Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice

Abstract

Cognitive behavioural therapy (CBT) is one of the treatments of choice for patients with chronic fatigue syndrome (CFS). However, the factors that predict recovery are unknown. The objective of this study was to ascertain the recovery rate among CFS patients receiving CBT in routine practice and to explore possible predictors of recovery. Recovery was defined as no longer meeting Oxford or CDC criteria for CFS measured at 6 months follow-up. A composite score representing full recovery additionally included the perception of improvement, and normal population levels of fatigue and of physical functioning. Logistic regression was used to examine predictors of recovery. Predictors included age, gender, cognitive and behavioural responses to symptoms, work and social adjustment, beliefs about emotions, perfectionism, anxiety and depression at baseline. At 6 months follow-up 37.5% of the patients no longer met either the Oxford or the CDC criteria for CFS while 18.3% were fully recovered. Multivariate analyses showed that worse scores on the work and social adjustment scale, unhelpful beliefs about emotions, high levels of depression and older age were associated with reduced odds for recovery. Recovery rates in this routine practice were comparable to previous RCTs. There was a wide spectrum of significant predictors for recovery.

Do more people recover from chronic fatigue syndrome with cognitive behaviour therapy or graded exercise therapy than with other treatments?

“…Interestingly, this Dutch Group found that having a comorbid illness reduced the numbers recovering, which supports our arguably conservative use of a rating of overall health to assess recovery [12]. Using similar criteria and thresholds 6 to those used in the PACE trial, Flo and Chalder found that 18% of 140 patients were recovered six months after receiving a course of CBT in a routine clinical setting [13]. These two cohort studies therefore provide further support for our finding that 22% of participants recovered after CBT, rather than the 7% reported by Wilshire et al [7,9].…”

Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands

“…Although recovery rates are similar [16,17,29], stating recovery as the treatment goal may boost treatment effect, as outcome expectation of patients, especially the idea that recovery is possible, is known to contribute to treatment outcome [13].…”

“…The Dutch protocol distinguishes between patients with a low physical activity level and patients with a fluctuating activity pattern. The former increase their activity level early in therapy, the latter first balance their activities more evenly [29]. The UK approach to activity is not protocol driven but individualized.…”

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

“…To influence the expectancy and/or credibility it is worthwhile studying factors that are associated with these concepts. Age, internal control over symptoms, self-efficacy, depression, duration of complaints and severity of symptoms have been proposed as factors influencing expectations before treatment [8][9][10]. Whether these factors influence the expectancy or credibility in patients with CFS referred for treatment needs to be studied.…”