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Novedades SFC

sábado, 05 de julio de 2008

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Novedades SFC

ACTUALIDAD EN SÍNDROME DE FATIGA CRÓNICA

Cognitive behavioural therapy in chronic fatigue syndrome: a randomised
controlled trial of an outpatient group programme.

Journal: Health Technol Assess. 2006 Oct;10(37):1-140.

Authors: O'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A.

Affiliation: Pain Management Centre, Frenchay Hospital, Bristol, UK.

NLM Citation: PMID: 17014748

OBJECTIVES: To test the hypothesis that group cognitive behavioural therapy
(CBT) will produce an effective and cost-effective management strategy for
patients in primary care with chronic fatigue syndrome/myalgic
encephalopathy (CFS/ME).

DESIGN: A double-blind, randomised controlled trial was adopted with three
arms. Outcomes were assessed at baseline and 6 and 12 months after first
assessment and results were analysed on an intention-to-treat basis.

SETTING: A health psychology department for the management of chronic
illness in a general hospital in Bristol, UK. PARTICIPANTS: Adults with a
diagnosis of CFS/ME referred by their GP.

INTERVENTIONS: The three interventions were group CBT incorporating graded
activity scheduling, education and support group (EAS) and standard medical
care (SMC).

OUTCOME MEASURES: The primary outcome measure was the Short Form with 36
Items (SF-36) physical and mental health summary scales. Other outcome
measures included the Chalder fatigue scale, Hospital Anxiety and
Depression Scale, General Health Questionnaire, physical function (shuttles
walked, walking speed and perceived fatigue), health utilities index and
cognitive function (mood, recall and reaction times).

RESULTS: A total of 153 patients were recruited to the trial and 52 were
randomised to receive CBT, 50 to EAS and 51 to SMC. Twelve patients failed
to attend for the 12-month follow-up and 19 patients attended one
follow-up, but not both. The sample was found to be representative of the
patient group and the characteristics of the three groups were similar at
baseline. Three outcome measures, SF-36 mental health score, Chalder
fatigue scale and walking speed, showed statistically significant
differences between the groups. Patients in the CBT group had significantly
higher mental health scores [difference +4.35, 95% confidence interval (CI)
+0.72 to +7.97, p = 0.019], less fatigue (difference -2.61, 95% CI -4.92 to
-0.30, p = 0.027) and were able to walk faster (difference +2.83 shuttles,
95% CI +1.12 to +5.53, p = 0.0013) than patients in the SMC group. CBT
patients also walked faster and were less fatigued than those randomised to
EAS (walking speed: difference +1.77, 95% CI +0.025 to +3.51, p = 0.047;
fatigue: difference -3.16, 95% CI -5.59 to -0.74, p = 0.011). Overall, no
other statistically significant difference across the groups was found,
although for many measures a trend towards an improved outcome with CBT was
seen. Except for walking speed, which, on average, increased by +0.87
shuttles (95% CI +0.09 to +1.65, p = 0.029) between the 6- and 12-month
follow-ups, the scores were similar at 6 and 12 months. At baseline, 30% of
patients had an SF-36 physical score within the normal range and 52% had an
SF-36 mental health score in the normal range. At 12 months, the physical
score was in the normal range for 46% of the CBT group, 26% of the EAS
group and 44% of SMC patients. For mental health score the percentages were
CBT 74%, EAS 67% and SMC 70%. Of the CBT group, 32% showed at least a 15%
increase in physical function and 64% achieved a similar improvement in
their mental health. For the EAS and SMC groups, this improvement in
physical and mental health was achieved for 40 and 60% (EAS) and 49 and 53%
(SMC), respectively. The cost-effectiveness of the intervention proved very
difficult to assess and did not yield reliable conclusions.

CONCLUSIONS: Group CBT did not achieve the expected change in the primary
outcome measure as a significant number did not achieve scores within the
normal range post-intervention. The treatment did not return a significant
number of subjects to within the normal range on this domain; however,
significant improvements were evident in some areas. Group CBT was
effective in treating symptoms of fatigue, mood and physical fitness in
CFS/ME. It was found to be as effective as trials using individual therapy
in these domains. However, it did not bring about improvement in cognitive
function or quality of life. There was also evidence of improvement in the
EAS group, which indicates that there is limited value in the non-specific
effects of therapy. Further research is needed to develop better outcome
measures, assessments of the broader costs of the illness and a clearer
picture of the characteristics best fitted to this type of intervention.