Research abstract:
BACKGROUND: Medically-unexplained chronic fatigue states are prevalent, and challenging to manage. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are effective in clinical trials. Evaluation of delivery in a standard health care setting is rare. An integrated treatment program with individualised allocation of resources to patients’ needs, was developed and implemented though an academic outpatient clinic. It was hypothesised that the program would result in similar responses to those observed in the clinical trials.
AIM: To evaluate the outcomes of an integrated, 12-week CBT and GET program delivered by exercise physiologists and clinical psychologists.
METHODS: Consecutive eligible patients (n = 264) who met diagnostic criteria for chronic fatigue syndrome (CFS) or post-cancer fatigue (PCF) were evaluated with self-report measures of fatigue, functional capacity, and mood disturbance, at baseline, end-treatment (12-weeks), and follow-up (24-weeks). A semi-structured interview recording the same parameters was conducted pre- and post-treatment by an independent clinician. Primary outcome (fatigue) was analysed by repeated measures ANOVA and predictors of response was analysed by logistic regression
RESULTS: The intervention produced sustained improvements in symptom severity and functional capacity. A substantial minority of patients (35%) gained significant improvement, with male gender and higher pain scores at baseline predicting non-response. A small minority of patients (3%) worsened.
CONCLUSIONS: The manualised protocol of integrated CBT and GET was successfully implemented confirming the generally positive findings of clinical trials. Assessment and treatment protocols are available for dissemination to allow standardised management. The beneficial effects described here provide the basis for ongoing studies to further optimise the intervention and better identify those most likely to respond.
Outcomes and predictors of response from an optimised, multi-disciplinary intervention for chronic fatigue states, by CX Sandler, BA Hamilton, SL Horsfield, BK Bennett, U Vollmer-Conna, C Tzarimas, AR Lloyd in Intern Med J. 2016 Sep 13 [Epub ahead of print]
