Introduction
MS-related fatigue, fatigue
Severe fatigue is a highly prevalent and burdensome symptom in people with multiple sclerosis (MS).Cognitive behavioural therapy (CBT) for MS-related fatigue aims to decrease fatigue by changing fatigue-related behaviours and beliefs.E-health interventions decrease travelling for patients to the outpatient clinic and allow patients to follow CBT in their own time and pace. This may be attractive considering the nature of the condition. Blended CBT, consisting of online treatment modules and face-to-face consultations with a psychologist, has been proven effective in TREating FAtigue in MS (TREFAMS) and other chronic conditions.Thus far, effectiveness of blended CBT in reducing fatigue has not directly been compared to face-to-face CBT. The aim of this study was to determine whether blended CBT is non-inferior with respect to its effect on fatigue severity compared with face-to-face CBT in severely fatigued patients with MS. Furthermore, it was investigated whether blended CBT required less therapist time compared to face-to-face CBT and whether treatment is more effective when applied in the format congruent with the preference of the patient.