Implementing Evidence‐Based Practice for Patients with Chronic Fatigue Syndrome

Abstract

Implementation of CBT for CFS in community-based MHCs was monitored. External support was provided in addition to an implementation manual during initial implementation of CBT for CFS. Participating MHCs were generally capable of successfully implementing and delivering CBT for CFS. Implementation of low-intensity interventions for CFS might better be postponed until therapists have sufficient experience with conventional CBT for CFS.

Randomised Controlled Trial of Cognitive Behaviour Therapy Delivered in Groups of Patients with Chronic Fatigue Syndrome

“…Still about 15% reached rigorous criteria for normal functioning on all primary outcome measures. These findings are generally in line with current studies focusing on improvement and recovery following CBT for CFS [7,24,25] . In the control group, in contrast, few patients reached criteria for improvement, and virtually none reached criteria for recovery, which is in line with prognostic research on CFS [26] .…”

“…The CIS is a reliable and valid instrument for the assessment of fatigue which is sensitive to change and which helps to discriminate between patients with CFS and healthy individuals [10,15] . The CIS is part of our routine assessment for CFS patients and has been used in previous clinical trials conducted by our research group [4,7,11,14] . Our fatigue assessment was complemented by additional questions about other clinical features relevant to CFS such as the number of additional symptoms and the duration of the complaints, both aspects which are required by the US Center for Disease Control to classify patients as CFS cases [9] .…”

“…Our definition for clinically significant improvement included a reliable change index of >1.96 on the CIS fatigue subscale, a CIS fatigue score of <35 and an SF-36 physical functioning score of ≥ 65 in combination with a SIP overall impairment score of <700 [7] . Our definition for recovery was based on mean scores of healthy controls + 1 standard deviation on the primary outcome measures and was operationalised as a CIS fatigue score of <27, an SF-36 physical functioning score of ≥ 80 and a total score of <203 on the SIP [14] .…”

“…While we normally deliver group therapy in groups of 8 patients and 2 therapists, implementation of CBT for CFS has shown that the number of patients who are referred for treatment in community-based settings can be substantially lower than in academic settings [7] . To increase the flexibility of the group size for an implementation of the group intervention outside academic settings, we decided to also deliver treatment in groups of 4 patients and 1 therapist and tested the efficacy of the different group sizes against the control condition in subgroup analyses.…”

Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states

“…In fact, the only study that explicitly sought to isolate these interventions (the ‘Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy and specialist medical care for chronic fatigue syndrome’ (PACE) trial) reported improvements and similar effect sizes after both CBT and GET, and a mediation analysis suggested that benefit was primarily through the reduction of fear avoidance of activity . Evaluations of outcomes in community‐based studies have focused solely on CBT, but incorporate unstructured elements of GET rather than formalising the two . Accordingly, an outpatient, integrated CBT and GET treatment programme was established within an academic research framework at the Lifestyle Clinic, University of New South Wales.…”