Fatigue is a common, distressing symptom for people living with chronic musculoskeletal (MSK) conditions. This scoping review sought to create a comprehensive overview of non‑pharmacological interventions aimed at reducing fatigue or its impact across the lifespan of people with MSK conditions. Specific aims were to describe the types of interventions studied, participant characteristics, the theoretical bases reported and the clinical competencies required to deliver interventions. The review also aimed to use these findings, in collaboration with patient and public involvement groups, to identify priorities for future research and clinical practice.
The review was conducted following Joanna Briggs Institute scoping review methodology. Multiple electronic databases were searched for the period 1 January 2007 to 1 February 2026. Databases searched included AMED, MEDLINE, PsycINFO, CINAHLPlus (EBSCO), EMBASE (Ovid), SCOPUS and Cochrane databases. The search strategy targeted peer‑reviewed primary research describing non‑pharmacological interventions with either the intention or an observed effect of reducing MSK‑related fatigue.
Studies were eligible if they were peer‑reviewed primary research and described a non‑pharmacological intervention intended to reduce fatigue or its impact in people with chronic MSK conditions. Title and abstract screening and subsequent full‑text review were performed by two independent reviewers in duplicate. Where details were not reported in primary studies, the review did not invent or infer missing information.
Included study data were charted into categories reflecting intervention types, participant characteristics and reported theoretical bases. The review also extracted information on whether studies specified the clinical competencies required to deliver the intervention. Results were synthesised descriptively to characterise the current evidence base and identify patterns, common exclusions and gaps.
A total of 337 studies met the review inclusion criteria. The evidence base therefore spans several hundred primary studies published within the specified search window. The review presents a descriptive analysis of these studies grouped by intervention type, participants and reporting of theoretical and competency information.
Conditions most frequently studied were fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus. Most participants across the included studies were adults. Across studies where participant sex was reported, approximately 82% of participants were female. The review highlights that many populations were excluded from research by common eligibility criteria (see section below).
The most commonly investigated intervention type was physical activity. Of the 337 included studies, 245 reported single‑component interventions. This indicates that most research to date has focused on isolated interventions rather than combined or multi‑component approaches. The review notes that few studies examined how combining single‑component interventions might support person‑centred fatigue management.
Only 80 of the included studies reported an explicit theoretical basis for the intervention or described the clinical competencies required to deliver it. Thus, the majority of studies did not clearly state the underpinning theory guiding the intervention or the specific skills clinicians need to implement the intervention effectively. This underreporting limits understanding of mechanisms of action and the training required for scalable delivery.
Common exclusion criteria across the included studies included the presence of physical comorbidities, psychiatric disease or unstable health conditions, and cognitive impairments. The review therefore identifies that many patient groups—those with multimorbidity, mental health conditions or cognitive challenges—were frequently omitted from the evidence base.
The scoping review found a substantial number of primary studies on non‑pharmacological approaches to MSK‑related fatigue, but several important gaps. Few studies evaluated combined or multi‑component interventions that could enable person‑centred management. Many studies excluded participants with comorbid physical or psychiatric conditions or cognitive impairment, limiting generalisability.
To tailor interventions effectively for people with MSK conditions, the review concludes it is essential to: understand how individual characteristics interact with health needs; define the underlying theory for interventions; identify the clinical skills required for effective delivery; and adopt more inclusive eligibility criteria in research. The review emphasises the importance of working with patient and public involvement groups to establish priorities for future research and clinical practice.