Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions Quality of life and symptom severity for individuals with chronic fatigue syndrome: findings from a randomized clinical trial. Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial
OBJECTIVE This study evaluated the long-term outcome of cognitive behavior therapy versus relaxation therapy for patients with chronic fatigue syndrome . METHOD Sixty patients who participated in a r and omized controlled trial of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome were invited to complete self-rated measures and participate in a 5-year follow-up interview with an assessor who was blind to treatment type . RESULTS Fifty-three patients ( 88 % ) participated in the follow-up study : 25 received cognitive behavior therapy and 28 received relaxation therapy . A total of 68 % of the patients who received cognitive behavior therapy and 36 % who received relaxation therapy rated themselves as " much improved " or " very much improved " at the 5-year follow-up . Significantly more patients receiving cognitive behavior therapy , in relation to those in relaxation therapy , met criteria for complete recovery , were free of relapse , and experienced symptoms that had steadily improved or were consistently mild or absent since treatment ended . Similar proportions were employed , but patients in the cognitive behavior therapy group worked significantly more mean hours per week . Few patients crossed the threshold for " normal " fatigue , despite achieving a good outcome on other measures . Cognitive behavior therapy was positively evaluated and was still used by over 80 % of the patients . CONCLUSIONS Cognitive behavior therapy for chronic fatigue syndrome can produce some lasting benefits but is not a cure . Once therapy ends , some patients have difficulty making further improvements . In the future , attention should be directed toward ensuring that gains are maintained and extended after regular treatment ends OBJECTIVE Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a r and omized controlled trial . METHODS Sixty patients with chronic fatigue syndrome were r and omly assigned to 13 sessions of either cognitive behavior therapy ( grade d activity and cognitive restructuring ) or relaxation . Outcome was evaluated by using measures of functional impairment , fatigue , mood , and global improvement . RESULTS Treatment was completed by 53 patients .  Functional impairment and fatigue improved more in the group that received cognitive behavior therapy . At final follow-up , 70 % of the completers in the cognitive behavior therapy group achieved good outcomes ( substantial improvement in physical functioning ) compared with 19 % of those in the relaxation group who completed treatment . CONCLUSIONS Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome . Improvements were sustained over 6 months of follow-up OBJECTIVE To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors . METHODS In ten German centres , 261 patients with cancer-related fatigue were r and omly assigned to a patient education program consisting of 6 sessions à 90 min or st and ard care . The primary outcome measure was cancer-related fatigue . Data were analysed using analysis of variance ( ANOVA ) with repeated measures . RESULTS Patients in the intervention group showed statistically significant reduction in cancer-related fatigue ( F = 76.510 , p < 0.001 , η(2 ) = 0.248 ) . Secondary outcomes also showed significant improvements in all measures , including quality of life ( F = 29.607 , p < 0.001 , η(2 ) = 0.113 ) , general self-efficacy ( F = 27.680 , p < 0.001 , η(2 ) = 0.107 ) , exercise self-efficacy ( F = 49.230 , p < 0.001 , η(2 ) = 0.175 ) , physical activity ( F = 8.036 , p < 0.001 , η(2 ) = 0.033 ) , anxiety ( F = 33.194 , p < 0.001 , η(2 ) = 0.125 ) , depression ( F = 24.604 , p < 0.001 , η(2 ) = 0.096 ) , and fatigue knowledge ( F = 55.157 , p < 0.001 , η(2 ) = 0.192 ) . CONCLUSION The program was effective in reducing perceived fatigue as well as further outcomes . PRACTICE IMPLICATION S This newly developed education program has the potential to fill a gap in the care of cancer survivors . The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group Background The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries , but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions . While most workers are eligible for job accommodation and disability compensation benefits , other workplace strategies might improve individual-level coping and problem solving to prevent work disability . In this study , we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders . Methods In a r and omized controlled trial ( RCT ) , workers participating in an employer-sponsored self-management group intervention  will be compared with a no-treatment ( wait list ) control condition .  Volunteer employees ( n = 300 ) will be recruited from five participating employers and r and omly assigned to intervention or control . Participants in the intervention arm will attend facilitated group workshop sessions at work ( 10 hours total ) to explore methods for improving comfort , adjusting work habits , communicating needs effectively , applying systematic problem solving , and dealing with negative thoughts and emotions about work . Work engagement and work limitation are the principal outcomes . Secondary outcomes include fatigue , job satisfaction , self-efficacy , turnover intention , sickness absence , and health care utilization . Measurements will be taken at baseline , 6- , and 12-month follow-up . A process evaluation will be performed alongside the r and omized trial . Discussion This study will be most relevant for organizations and occupational setting s where some degree of job flexibility , leeway , and decision-making autonomy can be afforded to affected workers . The study design will provide initial assessment of a novel workplace approach and to underst and factors affecting its feasibility and effectiveness . Trial registration Clinical trials.gov : NCT01978392 ( Issued November 6 , 2013 OBJECTIVE Chronic fatigue syndrome is a profoundly disabling condition characterized by severe , unrelenting fatigue and a number of other physical and cognitive symptoms . Currently , there is no cure or widely accepted treatment for chronic fatigue syndrome , and few rehabilitation programs exist to address quality of life issues in chronic fatigue syndrome . In the present r and omized clinical trial , the effects of an integrative , consumer-driven rehabilitation program on quality of life and symptom severity for individuals with chronic fatigue syndrome were examined . METHOD Forty-seven participants were r and omly assigned to either an immediate program group ( n = 23 ) or a delayed program control group ( n = 24 ) and assessed with the Chronic Fatigue Syndrome Symptom Rating Scale and the Quality of Life Index before the program , after program participants completed the group phase , and after program participants completed the one-on-one phase . It was hypothesized that the program would lead to improvements in quality of life and an overall reduction in symptom severity . RESULTS Linear growth models were estimated comparing program and control conditions over time using r and om-effects regression analyses . Significant condition by time interactions were observed for the main outcomes of symptom severity and overall quality of life . Effect sizes for these interactions involving symptom severity ( Cohen 's d = 0.71 ) and overall quality of life ( Cohen 's d = .66 ) were moderate . CONCLUSIONS Findings indicate that consumer driven programs such as this one can have a positive impact on symptom severity and quality of life over time for individuals with chronic fatigue syndrome Chronic fatigue syndrome ( CFS ) produces physical and neurocognitive disability that significantly affects health-related quality of life ( HRQL ) .  Multidisciplinary treatment combining grade d exercise therapy ( GET ) cognitive behavioural therapy ( CBT ) and pharmacological treatment has shown only short-term improvements . To compare the effects on HRQL of ( 1 ) multidisciplinary treatment combining CBT , GET , and pharmacological treatment , and ( 2 ) usual treatment ( exercise counselling and pharmacological treatment ) at 12 months of follow-up . Prospect i ve , r and omized controlled trial with a follow-up of 12 months after the end of treatment . Patients consecutively diagnosed with CFS ( Fukuda criteria ) were r and omly assigned to intervention ( n = 60 ) or usual treatment ( n = 60 ) groups . HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form question naire ( SF-36 ) . Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Question naire ( HAQ ) and comorbidities . At baseline , the two groups were similar , except for lower SF-36 emotional role scores in the intervention group . At 12 months , the intervention did not improve HRQL scores , with worse SF-36 physical function and bodily pain scores in the intervention group . Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL . The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis BACKGROUND Disability is a defining feature of chronic conditions , and it is an increasingly used measure of therapy effectiveness . The  Work and Social Adjustment Scale ( WSAS )  is a simple and clear measure of disability . Although the scale is widely used , no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome ( CFS ) . METHODS Data from two sample s of patients were used , one from a multicenter r and omized controlled clinical trial of treatments for CFS ( n = 639 ) and the other from a clinic that specializes in CFS ( n=384 ) . All patients completed the WSAS as well as other measures . RESULTS Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable . CFS patients who had comorbid diagnoses of depression , anxiety or fibromyalgia had higher WSAS scores . High levels of disability were associated with high number of physical symptoms , severe fatigue , depression , anxiety , poor sleep quality and poor physical fitness , with correlation coefficients ranging between 0.41 and 0.11 . Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test . Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy .  Disability significantly decreased after therapy and remained stable at follow-ups . CONCLUSION The WSAS is a reliable and valid assessment tool for disability in patients with CFS Abstract Objective : To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome . Design : R and omised controlled trial with final assessment at 12 months . Setting : An infectious diseases outpatient clinic . Subjects : 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome . Interventions : Medical care comprised assessment , advice , and follow up in general practice . Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care . Main outcome measures : The proportions of patients ( a ) who achieved normal daily functioning ( Karnofsky score 80 or more ) and ( b ) who achieved a clinical ly significant improvement in functioning ( change in Karnofsky score 10 points or more ) by 12 months after r and omisation . Results : Only two eligible patients refused to participate . All r and omised patients completed treatment . An intention to treat analysis showed that 73 % ( 22/30 ) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27 % ( 8/30 ) of patients who were given only medical care ( difference 47 percentage points ; 95 % confidence interval 24 to 69 ) . Similar differences were observed in subsidiary outcome measures . The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy . Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone . Conclusion : Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment . Key messages Key messages There is no generally accepted form of treatment New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue
Rehabilitation programs that promote physiotherapy techniques such as exercise , mobilization , and body awareness ( e.g. , MRT and GET ) are the most effective in reducing medium and long-term fatigue severity in CFS patients
OBJECTIVE The objectives of this work were to fill the gap in the scientific literature and to evaluate the results of physical therapy treatments  in individuals affected by chronic fatigue syndrome , considering only studies that employed a r and omized controlled trial .