Predictors of Change Following Participation in Non-Pharmacologic Interventions for CFS

Abstract

The purpose of this study was to evaluate predictors of change in physical function in individuals diagnosed with chronic fatigue syndrome (CFS) following participation in nurse delivered, non-pharmacologic interventions. Participants diagnosed with CFS were randomly assigned to one of four, 6-month interventions including cognitive behavior therapy, cognitive therapy, anaerobic exercise, or a relaxation control group. Baseline measures including immune function, actigraphy, time logs, sleep status, and past psychiatric diagnosis significantly differentiated those participants who demonstrated positive change over time from those who did not. Understanding how patient subgroups differentially respond to non-pharmacologic interventions might provide insights into the pathophysiology of this illness.

Case definitions integrating empiric and consensus perspectives

“…In addition, those with psychiatric reasons for their fatigue might also be more likely to benefit from the non-pharmacologic interventions. In support of this proposition, Jason et al [51] found that those with the most severe immune baseline characteristics tended to be non-improvers within non-pharmacologic interventions. Jason et al [52] also found that patients with CFS with normal baseline cortisol evidenced improvements on a number of immunologic and self-report measures, whereas patients most impaired on hypothalamic-pituitary-adrenal (HPA) functioning at baseline were least able to improve when provided rehabilitation interventions.…”

Energy conservation/envelope theory interventions

“…About half the participants in each group were improvers and the other half were non-improvers. [34] We found important baseline differences between those who improved versus did not improve over time. Improvers, at baseline, had decreased T and B cells and elevated NK percentage numbers, whereas non-improvers had an elevated humoral immune response (a dominance of the Type 2 over the Type 1 immune response).…”

Sub-typing daily fatigue progression in chronic fatigue syndrome

“…Hanson, Gause, and Natelson (2001) used neural-network classifiers to support this Th 2 shift among patients with CFS. In a non-pharmacologic intervention study, Jason et al (2008) found those who improved had a Th 1 shift as indicated by the relatively expanded cytotoxic subsets (CD8, CD56), while non-improvers had a Th 2 shift. The current study further supports the contention that clinically distinct subsets of patients exist within the current definition of CFS.…”