Bob
Senior Member
- Messages
- 16,455
- Location
- England (south coast)
Cognitive behaviour therapy for chronic fatigue syndrome in adults.
Jonathan R Price, Edward Mitchell, Elizabeth Tidy, Vivien Hunot
Published Online: 15 APR 2009
DOI: 10.1002/14651858.CD001027.pub2
Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027.
Publication status and date: Edited (no change to conclusions), published in Issue 2, 2009.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001027.pub2/abstract
Summary of main conclusions (based on subjective measures):
Fatigue severity. CBT vs usual care. Post treatment.
Post treatment, the Standard Mean Difference, between CBT and usual care, was -0.39, in favour of CBT.
Five traditional CBT studies and one mindfulness/compassion-focused CBT study (373 participants in total) contributed to this outcome. The difference in fatigue mean scores between the CBT group and usual care group was highly significant in favour of the CBT group (SMD -0.39, 95% CI -.0.60 to -0.19). No statistical heterogeneity was indicated.
Clinical response rate. CBT vs usual care. Post treatment.
Post treatment, an extra 14% of patients responded to CBT, compared to usual care, when using subjective measures.
Four studies (371 participants) contributed to this outcome. A total of 40% of participants in the CBT group showed clinical response to treatment, in contrast with 26% in the treatment as usual care group. The difference between the two groups was highly significant (OR 0.47, 95% CI 0.29 to 0.76). No statistical heterogeneity was indicated.
Follow up.
"Findings at follow-up were inconsistent."
"Findings at follow-up were heterogeneous and inconsistent."
"At follow-up, 1-7 months after treatment ended, people who had completed their course of CBT continued to have lower fatigue levels, but when including people who had dropped out of treatment, there was no difference between CBT and usual care"
CBT vs other psychological therapies.
There's also a comparison of "CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20)."
However, "At short term follow-up, the difference between CBT and other psychological therapies was inconsistent, and statistical heterogeneity was indicated."
Interesting secondary outcomes ('No significant differences'):
1) Improvement in physical functioning. Post treatment.
Three traditional CBT studies and one mindfulness/compassion-focused CBT study (318 participants in total) contributed to this outcome. Measures used to assess physical functioning comprised Karnofsky performance status scale (one study) and SF-36 physical functioning subscale (three studies). The difference in physical functioning mean scores between the CBT group and the usual care group was not significant (SMD 0.11, 95%CI -0.32 to 0.54). Significant heterogeneity was indicated (I2 = 68%) and a random effects model was used.
5) Improvement in quality of life. Post treatment.
One traditional CBT study (184 participants) contributed to this outcome. The measure used to assess improvement in quality of life comprised the Euro-Qol. The difference in QoL improvement rates between the CBT group and the usual care group was not significant (OR 1.19, 95%CI 0.58 to 2.46).
7) Adverse effects
No studies contributed to this outcome at post treatment or follow-up.
--------------------------------------------------------------------------------------------------------
Jonathan R Price, Edward Mitchell, Elizabeth Tidy, Vivien Hunot
Published Online: 15 APR 2009
DOI: 10.1002/14651858.CD001027.pub2
Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027.
Publication status and date: Edited (no change to conclusions), published in Issue 2, 2009.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001027.pub2/abstract
Summary of main conclusions (based on subjective measures):
Fatigue severity. CBT vs usual care. Post treatment.
Post treatment, the Standard Mean Difference, between CBT and usual care, was -0.39, in favour of CBT.
Five traditional CBT studies and one mindfulness/compassion-focused CBT study (373 participants in total) contributed to this outcome. The difference in fatigue mean scores between the CBT group and usual care group was highly significant in favour of the CBT group (SMD -0.39, 95% CI -.0.60 to -0.19). No statistical heterogeneity was indicated.
Clinical response rate. CBT vs usual care. Post treatment.
Post treatment, an extra 14% of patients responded to CBT, compared to usual care, when using subjective measures.
Four studies (371 participants) contributed to this outcome. A total of 40% of participants in the CBT group showed clinical response to treatment, in contrast with 26% in the treatment as usual care group. The difference between the two groups was highly significant (OR 0.47, 95% CI 0.29 to 0.76). No statistical heterogeneity was indicated.
Follow up.
"Findings at follow-up were inconsistent."
"Findings at follow-up were heterogeneous and inconsistent."
"At follow-up, 1-7 months after treatment ended, people who had completed their course of CBT continued to have lower fatigue levels, but when including people who had dropped out of treatment, there was no difference between CBT and usual care"
CBT vs other psychological therapies.
There's also a comparison of "CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20)."
However, "At short term follow-up, the difference between CBT and other psychological therapies was inconsistent, and statistical heterogeneity was indicated."
Interesting secondary outcomes ('No significant differences'):
1) Improvement in physical functioning. Post treatment.
Three traditional CBT studies and one mindfulness/compassion-focused CBT study (318 participants in total) contributed to this outcome. Measures used to assess physical functioning comprised Karnofsky performance status scale (one study) and SF-36 physical functioning subscale (three studies). The difference in physical functioning mean scores between the CBT group and the usual care group was not significant (SMD 0.11, 95%CI -0.32 to 0.54). Significant heterogeneity was indicated (I2 = 68%) and a random effects model was used.
5) Improvement in quality of life. Post treatment.
One traditional CBT study (184 participants) contributed to this outcome. The measure used to assess improvement in quality of life comprised the Euro-Qol. The difference in QoL improvement rates between the CBT group and the usual care group was not significant (OR 1.19, 95%CI 0.58 to 2.46).
7) Adverse effects
No studies contributed to this outcome at post treatment or follow-up.
--------------------------------------------------------------------------------------------------------
Last edited: