Given that the term "recovery" was often based on limited assessments and less than full restoration of health, other more precise and accurate labels (e.g., clinically significant improvement) may be more appropriate and informative. In keeping with common understandings of the term recovery, we recommend a consistent definition that captures a broad-based return to health with assessments of both fatigue and function as well as the patient's perceptions of his/her recovery status.
Objective To assess the efficacy of brief fatigue self-management for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care. Methods A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to: two sessions of fatigue self-management (FSM), two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3- and 12-months post-treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention-to-treat (multiple imputation) and also by per protocol. Results A group by time interaction across the 15 month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison to the AC group (p< .023) and the UC group (p< .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d=.46) and the UC group (d=.40). The per protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12 month follow-up were high (42%–53%) perhaps attributable to the burden of monthly phone calls to assess health care utilization. Conclusion A brief self-management intervention for patients with UCF or CFS appeared to be clinically effective for reducing the impact of fatigue on functioning.
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