Strengths and limitations
depression, fatigue, MS-related fatigue, somatic comorbidity
Conducting this multicentre RCT implicated training and supervising 26 psychologists in 14 hospitals and rehabilitation centres, which in itself led to simultaneous implementation of CBT for MS-related fatigue in a large part of the Netherlands and in an MS centre in Belgium. Even though treatment centres may vary in patient populations, and therapists may differ in their experience in providing (blended) CBT, treatment effects did not depend on treatment centre or therapist. Implementation of both forms of CBT seems to be possible irrespective of these factors.We have no data on cost-effectiveness of blended CBT compared to face-to-face CBT. Although blended CBT saves therapist time, there are costs of the access to and maintenance of the e-health platform. Costs may depend on the scale on which MS Fit can be applied within a treatment centre and whether the platform is used for other e-health programmes as well.A debatable consideration of this study is the choice of the non-inferiority margin, which may have been too liberal.This study included ambulatory patients (EDSS ⩽ 6) without severe somatic comorbidity and/or depression. Future research needs to confirm effectiveness of CBT for fatigue in wheelchair-bound patients.Results of this non-inferiority study are limited to fatigue severity directly post-treatment. However, patients were randomized again at the end of treatment, to either receiving a blended booster programme, or no booster programme, in order to test whether a booster is superior to improve long-term effects of CBT for fatigue. Results of this study will be presented separately.