Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database

Crawley, Esther; Collin, Simon M.; White, P D; Rimes, Katharine A.; May, M T

doi:10.1093/qjmed/hcaa090

Cited by 4 publications

(7 citation statements)

References 27 publications

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“…A large cohort study of specialist services in the UK found positive outcomes such as reductions in fatigue, anxiety and depression. 12 Flo and Chalder conducted a study within routine practice and found that after cognitive behavioural therapy treatment, just under 40% of patients no longer met Oxford or Centers for Disease Control and Prevention criteria for chronic fatigue syndrome, and just under 20% were recovered, similar to rates of recovery reported in the Netherlands. 13 …”

Section: Introductionmentioning

confidence: 62%

“… 15 Baseline physical functioning (36-item Short Form Health Survey) and increased levels of pain predicted poor outcomes in a large study across six specialist units. 12 However, duration of illness, counter-intuitively, was not a predictor of outcome regardless of setting. 12 , 16 – 18 …”

Section: Introductionmentioning

confidence: 95%

“… 12 However, duration of illness, counter-intuitively, was not a predictor of outcome regardless of setting. 12 , 16 – 18 …”

Section: Introductionmentioning

confidence: 95%

“…Research suggests that older age has been consistently shown to be a predictor of poor outcomes. 11 , 12 , 15 Furthermore, worse social adjustment, catastrophising and depression all predicted poor outcomes in patients with chronic fatigue syndrome in a specialist clinic. 15 Baseline physical functioning (36-item Short Form Health Survey) and increased levels of pain predicted poor outcomes in a large study across six specialist units.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK

et al. 2020

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Objectives Cognitive behavioural therapy is commonly used to treat chronic fatigue syndrome and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic setting and examine what factors, if any, predicted outcome. Design Using linear mixed effects analysis, we analysed patients' self-reported symptomology over the course of treatment and at three-month follow-up. Furthermore, we explored what baseline factors were associated with improvement at follow-up. Setting Data were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK. Participants Participants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome. Main outcome measures Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction. Results Patients’ fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45–0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137). Conclusions Patients’ fatigue, physical functioning and social adjustment all significantly improved following cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic outpatient setting. These findings support the growing evidence from previous randomised control trials and suggest that cognitive behavioural therapy could be an effective treatment in routine treatment settings.

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Section: Introductionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 95%

“… 12 However, duration of illness, counter-intuitively, was not a predictor of outcome regardless of setting. 12 , 16 – 18 …”

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK

et al. 2020

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“…This is much higher than in healthy children where between 3.6% and 16.6% will describe severe pain 8. In adult patients with CFS/ME pain is associated with worse outcomes 7 9…”

Section: Introductionmentioning

confidence: 97%

Interventions to treat pain in paediatric CFS/ME: a systematic review

Ascough

King

Serafimova

et al. 2020

bmjpo

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BackgroundPaediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%–2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.ObjectiveIdentify whether specialist treatment of paediatric CFS/ME improves pain.MethodsWe conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged <19 years with CFS/ME; and (3) measure of pain before and after an intervention.ResultsOf 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.ConclusionsDespite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.PROSPERO registration numberCRD42019117540.

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Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review

Vink¹,

Vink-Niese²

2019

Health Psychology Open

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Analysis of the 2008 Cochrane review of cognitive behavioural therapy for chronic fatigue syndrome shows that seven patients with mild chronic fatigue syndrome need to be treated for one to report a small, short-lived subjective improvement of fatigue. This is not matched by an objective improvement of physical fitness or employment and illness benefit status. Most studies in the Cochrane review failed to report on safety or adverse reactions. Patient evidence suggests adverse outcomes in 20 per cent of cases. If a trial of a drug or surgical procedure uncovered a similar high rate, it would be unlikely to be accepted as safe. It is time to downgrade cognitive behavioural therapy to an adjunct support-level therapy, rather than a treatment for chronic fatigue syndrome.

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Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database

Cited by 4 publications

References 27 publications

Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK

Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK

Interventions to treat pain in paediatric CFS/ME: a systematic review

Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review

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