Abstract
BackgroundChronic fatigue syndrome (CFS, also called myalgic encephalomyelitis/encephalopathy or ME) is a debilitating condition with no known cause or cure. Improvement may occur with medical care and additional therapies of pacing, cognitive behavioural therapy and graded exercise therapy. The latter two therapies have been found to be efficacious in small trials, but patient organisations' surveys have reported adverse effects. Although pacing has been advocated by patient organisations, it lacks empirical support. Specialist medical care is commonly provided but its efficacy when given alone is not established. This trial compares the efficacy of the additional therapies when added to specialist medical care against specialist medical care alone.Methods/Design600 patients, who meet operationalised diagnostic criteria for CFS, will be recruited from secondary care into a randomised trial of four treatments, stratified by current comorbid depressive episode and different CFS/ME criteria. The four treatments are standardised specialist medical care either given alone, or with adaptive pacing therapy or cognitive behaviour therapy or graded exercise therapy. Supplementary therapies will involve fourteen sessions over 23 weeks and a 'booster session' at 36 weeks. Outcome will be assessed at 12, 24, and 52 weeks after randomisation. Two primary outcomes of self-rated fatigue and physical function will assess differential effects of each treatment on these measures. Secondary outcomes include adverse events and reactions, subjective measures of symptoms, mood, sleep and function and objective measures of physical activity, fitness, cost-effectiveness and cost-utility. The primary analysis will be based on intention to treat and will use logistic regression models to compare treatments. Secondary outcomes will be analysed by repeated measures analysis of variance with a linear mixed model. All analyses will allow for stratification factors. Mediators and moderators will be explored using multiple linear and logistic regression techniques with interactive terms, with the sample split into two to allow validation of the initial models. Economic analyses will incorporate sensitivity measures.DiscussionThe results of the trial will provide information about the benefits and adverse effects of these treatments, their cost-effectiveness and cost-utility, the process of clinical improvement and the predictors of efficacy.
Highlights
Chronic fatigue syndrome (CFS, called myalgic encephalomyelitis/encephalopathy or Myalgic encephalomyelitis/encephalopathy (ME)) is a debilitating condition with no known cause or cure
Myalgic encephalomyelitis/encephalopathy (ME) refers to a severe debilitating illness thought by some to be a separate illness, but by others to be synonymous with chronic fatigue syndrome (CFS) [2,3,4,5,6]
The Chief Medical Officer (CMO)'s working group concluded; "Therapeutic strategies that can enable improvement include graded exercise/activity programmes, cognitive behaviour therapy, and pacing" [4]. This positive statement was balanced in the report by other statements: first the concern of patient organisations that graded exercise therapy (GET) may sometimes worsen symptoms and disability, and second that pacing, widely advocated by patients' organisations, is as yet unsupported by scientific evidence
Summary
Chronic fatigue syndrome (CFS, called myalgic encephalomyelitis/encephalopathy or ME) is a debilitating condition with no known cause or cure. Improvement may occur with medical care and additional therapies of pacing, cognitive behavioural therapy and graded exercise therapy The latter two therapies have been found to be efficacious in small trials, but patient organisations' surveys have reported adverse effects. The CMO's working group concluded; "Therapeutic strategies that can enable improvement include graded exercise/activity programmes, cognitive behaviour therapy, and pacing" [4]. This positive statement was balanced in the report by other statements: first the concern of patient organisations that graded exercise therapy (GET) may sometimes worsen symptoms and disability, and second that pacing, widely advocated by patients' organisations, is as yet unsupported by scientific evidence
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