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Cognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: Effectiveness and predictors of outcome

https://doi.org/10.1016/j.brat.2011.09.004Get rights and content

Abstract

Cognitive behavioural therapy (CBT) was combined with graded exercise therapy (GET) for patients with chronic fatigue syndrome (CFS) in an uncontrolled implementation study of an inpatient multidisciplinary group therapy. During the intake procedure, 160 CFS patients completed a questionnaire on fatigue related measurements, physical impairment, depression, somatic and psychological attributions, somatic focus, and sense of control over symptoms. Pre-treatment physical activity level was measured with an actometer. At baseline, post-treatment and 6-month follow-up individual strength, subjective fatigue and physical impairment, were reassessed. Large effect sizes were found on subjective fatigue (1.2 post-treatment; 1.2 follow-up) and physical impairment (−.9 post-treatment; −.9 follow-up), Clinically significant improvement was found in 33.8% of the participants at post-treatment and 30.6% at follow-up. Individual strength at post-treatment was predicted by level of physical activity before treatment, and by sense of control over symptoms and physical activity at follow-up. Clinically significant improvement in subjective fatigue was predicted by not receiving a disablement insurance benefit, shorter duration of fatigue, higher sense of control over symptoms and, at follow-up by more pre-treatment physical activity. In conclusion, the intervention was effective for CFS patients. Cognitive behavioural factors that perpetuate fatigue symptoms are also predictors of treatment outcome.

Highlights

► We studied CBT with GET for CFS in the daily practice of a tertiary rehabilitation centre. ► It concerns an uncontrolled implementation study of an inpatient group therapy. ► Large effect sizes were found on fatigue and physical impairment. ► Clinically significant improvement was found in 34% of the patients at post-treatment and 31% at follow-up. ► CBT with GET for CFS is not only effective in RCT’s but also in daily practice.

Section snippets

Participants

All participants in the current study gave a written permission to use their data. Participants were consecutive CFS patients who were admitted to an inpatient multicomponent rehabilitation program in a large tertiary centre in the Netherlands in the period January 2005–September 2009. Inclusion criteria were: a confirmed diagnosis of CFS according to the CDC criteria; being older than 18 years; severe fatigue (Checklist Individual Strength-20 (CIS-20) subscale subjective fatigue ≥35); being

Effectiveness of treatment

From baseline to post-treatment the mean subjective fatigue (CIS subjective fatigue subscale), individual strength (CIS-total) and physical impairment (SF-36) scores improved with respectively 23%, 21.0% and 29.9%. These changes were statistically significant (p < 0.001) and indicated large treatment effects (Table 2). From post-treatment to 6-month follow-up mean subjective fatigue, individual strength and, physical impairment scores did not significantly change.

At post-treatment 33.8% (n

Discussion

A multidisciplinary program consisting of a combination of CBT and GET offered in a tertiary rehabilitation clinic seems to be effective for CFS patients. Mean subjective fatigue, individual strength and, physical impairment scores were significantly improved at post-treatment and 6-month follow-up. Pre-post effect sizes were large and comparable (effect size subjective fatigue) with or higher (effect size physical impairment) than the effect sizes found by Scheeres et al. (2008) in a

Acknowledgements

This work is part of the ZonMw project ‘chronisch vermoeidheidssyndroom’ (http://www.zonmw.nl/nl/onderwerpen/alle-programma-s/cvs/gehonoreerd-onderzoek/).

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