Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: a randomized controlled trial

Abstract

Objectives. The aim of this trial was to evaluate the difference in treatment effect, at 26 and 52 weeks after the start of treatment, between cognitive behavioural therapy (CBT) and multidisciplinary rehabilitation treatment (MRT) for patients with chronic fatigue syndrome (CFS).Design. Multicentre, randomized controlled trial of patients with CFS. Participants were randomly assigned to MRT or CBT.Setting. Four rehabilitation centres in the Netherlands. Subjects. A total of 122 patients participated in the trial.Main outcome measures. Primary outcomes were fatigue measured by the fatigue subscale of the Checklist Individual Strength and health-related quality of life measured by the Short-Form 36. Outcomes were assessed prior to treatment and at 26 and 52 weeks after treatment initiation.Results. A total of 114 participants completed the assessment at 26 weeks, and 112 completed the assessment at 52 weeks. MRT was significantly more effective than CBT in reducing fatigue at 52 weeks. The estimated difference in fatigue between the two treatments was À3.02 [95% confidence interval (CI) À8.07 to 2.03; P = 0.24] at 26 weeks and À5.69 (95% CI À10.62 to À0.76; P = 0.02) at 52 weeks. Patients showed an improvement in quality of life over time, but between-group differences were not significant. Conclusion.This study provides evidence that MRT is more effective in reducing long-term fatigue severity than CBT in patients with CFS. Although implementation in comparable populations can be recommended based on clinical effectiveness, it is advisable to analyse the cost-effectiveness and replicate these findings in another multicentre trial.

Treatment expectations influence the outcome of multidisciplinary rehabilitation treatment in patients with CFS

“…This study is part of the FatiGo trial, a multi-centre, pragmatic twoarm randomized controlled trial (ISRCTN77567702) of which the methods and results are described previously [3,4]. The main aim of the FatiGo trial was to analyse the difference in treatment effect between MRT and CBT for patients with CFS.…”

“…Results of the randomized trial comparing MRT and CBT showed that immediately post-treatment (26 weeks after start of treatment) both treatments showed significant reduction of fatigue and increase of quality of life, however the between group differences were not significant. At 52 weeks follow-up, MRT was more effective in reducing fatigue and equally effective in improving quality of life [4]. To understand the working mechanisms of these interventions and to find out how to increase their effectiveness, it is important to study factors that influence the outcome of treatment.…”

Rehabilitation for patients with myalgic encephalomyelitis/chronic fatigue syndrome: time to extent the boundaries of this field

“…The rate of innovation in the field of ME/CFS rehabilitation has somewhat slowed over the past few years or even decades. However, in this issue of the Journal of Internal Medicine, Vos-Vromans et al report an innovative study showing that interdisciplinary rehabilitation is more effective than cognitive behavioural therapy in reducing fatigue for patients with ME/CFS [5].…”

“…The idea of 'blurred boundaries' between healthcare professions leads to the issue of to what extent different disciplines are required to deliver the intervention described by Vos-Vromans et al [5]. The interdisciplinary team consisted of an occupational therapist, physiotherapist, social worker and psychologist.…”

“…This might also be the case for other abnormal aspects of the stress response system in ME/CFS, including the dysfunctional hypothalamus-pituitary-adrenal axis [18,19]. With regard to the grading of physical activity levels in the rehabilitation protocol of Vos-Vromans et al [5], it would have been interesting to examine the possible impact upon established markers of immune hyper-responsiveness to exercise. Following exercise, ME/CFS patients have more pronounced complement system (i.e.…”