Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up
- 986 Downloads
Chronic fatigue syndrome (CFS) produces physical and neurocognitive disability that significantly affects health-related quality of life (HRQL). Multidisciplinary treatment combining graded exercise therapy (GET) cognitive behavioural therapy (CBT) and pharmacological treatment has shown only short-term improvements. To compare the effects on HRQL of (1) multidisciplinary treatment combining CBT, GET, and pharmacological treatment, and (2) usual treatment (exercise counselling and pharmacological treatment) at 12 months of follow-up. Prospective, randomized controlled trial with a follow-up of 12 months after the end of treatment. Patients consecutively diagnosed with CFS (Fukuda criteria) were randomly assigned to intervention (n = 60) or usual treatment (n = 60) groups. HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form questionnaire (SF-36). Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Questionnaire (HAQ) and comorbidities. At baseline, the two groups were similar, except for lower SF-36 emotional role scores in the intervention group. At 12 months, the intervention did not improve HRQL scores, with worse SF-36 physical function and bodily pain scores in the intervention group. Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL. The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis.
KeywordsChronic fatigue syndrome Cognitive behavioural therapy Graded exercise therapy Health-related quality of life Outcomes
We thank David Buss for his editorial advice.
Joaquim Fernandez-Solà received grants from the Generalitat of Catalonia, SGR 2009-1158, and CIBEROBN, Carlos III Health Institute, Majadahonda, Madrid.
- 7.Alonso J, Prieto L, Antó JM (1995) The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc) 104(20):771–776Google Scholar
- 14.Edmonds M, McGuire H, Price J (2004) Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev (3):CD003200 (Review)Google Scholar
- 15.Price JR, Mitchell E, Tidy E, Hunot V (2008) Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev (3):CD001027Google Scholar
- 17.Torenbeek M, Mes CA, van Liere MJ, Schreurs KM, ter Meer R, Kortleven GC, Warmerdam CG (2006) Favourable results of a rehabilitation program with cognitive behavioural therapy and graded physical activity in patients with chronic fatigue syndrome. Ned Tijdschr Geneeskd 150(38):2088–2094PubMedGoogle Scholar
- 19.O'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A (2006) Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme. Health Technol Assess 10(37) iii–iv, ix–x, 1–121Google Scholar
- 21.Boutron I, Moher D, Altman DG, Schulz K, Ravaud P, for the CONSORT group (2008) Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 8:295–309Google Scholar
- 22.Nou Model d'atenció a la Fibromiàlgia i la síndrome de Fatiga Crònica. Catalunya 2006 Available at http://www.gencat.cat/salut/depsalut/pdf/fm_sfccat.pdf
- 23.Fukuda K, Strauss SE, Hickie I, Sharp CM, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 12:953–959Google Scholar
- 28.Alijotas J, Alegre J, Fernández-Solà J, Cots JM, Panisello J, Peri JM et al (2002) Consensus report on the diagnosis and treatment of chronic fatigue syndrome in Catalonia. Med Clin (Barc) 118(2):73–76Google Scholar
- 32.Ramos-Casals M, Brito-Zerón P, Perez-De-Lis M, Jimenez I, Blanco MJ, Bove A et al (2009) Sjögren syndrome or Sjögren disease? The histological and immunological bias caused by the 2002 criteria. Clin Rev Allergy Immunol 38(2–3):178–185Google Scholar
- 38.Action for ME (AFME) (2001) Severely neglected ME in the UK. Action for ME, London. Available at http://www.afme.org.uk/res/img/resources/Severely%20Neglected.pdf. Accessed 12 August 2009
- 39.Action for ME (AFME) Members Survey—Conducted Spring 2003. 4. ME Essential Spring edition. ME, Gawcott. Available at http://www.afme.org.uk/res/img/resources/afme%20members%20survey.pdf. Accessed 12 August 2009
- 40.National Institute for Health and Clinical Excellence (2007) Clinical guideline CG53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. NICE, London. Available at http://guidance.nice.org.uk/CG53
- 42.Nijs J, Paul L, Wallman K (2010) Response 2 to letter to the editor by Kindlon & Goudsmit: new insights in post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. J Rehabil Med 42:185–186Google Scholar
- 43.Twisk FN, Maes M (2009) A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS. Neuro Endocrinol Lett 30(3):284–311PubMedGoogle Scholar