The Impact of Educational or Behavioural Interventions on Fatigue in Adults Receiving Haemodialysis: A Systematic Review and Meta-Analysis.

BACKGROUND: Fatigue is common and debilitating in adults undergoing haemodialysis, significantly impairing health-related quality of life. Non-pharmacological interventions such as self-management education, exercise training, and cognitive behavioural therapy have been shown to reduce fatigue in this population. However, a comprehensive quantitative synthesis of their overall effectiveness is still lacking. OBJECTIVES: To evaluate the efficacy of self-management education, exercise training, and cognitive behavioural therapy in reducing fatigue among adults receiving haemodialysis. DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults receiving haemodialysis. MEASUREMENTS: Nine databases were searched from inception to 27 January, 2026. Randomised controlled trials and quasi-experimental studies were included. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Meta-analyses were conducted using R (version 4.4.1), with pooled effects reported as standardised mean differences based on change scores. RESULTS: Thirty studies were included. Self-management education demonstrated a significant effect on fatigue (SMD = 0.98, 95% CI [0.69, 1.28], p < 0.001, moderate certainty evidence). Exercise training also yielded a significant benefit (SMD = 0.82, 95% CI [0.44, 1.20], p < 0.001, low certainty evidence). Cognitive behavioural therapy did not show a significant effect (SMD = 1.45, 95% CI [-0.46, 3.37], p = 0.137, very low certainty evidence). CONCLUSIONS: Self-management education may be considered for routine clinical care, while exercise training may serve as an adjunctive strategy. The efficacy of cognitive behavioural therapy remains inconclusive. Further high-quality trials are needed.