scholarly journals Recovery from chronic fatigue syndrome after treatments given in the PACE trial

2013 ◽  
Vol 43 (10) ◽  
pp. 2227-2235 ◽  
Author(s):  
P. D. White ◽  
K. Goldsmith ◽  
A. L. Johnson ◽  
T. Chalder ◽  
M. Sharpe
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Clinical Recovery ◽  
Fatigue Syndrome ◽  
Graded Exercise Therapy ◽  
Cognitive Behaviour ◽  
Significant Difference ◽  
Graded Exercise ◽  
Individual Criterion

BackgroundA multi-centre, four-arm trial (the PACE trial) found that rehabilitative cognitive behaviour therapy (CBT) and graded exercise therapy (GET) were more effective treatments for chronic fatigue syndrome (CFS) than specialist medical care (SMC) alone, when each was added to SMC, and more effective than adaptive pacing therapy (APT) when added to SMC. In this study we compared how many participants recovered after each treatment.MethodWe defined recovery operationally using multiple criteria, and compared the proportions of participants meeting each individual criterion along with two composite criteria, defined as (a) recovery in the context of the trial and (b) clinical recovery from the current episode of the illness, however defined, 52 weeks after randomization. We used logistic regression modelling to compare treatments.ResultsThe percentages (number/total) meeting trial criteria for recovery were 22% (32/143) after CBT, 22% (32/143) after GET, 8% (12/149) after APT and 7% (11/150) after SMC. Similar proportions met criteria for clinical recovery. The odds ratio (OR) for trial recovery after CBT was 3.36 [95% confidence interval (CI) 1.64–6.88] and for GET 3.38 (95% CI 1.65–6.93), when compared to APT, and after CBT 3.69 (95% CI 1.77–7.69) and GET 3.71 (95% CI 1.78–7.74), when compared to SMC (p values ⩽0.001 for all comparisons). There was no significant difference between APT and SMC. Similar proportions recovered in trial subgroups meeting different definitions of the illness.ConclusionsThis study confirms that recovery from CFS is possible, and that CBT and GET are the therapies most likely to lead to recovery.

Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention

2002 ◽  
Vol 65 (10) ◽  
pp. 461-468 ◽  
Author(s):  
Diane L Cox
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Occupational Therapy ◽  
Cognitive Behaviour Therapy ◽  
Comparison Group ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Significant Difference ◽  
Inpatient Group

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity. A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.

scholarly journals Chronic fatigue syndrome – mapping the interior

1999 ◽  
Vol 29 (2) ◽  
pp. 255-258 ◽  
Author(s):  
MATTHEW HOTOPF ◽  
SIMON WESSELY
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Cognitive Behaviour Therapy ◽  
Randomized Trials ◽  
Central Africa ◽  
Chronic Fatigue ◽  
Behaviour Therapy ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour ◽  
Graded Exercise ◽  
Psychological Medicine

Over a century ago Beard referred to fatigue as the ‘Central Africa of medicine – an unexplored territory which few men enter’ (Beard, 1869). The last decade has seen major advances in our understanding of chronic fatigue syndrome (CFS). Much is now known of the epidemiology, clinical features and prognosis of the condition (Wessely et al. 1998), and a number of recent papers have reported randomized trials of successful treatments involving cognitive behaviour therapy (CBT) and graded exercise (Sharpe et al. 1996; Wearden et al. 1996; Deale et al. 1997; Fulcher & White, 1997). Despite these advances, which have defined some of the broad landmarks of the illness, and improved the care of patients, many areas remain uncharted. Several papers published in this issue of Psychological Medicine take us into such unexplored territory.

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