis results of exercise intervention for general fatigue

The effectiveness of exercise intervention for sleep rest fatigue

The following is the result of the meta-analysis of the effectiveness of exercise

interventions on sleep rest fatigue First the heterogeneity test was conducted with P gt

005 representing small heterogeneity and the fixed effects model was used Fig 4

shows the effect size is -035 indicating no statistically significant differences (p = 023

95 CI-092 to 022 Fig 4)

658

26

Fig 4 Meta-analysis results of exercise intervention for sleep rest fatigue

The effectiveness of exercise intervention for cognitive fatigue Lastly the following data reports the results of meta-analysis of the effectiveness of

exercise interventions for cognitive fatigue The heterogeneity was p＞005 then the

fixed effects model was used The effect size is -035 indicating no statistically significant

differences (p = 024 95 CI-092 023 Fig 5)

Fig 5 Meta-analysis results of exercise intervention for cognitive fatigue

Narrative presentation of remaining included studies

Three studies were not included in meta-analysis Post-White et al7 one of the aims in

this study was to examine the effect of massage therapy on fatigue in children with

cancer The study was a quasi-experimental design Twenty-three childrenparent dyads

were enrolled 17completed all data points Children with cancer ages 7 to 18 years

received at least 2 identical cycles of chemotherapy and one parent participated in the

2-period crossover design in which 4 weekly massage sessions (MT) alternated with 4

659

27

weekly quiet-time (QT) control sessions There were no significant changes in fatigue in

children over the 4-week MT or QT conditions either independently (change over time) or

when we compared fatigue by condition

The lack of effect of massage on fatigue may be the difficulty some children had in

differentiating fatigue from being relaxed underscores the challenge of measuring fatigue

in children Some children interpreted being tired or relaxed as having greater fatigue

because they felt like lying around and sleeping or felt unmotivated to do their usual

activities all measures of fatigue in the instrument used in the study

Hinds et al24conducted a prospective two-site randomized controlled pilot study to

assess the feasibility of an enhanced physical activity (EPA) intervention in hospitalized

children and adolescents receiving treatment for a solid tumor or for acute myeloid

leukemia (AML) Twenty-nine patients (25 with a solid tumor and 4 with AML) participated

age range from 736 to 1816 (mean 1248 y) The EPA intervention selected was

pedaling a stationary bicycle-style exerciser (Chattanooga Peddler Deluxe Bio-Teck

Medical Memphis TN) for 30 minutes twice daily for 2 to 4 days of hospitalization The

mixed model analysis revealed no significant differences in patient reports of fatigue

between the two study arms or over time

Genc et al2 conducted a RCT involving children with cancer who are 7 to 12 years of age

and receiving chemotherapy treatment to determine the impact of educational

intervention by nurses on decreasing the fatigue syndrome The research sample was

composed of a total of 60 children with cancer with 30 children being included in the

660

28

experimental group (mean age 923)and 30 children included in the control group (mean

age 937) with their mothers In the experimental group after the 7th to 10th day of the

chemotherapy treatment throughout a week the researcher conducted the nursing

interventions every day for 45 to 60 minutes In the control group routine nursing

interventions were carried out The experimental group received education about the

fatigue with the chemotherapy and fatigue handbook was given which was developed by

the authors Children and mothers were consulted for including activities that could

decrease fatigue which were described as effective interventions A statistically

significant difference was found between the Fatigue Scale-Child mean scores of the

experimental (2723) and the control group (4213) The results suggest that fatigue of

children with cancer can be reduced by implementing appropriate nursing interventions

(t=567 Plt00)

Discussion The purpose of this systematic review was to determine the effectiveness of

non-pharmacological interventions specifically targeting fatigue for children and

adolescents with cancer undergoing chemotherapy or after receiving chemotherapy

Included articles about the effectiveness of non-pharmacological interventions for

children and adolescents with cancer were published between the years of 2007 and

2009 Although interventions for cancer fatigue for adults have been extensively studied

it can be seen from either the title of the paper or related content that an intervention

study on children was a pilot study or a feasibility study Representing a field in its early

stage these studies show that the fatigue issues with young cancer patients have only

recently been taken seriously

661

29

The results of our meta-analysis include measurement of the four performance indicators

fatigue and general fatigue sleep rest fatigue and cognitive fatigue The results show

that there is a statistically significant difference only in the domain of general fatigue

using an exercise intervention for children with cancer can improve the degree of fatigue

with the effect size reaching 0671 Other results do not indicate significant differences

The reasons may include the following

1 Characteristics of the cancer The exhaustion from cancer occurs not only during cancer treatment but also in during

long-term survival a time during which patients may continue to be affected by this

symptom 8 26 Therefore when using intervention measures to improve fatigue

circumstances should be considered such as the process of the treatment and the course

or stage of the disease Because cancer patients will experience different forms of

treatment or courses of treatment the disease itself or treatment differences should be

considered in the choice of intervention Even chemotherapy drugs should be taken into

consideration For example a period of general steroid treatment can increase patientsrsquo

fatigue In those studies of children with cancer few studies looked solely at one type of

cancer most studies included a variety of cancer patients Furthermore most studies do

not clearly explain the stage of the disease or course of treatment and most do not

include treatment variables in the control group Moreover children with cancer may

have different levels of physical function

2 Research design The sample size Currently there are few studies with large sample size and a rigorous

RCT design due to the small number of papers available for analysis The sample size

included in our studyrsquos data analysis is between 20 and 42 people this small sample size

will affect the power available to evaluate outcome variables

Although most of the non-pharmacological interventions still use exercise and physical

activity and these studies overall show better results for fatigue as compared with

controls more research is still needed to further confirm the efficacy of these findings

662

30

The dropout rate in the evaluated research varies a great deal ranging from 5 to 45

these dropout rates may result from the characteristics of the research subjects or the

lengthy time involved in participating in these studies The research data with a high

turnover rate might not reflect the actual outcomes of participation in exercise and the

quality of the research contained in articles with high subject turnover rates may be

lower

Exercise doses and time The exercise doses needed to reduce fatigue cannot be

determined additionally the amount of exercise completed by the patient is also

inconsistent interventions vary between 2-3 times per week and two times a day and

exercise duration varies between 10 and 45 minutes each time Furthermore the study

interventions vary in length between a couple of days and a long period of 16 weeks The

data collection times are different some were measured 12 weeks after the intervention

began some were measured during the 6 weeks of intervention some were measured

three months after the intervention was finished and some were measured after one

year

In addition disease-related symptoms decrease childrenrsquos willingness to participate in

exercise interventions inappropriate exercise intervention programs may actually

increase childrens fatigue In addition the children in the study are still developing

physically it is important to consider ways to design an interesting exercise intervention

to increase the compliance of patients in order to improve the effectiveness Although

intervention programs in the hospital or in a community sports center can improve the

effectiveness because they provide supervision the feasibility of these programs is

questionable However if the program is home-based the children need to be

supervised by parents in order to improve their compliance in doing the exercises

Furthermore regarding the nature of the intervention the results from this study indicate

that the researched non-pharmacological interventions include the following exercise

training programs physical activity massage therapy and health education interventions

However according to the National Comprehensive Cancer Network 1 clinical guidelines

663

31

for cancer non-drug measures for cancer fatigue can be separated into five categories

(1) activity enhancement (2) psychosocial interventions such as cognitive behavioral

therapy (CBT) stress management relaxation techniques and support groups (3)

attention-restoring therapy (4) nutritional consultation and (5) cognitive behavioral

therapy specifically targeting sleep disturbance Researchers have also suggested that

psychosocial interventions should be included in the future research for children with

cancer-related fatigue 22

(2) The measurement tools in the study The assessment of fatigue can be

one-dimensional or multidimensional One-dimensional assessment can help understand

the severity of fatigue symptoms however multidimensional scales are often more

credible Therefore when measuring cancer-related fatigue researchers should consider

whether there is a uniform definition of fatigue or a standardized tool for measuring

fatigue in order to facilitate further systematic meta-analyses and further develop the

clinical care guidelines

Limitations of the review The present review has some potential limitations First the low methodological quality

may influence the result Although exercise intervention seems promising quality of the

RCTs was generally quite low Future studies require better design and reporting if

methodological issues to establish evidence-based nonpharmcologic intervention

Second the identified studies covered only a limited types of nonpharmcological

intervention especially in exercise intervention The guidelines for cancer-related fatigue

in NCCN (2011)1 referred to more interventions than the ones included in this review

such as cognitive behavioral therapy and nutrition consultation Thirdly the small sample

size and effect size could be potentially having led to underpowered approach for

detecting the effects on fatigue Therefore we recommend that as research continues to

grow a re-analysis can be undertaken Fourthly Combining data in meta analysis from

664

32

studies where the ages were quite different is a potential source of heterogeneity and

may affect the interpretation of the results

Conclusion At present clinical treatment is widely used for cancer patients However child and

adolescent cancer patients often experience various side effects which cause short-term

or long-term discomfort both physically and psychologically In particular with the

increasing cure rate cancer related fatigue during or after treatment has become an

important issue This study result provided positive effect of exercise intervention on

general fatigue

Implications for practice The results of this systematic review and meta-analysis show that exercise interventions

can effectively improve the level of general fatigue In particular although the articles

were self-reported feasibility studies their results all indicate that exercise interventions

for fatigue are feasible and safe there was no conclusion to be made for the use of

massage therapy or health education measures because there was only one article for

each of these interventions

Recommendations for practice

Cancer-related fatigue is one of the most severe and frequent symptoms by pediatric

oncology children and adolescent suffered during treatment and the symptom existed

even after treatment has ended Until now no golden standard of treatment to fatigue is

established The findings call for more attention to how to reduce patientrsquos levels of

fatigue Based on the available information evaluated in this review the following

recommendations for practice are provided

665

33

bull For children aged 7 to 18 who has cancer (eg Lymphoma leukemia CNS tumor

germ cell tumor) an effective progressive aerobic exercise program is recommended to

be at least 2-3 times per week 20 to 45 minute for each session and last for 6-16 weeks

in order to reduce their general fatigue (tiredness physically weakness) In addition

adults should be involved in accompanying children while they are performing physical

exercise of which should be able to improve the adherence rate (level 2 ) ( Grade of

recommendation A)


germ cell tumor) an progressive aerobic exercise program will not be effective to reduce

their sleep andor rest (sleeping or resting a lot) or cognitive fatigue (problems with

thinking quickly or problems with remembering) (level 2 ) ( Grade of recommendation C)

bull Nursing interventions in educating treatment of fatigue include information about

activity nutrition energy preservation consulting and providing a useful fatigue

handbook will benefit those children who are 7 to 12 years have a new diagnosis of ALL

AML or lymphoma and receive for the first time after being diagnosed a 7- to 10-day

chemotherapy treatment (level 2) ( Grade of recommendation A)

bull A 4-week massage therapy program (the therapists massage childrenrsquos back legs

arms stomachchest and face) is not effective for children who are aged 7 to 18 and

have acute lymphoblastic leukemia brain tumors lymphoma rhabdomyosarcoma

Wilms tumor or Ewing sarcoma(level 2)( Grade of recommendation C)

bull Using a 12-week aerobic and strength exercise (45-min exercise sessions twice a

week) is not effective for children who are aged 6-14 and survived acute lymphoblaststic

leukemia age from 6 to 14(level 2) ( Grade of recommendation C)

bull Using a physical activity intervention (30minutestwice daily for 2-4days) is not

effective for children who are 7 to 18 years of age with soild tumor or AML(level 2)

( Grade of recommendation C)

666

34

Implications for research According to this systematic review and meta-analysis results there are suggestions to

improve the effectiveness of future research on non-pharmacological interventions for

children and young peoplersquos cancer-related fatigue

As the majority of included non-pharmacological interventions for the fatigue of cancer

patients consist of exercise programs future research should also consider various

non-pharmacological interventions in order to understand the effectiveness of different

methods

Regarding the exercise intervention methods and studies should consider multiple

factors including the age or personal condition of the subject the disease stage and the

amount of daily activities Studies should use design prescriptions (eg frequency

intensity duration and type of exercise) and consider the adherence to the measures in

order to enhance the study strength

In measuring the results of non-pharmacological interventions there should be standard

definitions or standard measurement tools to facilitate the following systematic review

and meta-analysis that can subsequently be developed into clinical care guidelines

Reviewing the effectiveness of the current non-pharmacological management of children

and adolescent cancer patients there is still a lack of rigorous RCT research Limited by

the characteristics of cancer there is still a lack of large sample sizes

Potential conflicts of interest There is no conflict of interest

Acknowledgements

Thank you to Dr Rie Konno Research Fellow Joanna Briggs Institute for her help in

assessing studies

667

35

References 1 National Comprehensive Cancer Network( NCCN) in USA NCCN clinical practice

guideline in oncology cancer-related fatigue 2011 2 Ekti Genc R amp Conk Z Impact of effective nursing interventions to the fatigue

syndrome in children who receive chemotherapy Cancer Nursing 200831(4)312-317

3 Childhood Cancer Foundation of ROC (2009March) The classification of diseases

and age sex statistical tables of case Childhood Cancer Foundation of ROC newsletter103105-106

4 Department of Health Executive Yuan ROC (TAIWAN)（2009 March 20）2009 cause of death statistic Health and National Health Insurance Annual Statistics Information Service 2010 June 28Available httpwwwdohgovtwstatisticdatavital statists9898health statistic--lifepdf

5 Chang TK (2007December 8) Common childhood cancer and its treatment Status

Childhood Cancer Foundation of ROC (TAIWAN) 2010 September 23 Available httpwwwccfrocorgtwchildchild_events_readphpe_id=45

6 Hockenberry MJ amp Wilson D Wongs nursing care of infants and children (8th ed) St

Louis MO Mosby 2007

7 Post-White J Fitzgerald M Savik K Hooke MC Hannahan AB amp Sencer SF

Massage therapy for children with cancer Journal of Pediatric Oncology Nursing 2009 26(1)16-28

8Chiang YC Yeh CH Wang WKamp Yang CP The experience of cancer-related fatigue

in Taiwanese children European Journal of Cancer Care 2009 18(1)43-49 9Langeveld NE Grootenhuis M A Voute P A de Haan RJ amp van den Bos C No excess

fatigue in young adult survivors of childhood cancer European Journal of Cancer 200339(2)204-214

10Piper BF Lindsey AM amp Dodd MJ Fatigue mechanisms in cancer patients

developing nursing theory Oncology Nursing Forum 1987 14(6)17-23 11Nail LM amp Winningham ML Fatigue In S L Groenwald M H Forgge M Goodman

amp C H Yarbro (Eds) Cancer Nursing Principles and practice (4 th ed) Boston Jones and Bartlett1997

12Irvine D Vincent L Graydon JE Bubela N amp Thompson L The prevalence and

correlates of fatigue in patients receiving treatment with chemotherapy and

668

36

radiotherapy A comparison with the fatigue experienced by healthy individuals Cancer Nursing 199417(5)367-378

13Hinds PS amp Hockenberry-Eaton M Developing a research program on fatigue in

children and adloescents diagnosed with cancer Journal of Pediatric Oncology Nursing 200118(2)3-12

14Aaronson LS Teel CS Cassmeyer V Neuberger GB Pallikkathayil L Pierce J Press

AN Williams DP amp Wingate A Defining and measuring fatigue Journal of Nursing scholarship 1999 31(1)45-50

15Yeh CH Wang CH Chiang YC Lin Lamp Chien LC Assessment of symptoms reported

by 10- to 18-year-old cancer patients in Taiwan 2009 38(5)738-746 16 Okuyama T Akechi T Kugaya A Okamura H Shima Yamp Maruguchi M

Development and validation of the cancer fatigue scale a brief three-dimensional self-rating scale for assessment of fatigue in cancer patients Journal of Pain amp Symptom Management 2000 19(1) 5-14

17Gibson F Mulhall AB Richardson A Edwards JL Ream E amp Sepion BJ A

phenomenologic study of fatigue in adolescents receiving treatment for cancer Oncology Nursing Forum200532(3)651-660

18Wolfe J Grier HE Klar N Levin SB Ellenbogen JMamp Salem-Schatz S et al

Symptoms and suffering at the end of life in children with cancer New England Journal of Medicine 2000342(5)326-333

19Whiting P Bagnall AM Sowden AJ Cornell JE Mulrow CD amp Ramirez G

Interventions for the treatment and management of chronic fatigue syndrome a systematic review JAMA the Journal of the American Medical Association 2001286(11)1360-1368

20 Kangas M Bovbjerg DHamp Montgomery G H Cancer-related fatigue a systematic

and meta-analytic review of non-pharmacological therapies for cancer patients Psychological Bulletin 2008134 (5)700-741

21Williams PD Schmideskamp J Ridder EL amp Williams AR Symptom monitoring and

dependent care during cancer treatment in children pilot study Cancer Nursing 200629(3)188-197

22Takken T van der Torre P Zwerink M Hulzebos EH Bierings M Helders PJMamp van

der Net J Development feasibility and efficacy of a community-based exercise training

669

37

program in pediatric cancer survivors Psycho-Oncology 200918(4)440-448

23Keats MR amp Culos-Reed SN A community-based physical activity program for

adolescents with cancer (project TREK) program feasibility and preliminary findings

Pediatric hematology and oncology 200830(4) 272-280

24Hinds PS Hockenberry M Rai SN Zhang L Razzouk B I Cremer L McCarthy K amp

Rodriguez-Galindo C Clinical field testing of an enhanced-activity intervention in

hospitalized children with cancer Journal of Pain amp Symptom Management 2007

33(6)686-697

25Chiang YC The effects of ldquo a home-based aerobic exercise interventionrdquo on fatigue

and cardiorespiratory fitness in children with acute lymphoblastic leukemia during the

maintenance stage of chemotherapy Unpublished thesis Taiwan Tao-Yuan 2007

26Langeveld N Ubbink M amp Smets E I dont have any energy The experience of

fatigue in young adult survivors of childhood cancer European journal of oncology

nursing 20004(1)20-28

27 Kisner C Colby L Therapeutic exercise Foundations and techniques 2nd ed Philadelphia PAFA Davies 2007

670

38

Appendix I JBI Critical Appraisal Checklist for Experimental studies

Author__________ Year_________ Record Number__________________

Questions 1 to 4 must be answered ldquoyesrdquo for study to be included in the metashyanalysis

1 Were the participants randomized to study groups

Yes No Not clear

2 Other than research intervention were participants in each groups treated the same

Yes No Not clear

3 Were the outcomes measured in the same manner for all participants

Yes No Not clear

4 Were groups comparable at entry

Yes No Not clear

5 Was randomization of participants blinded

Yes No Not clear

6 Were those assessing outcome blinded to treatment allocation (if outcome not objective such as survival or length of hospitalization)

Yes No Not clear

7 Was allocation to treatment groups concealed from the allocator

Yes No Not clear

8 Was an appropriate statistical analysis used

671

39

Yes No Not clear

9 Were outcomes measured in a reliable way

Yes No Not clear

10 Was there adequate followshyup of participants

Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject

Narrative summary only Further information needed

COMMENTS

672

40

Appendix II JBI Data Extraction Tool for Quantitative Studies Authors and Year

Journal Title

Record NumberArticle Reference No

Reviewer

Method

Settings

Participants

Number of participants

Group A Group B Group C

Control Intervention 1 Intervention 2

Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41

Other outcome measures

Outcome description ScaleMeasure

Results

Dichotomous Data

Outcome Control Group

Numbertotal number

Treatment Group

Numbertotal number

Continuous Data

Authorrsquos Conclusions

Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43

Appendix III Details of included studies (N=6)(2720212223) RefNo Author(s)

(years) Title Study question Research

method Comparison group

Sampling

Measurement variables

Data collection

Intervention Data collection time

OutcomesResults

22 Takken T van der Torre P Zwerink M Hulzebos E H Bierings M Helders P J Mamp van der Net J (2009)

Development feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors

To develop a 12-week home-based exercise training program (comprising aerobic and strength exercises) for children who survived ALL and to study itrsquos feasibility and efficacy

Pre-post test design

No comparsion group

Survived ALL(N=9)ages 6-14 years

1anthropometry 2 muscle strength 3functional mobility 4cardio-pulmonary

exercise test 5Fatigue

1 Feasibility questionnaire 2 anthropometry electronic scale and a wallmounted stadiometerHarpenden skin fold calipers 3 muscle strength handheld dynamometer 4functional mobility Timed Up

and Go test (TUG) 5cardio-pulmonary exercise test electronically braked cycle ergometer 6Fatigue(mean)CSI-20 (subjective experience of fatigueconcentrationmotivationphysical activity)

112-week exercise training program

2 Patients were assessed before (T0) and after (T1) 12 weeks of training

1 muscle strength execapacity functional moand fatigue showed nosignificant differences between pre(meanplusmnSD415plusmn147) and post training(meanplusmnSD3687)

RefNo

Author(s) (years)

Title Study question Research method

Comparison group

Sampling


Data collection


OutcomesResults

7 Post-White J Fitzgerald M Savik K Hooke M C Hannahan A B amp Sencer S F (2009)

Massage therapy for children with cancer

To determine whether 4 weekly sessions of massage compared with 4 quiet-time control conditions would reduce anxiety cortisol levels fatigue nausea and pain in children with cancer undergoing chemotherapy and would reduce anxiety fatigue and mood disturbance in a parent

2-period crossover design (Randomized)

quiet-time

control

sessions

Children with cancer 1 to 18 years of age Twenty-three childrenparent dyads were enrolled 17 completed all data points

children 1relaxation 2symptoms 3 fatigue

parents

1anxiety 2 fatigue

children 1relaxation (heart and respiratory rates blood pressure and salivary cortisol level)

2symptoms (pain nausea anxiety 3 fatigue 1-2y3-6yLansky Play Performance Scale (PPS) 7-13y

1 4 weekly massage (MT) sessions alternated with 4 weekly quiet-time(QT) control sessions

2 children included presession and postsession vital signs (heart rate respiratory rate blood pressure) and self-report (parent proxy report for age 1-2 years) of pain nausea and anxiety Fatigue was measured before sessions 1 and 4 and at each follow-up Parent measures

included anxiety fatigue and mood states

1Massage was moreeffective than quiet tireducing heart rate inchildren anxiety in cless than age 14 yeaparent anxiety 2There were no sign

changes in blood pcortisol pain naufatigue (no state d

3 Children reported tmassage helped thebetter lessened theirand worries and hadlasting effects than q

675

44

14-18yChild Fatigue Scale (CFS) (frequency

intensity) 2 parents anxiety and fatigue

676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

24 Hinds P S Hockenberry M Rai S N Zhang L Razzouk B I Cremer L McCarthy K amp Rodriguez-Galindo C (2007)

Clinical field testing of an enhanced-activity intervention in hospitalized children with cancer

To determine the feasibility of an

enhanced physical activity EPA intervention in children and adolescents hospitalized to receive chemotherapy for a solid tumor or AML and to assess the sleep and fatigue outcomes of the intervention using two different statistical approaches to analyze the longitudinal symptom data

randomized prospective two-site and two-group pilot study

Standard care Twenty nine patients (25 with a solid tumor and 4 with AML)ages 7-18 years

1 sleep duration 2 sleep efficiency 3 fatigue

1sleep duration sleep efficiency The

Wrist Actigraph The Daily Sleep Diary-Parent 2 fatigue (mean) The Fatigue Scale(FS-C) for 7-12 (intensity) The Fatigue Scale(FS-A) for 13-18 The Fatigue Scale Parent Version (FS-P) The Fatigue Scale Staff Version (FS-S)

1enhanced physical activity (EPA) (hospital-based 30 minutes

twice daily for 2-4 days) 2 T0On the day of admission

(Day 0 or baseline)patient and parents completed the fatigue instruments and a team member applied the actigraph Patients wore the wrist actigraph T1 from Day 0 to 2 or 3 consecutive days (Days 0e3) In addition the patient same parent and staff nurses completed the daily sleep and fatigue reports in the late afternoons of Days 1-3

1 ANOVA model slesignificantly more the experimental athe control arm whdifferences from bsleep efficiency vaaveraged and com

2 The patient-reported mean fatigue scoresarms were higher amadolescents than for

3 The mixed model anarevealed no significandifferences in patientfatigue between

the two study arms otime( no final result iSD only give mixed result)

677

46

23 Keats M

R amp Culos-Reed S N (2008)

A community-based physical activity program for adolescents with cancer (project TREK) program feasibility and preliminary findings

To examine the

feasibility of a

theoretically-based

physical activity (PA)

intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical

well-being(including fatigue)

Repeat measures longitudinal design

No comparsion group

10 adolescents（Lymphoma(4)leukemia(4)CNS tumor(1)germ cell tumor(1)） ages 14-18 years

1physical fitness 2quality of life (QOL) 3PA behavior 4fatigue

1 Feasibility was assessed by participant recruitment attendance and adherence

2physical fitness Fitnessgram 3quality of life (QOL) Pediatric Quality of Life Inventory (PedsQL) 4PA behavior leisure score index (LSI) 5fatigue (mean) pediatric Quality of life

Multidimensional Fatigue Scale (Peds QL-MFS)

(Generalsleepcognitive fatigue)

116week physical activity (PA)

2 total PA physical fitness and overall QOL was assessed at 5 different intervals T0 preintervention (baseline) T1midintervention (after the

first 8 wk) T2 postintervention

(16 wk) T3 3-months

postintervention T4 1-year poststudy

initiation

1 from baseline -wkssig Improvementstotal PA physfitness and Qgeneral fatigue(meanplusmnSD 796plusmn135)

2 from baseline to 3FUsig Improvin general fatigue(meanplusmnSD824plusmn131)slefatigue(meanplusmnSD755plusmn191)totafatigue(meanplusmnSD778plusmn150)

3at 1 years FUsImprovements in sleeprest fatigue(meanplusmnSD725plusmn203)total (meanplusmnSD 763plusmn

678

47

RefNo

Author(s) (years)


Comparison group

Sampling Measurement variables

Data collection


OutcomesResults

2 Gene R E amp Conk Z (2008)

Impact of Effective Nursing Interventions to the Fatigue Syndrome in Children Who Receive Chemotherapy

1 to examine the effects of an effective nursing intervention to the fatigue syndrome of children 7 to 12 years of age who receive chemotherapy 2Tto examine the relationship between fatigue and demographic variables (age sex) diagnoses ([ALL AML] lymphoma) and therapy-related variables (eg level of hemoglobin

experimental randomized controlled study

Routine nursing care

A total of 60 children who are 7-12 years of age(a new diagnosis of ALL AML or lymphoma and receiving for the first time after being diagnosed a 7- to 10-day chemotherapy treatment )

fatigue The Fatigue Scale(FS-C) for 7-12 (intensity)

The Fatigue Scale Parent Version (FS-P)

1 effective nursing interventions(45- 60mdaya week)education about the fatigue with the chemotherapy and fatigue handbook 2 T1 After a 7-day period the children

and parent were evaluated with the Fatigue Scale

1The difference betwthe 2 mean values wafound to be statisticallsignificant 2 statistically significadifference was found between the Fatigue Scale-Child mean scothe experimental (272the control group (4213)children

679

48

25 Chiang et

al(2007)

The effects of ldquo a home ndashbased aerobic exercise interventionrdquo on fatigue and cardiorespiratory fitness in children with Acute Lymphoblastic Leukemia during the maintenance stage of chemotherapy

To examine the effect of ldquo a home ndashbased aerobic exercise interventionrdquo on fatigue and cardiorespiratory fitness in children with Acute Lymphoblastic Leukemia during the maintenance stage of chemotherapy

Quasi-experi -mental

Routine

nursing care

14 pediatric oncology patients in the experimental group and 10 in control group who were matched by age and sex ages7-18 years

1Cardiorespiratory fitness

2Fatigue

1Cardiorespiratory fitness Physical Activity Recall

VO2maxHR peak 6MWT

2 Fatigue PedsQL-MFS(Generalsleepcognitive fatigue)

1A six-week home-based aerobic exercise intervention 2 8 time points T0 baseline T1-T6 every week during the

intervention(6 weeks) T7 post intervention T8 follow-up (one month after

the end of the home-based exercise program)

1 For intent-to ndash treatthe findings indicated are no intervention efftime differences by anon the subscale of fat2 For per-protocol angeneral fatigue( mean422plusmn402) was the osubscale that was siglower for children whothe exercise interventthose in control groupfollow-up assessmentmonth after the compintervention) 3 The VO2peak are significantly improvingexperimental group atbaseline- and post-intassessment The VO2was significantly highechildren who were in experimental group thcontrol subjects at post-intervention assefor the per-protocol an

680

49

Appendix IV Instrument used to measure fatigue

Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument

Checklist Individual Strength

(CIS)22

Vercoulen et

al1996

20 items using 7-point Likert scale of

fatigue To measure four aspects of

fatiguesubjective experience

contractionmotivation physical

Activity

6-14 Not reported

Child Fatigue Scale (CFS)7 Hockenberry

et al2003

14 items 2 part questionnaire frequency

(yes or no) 5-point Likert scale of the

intensity of any yes responses

7-13

14-18 α073-o84

The Fatigue Scale for 7-12

year Olds (FS-C)224

Hockenberry

et al

14 items provide a fatigue intensity score

5-point Likert scale

7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96

Pediatric Quality of life

Multidimensional Fatigue

Scale (Peds QL-MFS)2325

Varni2002 18 items to measure three aspects of

fatigueGeneralsleepcognitive

14-18 Not reported

681

50

Appendix V Excluded studies and reasons for exclusion

Baggott C Dodd M Kennedy C Marina N Miaskowski C Multiple Symptoms in Pediatric Oncology

Patients A Systematic Review Journal of Pediatric Oncology Nursing 2009 Nov-Dec 27(6)

325-339

Reason for exclusion Not outcome of interest

Barlow JH Ellard DR Psycho-educational interventions for children with chronic disease parents and

siblings an overview of the research evidence base Care Health amp Development 2004 Nov

30(6)637-45


Bedider S Moyer CA Randomized controlled trials of pediatric massage A review Evid Based

Complement Alternat Med 2007 Mar 4(1)23-34 Epub 2006 Nov 3


de Nijs EJ Ros W Grijpdonck MH Nursing intervention for fatigue during the treatment for cancer Cancer

Nursing 2008 31(3)191-206

Reason for exclusion Not population of interest

Edwards JL Gibson F Richardson A Sepion B Ream E Fatigue in adolescents with and following a

cancer diagnosis developing an evidence base for practice European Journal of Cancer 2003

Dec 39(18)2671-80

Reason for exclusion Not experimental or quasi-experimental study

Hinds PS Hockenberry-Eatan M Developing a research program on fatigue in children and adolescents

diagnosed with cancer Journal of Pediatric Oncology Nursing 2001 Mar-Apr 18(2 Suppl

1)3-12


Hockenberry-Eaton M Hinds PS Alcoser P ONeill JB Euell K Howard V Gattuso J Taylor J Fatigue in

Children and Adolescents With Cancer Journal of Pediatric Oncology Nursing 1998 July

15(3)172-182


Jean-Pierre P Mustian K Kohli S Roscoe JA Hickok JT Morrow GR Community-based clinical oncology

research trials for cancer-related fatigue The Journal of Supportive Oncology 2006 Nov-Dec

4(10)511-6

682

51


Kangas M Bovbjerg DH Montgomery GH Cancer-Related Fatigue A Systematic and Meta-Analytic

Review of Non-Pharmacological Therapies for Cancer Patients Psychological Bulletin 2008 Sep

134(5)700-41


Lotfi-Jam K Carey M Jefford M Schofield P Charleson C Aranda S Nonpharmacologic strategies for

managing common chemotherapy adverse effects A systematic review Journal of Clinical

Oncology 2008 Dec 1 26(34)5618-29 Epub 2008 Nov 3


Marchese VG Chiarello LA Lange BJ Effects of physical therapy intervention for children with acute

lymphoblastic leukemia Pediatr Blood Cancer 2004 Feb42(2)127-33


Meeske KA Siegel SE Globe DR Mack WJ Bernstein L Prevalence and correlates of fatigue in

long-term survivors of childhood leukemia Journal of Clinical Oncology 2005 Aug 20

23(24)5501-10

Reason for exclusion Not intervention study

Minton O Richardson A Sharpe M Hotopf Stone P A systematic review and meta-analysis of the

pharmacological treatment of cancer-related fatigue J Natl Cancer Inst 2008 Aug 20

100(16)1155-66 Epub 2008 Aug 11

Reason for exclusion Not population and intervention of interest

Mustian KM Morrow GR Carroll JK Figueroa-Moseley CD Pascal JP Williams GC Integrative

nonpharmacologic behavioral interventions for the management of Cancer-Related fatigue The

Oncologist 2007 12(1)52-67


Neill J Belan I Ried K Effectiveness of non-pharmacological interventions for fatigue in adults with

multiple sclerosis rheumatoid arthritis or systemic lupus erythematosus a systematic review

Journal of Advanced Nursing 2006 Dec 56(6)617-35


Rheingans JI A systematic review of nonpharmacologic adjunctive therapies for symptom management

Journal of Pediatric Oncology Nursing 2007 24(2) 81-94

683

52


Rheingans JI Pediatric oncology nursesrsquo management of patients symptoms Journal of Pediatric

Oncology Nursing 2008 Nov 25(6) 303-11


San Juan AF Fleck SJ Chamorro-Vintildea C Mateacute-Muntildeoz JL Moral S Peacuterez M Cardona C Del Valle MF

Hernaacutendez M Ramiacuterez M Madero L Lucia A Effects of an intrahospital exercise program

intervention for children with leukemia Medicine amp Science in Sports amp Exercise 2007 Jan

39(1)13-21


Sanford SD Okuma JO Pan J Srivastava DK West N Farr L Hinds PS Gender differences in sleep

fatigue and daytime activity in a pediatric oncology sample receiving dexamethasone Journal of

Pediatric Psychology 2008 Apr 33(3)298-306 Epub 2007 Nov 17


Schmitz KH Holtzman J Courneya KS Macircsse LC Duval S Kane R Controlled physical activity trials in

cancer survivors a systematic review and meta-analysis Cancer Epidemiol Biomarkers Prev

2005 Jul 14(7)1588-95


van Brussel M Takken T Lucia A van der Net J Helders PJ Is physical fitness decreased in survivors of

childhood leukemia A systematic review Leukemia 2005 Jan 19(1)13-7


Whiting P Bagnall AM Snowden AJ Cornell JE Mulrow CD Ramirez G Interventions for the treatment

and management of chronic fatigue syndrome JAMA 2001 Sep 19 286(11)1360-8

Reason for exclusion Not intervention of interest

Whitsett SF Gudmundsdottir M Davies B McCarthy P Friedman D Chemotherapy-related fatigue in

childhood cancer correlates consequences and coping strategies Journal of Pediatric

Oncology Nursing 2008 Mar-Apr 25(2)86-96 Epub 2008 Feb 29


Winner C Muumlller C Hoffmann C Boos J Rosenbaum D Physical activity and childhood cancer Pediatr

Blood Cancer 2010 Apr 54(4)501-10

Reason for exclusion Not research study

684

53

Wu M Hsu L Zhang B Shen N Lu H Li S The experiences of cancer-related fatigue among Chinese

children with leukaemia A phenomenological study Journal of Nursing Studies 2010 Jan

47(1)49-59 Epub 2009 Aug 25


Yeh CH Chiang YC Lin L Yang CP Chien LC Weaver MA Chuang HL Clinical factors associated with

fatigue over time in paediatric oncology patients receiving chemotherapy British Journal of

Cancer 2008 Jul 8 99(1)23-9 Epub 2008 Jun 24


685

2

Objectives The objective of this systematic review was to determine the best available

evidence concerning the effectiveness of non-pharmacological interventions on fatigue in


Search strategy The search strategy aimed to find studies published between 1960 and

2010 in either the English or Chinese languages Reference lists of studies that met the

inclusion criteria were also searched for additional studies

Types of studies This review included randomised controlled trials and

quasi-experimental studies that examined the effectiveness of non-pharmacological

interventions for fatigue in children and adolescents with cancer

Types of participants Children and adolescents aged from 1 to 18 years old with

cancer either during or after the chemotherapy The types of cancer included were Acute

lymphoblastic leukemia Acute myeloid leukemia lymphoma and solid tumors

Types of interventions This review considered studies that examine

non-pharmacological interventions on fatigue for children and adolescents with cancer

including activity enhancement (exercise physical activity) psychosocial interventions

cognitive behavioral therapy stress management relaxation nutrition consultation

massage and educational interventions The intervention descriptions included the length

frequency setting and intervention providers

Types of outcome measures The outcome measures considered fatigue scores

assessment

Types of setting The review focused on studies that conducted either in a hospital or a

community setting

Data collection and synthesisThe data were extracted using the standardised data

635

3



Results






-017)

Conclusions













636

4



BACKGROUND



















637

5









Model12











life


638

6























639

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

3



Results






-017)

Conclusions













636

4



BACKGROUND



















637

5









Model12











life


638

6























639

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

4



BACKGROUND



















637

5









Model12











life


638

6























639

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

5









Model12











life


638

6























639

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

6























639

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

7
























640

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

8























641

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

9




staffs




















642

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

10










children













643

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

11










Definition of terms












644

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

12


Review Objective




Review Question





Types of studies











645

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

13




treatment











tested








646

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

14


Types of settings


Search Strategy










studies

Types of languages

1 English

2 Chinese




647

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

15



















648

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

16





Data Synthesis















649

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

17











(n=40)


quality (n=6)


(n=6)




650

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

18




Randomisation








Adequate follow up










651

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

19

















Countries



Intervention types

652

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

20























653

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

21











Outcome measures













654

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

22








studies 222325













655

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

23















656

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

24














intervention)





657

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

25
















95 CI-092 to 022 Fig 4)

658

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

26














659

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

27






















660

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

28












(t=567 Plt00)











661

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

29



























662

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

30






lower









year














663

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

31


























664

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

32








general fatigue














665

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

33







recommendation A)




















666

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

34







methods













Acknowledgements


assessing studies

667

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

35










Louis MO Mosby 2007











668

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

36





















669

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

37








33(6)686-697






nursing 20004(1)20-28


670

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

38





Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


Yes No Not clear


671

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

39

Yes No Not clear


Yes No Not clear


Yes No Not clear

Summary

TOTAL

Yes No Not clear

DECISION

Use Reject


COMMENTS

672

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

40


Journal Title


Reviewer

Method

Settings

Participants




Interventions

Group A

Control

Group B

Intervention 1

Group C

Intervention 2

Outcome measures

Definition

673

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

41



Results

Dichotomous Data


Numbertotal number

Treatment Group

Numbertotal number

Continuous Data


Comments


Mean amp SD

Treatment Group

Mean amp SD

674

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

43




Sampling


Data collection


OutcomesResults





No comparsion group









RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults





quiet-time

control

sessions



parents

1anxiety 2 fatigue









675

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

44



676

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

45

RefNo

Author(s) (years)


Comparison group

Sampling


Data collection


OutcomesResults

















677

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

46

23 Keats M



To examine the

feasibility of a

theoretically-based


intervention in

adolescents with

cancerand

examination of the

impact of the

program on

participant QOL

including social

emotional and

physical



No comparsion group










(16 wk) T3 3-months


initiation




678

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

47

RefNo

Author(s) (years)


Comparison group


Data collection


OutcomesResults












679

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

48

25 Chiang et

al(2007)




Routine

nursing care



2Fatigue


VO2maxHR peak 6MWT






680

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

49


Name Instrument

developers

Description Used in

age in

ref

Reliability

Consistency of

instrument


(CIS)22

Vercoulen et

al1996





Activity

6-14 Not reported


et al2003




7-13

14-18 α073-o84


year Olds (FS-C)224

Hockenberry

et al



7-12 αo84


year Olds (FS-A)24

Hockenberry

et al



13-18 α076-o96






14-18 Not reported

681

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

50




325-339




30(6)637-45






Nursing 2008 31(3)191-206




Dec 39(18)2671-80




1)3-12




15(3)172-182




4(10)511-6

682

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

51




134(5)700-41











23(24)5501-10




100(16)1155-66 Epub 2008 Aug 11




Oncologist 2007 12(1)52-67








683

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

52








39(1)13-21








2005 Jul 14(7)1588-95















684

53



47(1)49-59 Epub 2009 Aug 25






685

53



47(1)49-59 Epub 2009 Aug 25






685

¥_°Ï(¤G)The effectiveness of non-pharmacological interventions on fatigue in children and...

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Transcript of ¥_°Ï(¤G)The effectiveness of non-pharmacological interventions on fatigue in children and...