Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study

Abstract

Background Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability. Objective We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark. Methods Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered. Results Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ21=3.5, P=.06; physical functioning: 4.1% vs 11.4%, χ21=3.3, P=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations. Conclusions IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.

Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach

“…Therefore, they may be effective as a self-management tool for individuals with ME/CFS or long COVID. Several recent studies have explored the effectiveness of internet-based cognitive behavioral therapies in fatigue management among individuals with ME/CFS [4,5]. Despite the potential benefits of digital health solutions for the self-management of ME/CFS and long COVID, there are no evidence-based, personalized, and context-aware solutions designed specifically for supporting patients with ME/CFS or long COVID in fatigue self-management.…”

Internet-delivered cognitive behavioural therapy for chronic fatigue among adolescents with a chronic medical condition: a single case study

“…Secondary outcomes were the effects of treatment on daily functioning and pain severity. Limitations in daily functioning were measured by (1) Physical functioning assessed with the subscale physical functioning (9 items) of the Child Health Questionnaire (CHQ-CF87) (0-100%), and (2) School absence expressed in obliged hours minus attended/obliged hours (Albers et al, 2021). Pain severity was assessed using the Visual Analogue Scale (VAS) scores for pain (0-100 mm).…”

“…FITNET-plus builds on FITNET: an established eHealth CBT protocol for ME/CFS in adolescents (Albers et al, 2021) and is enriched with elements of evidence-based CBT protocols for fatigued adults with a chronic medical condition (Goërtz et al, 2021). Clinical interviews with adolescents with IDD gained insight into beliefs and behaviours related to their fatigue and ensured that the content of the treatment portal suited this target group.…”

“…Severe fatigue is frequently reported by adolescents and when persistent it leads to significant physical and social impairments (Rimes et al, 2007). Internet-delivered cognitive behaviour therapy (I-CBT) is an evidence-based treatment for myalgic encephalitis/chronic fatigue syndrome (ME/CFS) (Albers et al, 2021). According to the model applied in CBT for ME/CFS, the trigger of severe fatigue should be discerned from fatigue-related behaviours and beliefs which perpetuate the fatigue (Goërtz et al, 2021).…”

Social Media Fatigue Management among Adolescents: Rapid Review

“…Fatigue termasuk salah satu kondisi medis yang dapat dialami dari rentang ringan hingga berat. Salah satu bentuk fatigue adalah social media fatigue (1).…”