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Chronic Fatigue Self-Management in Primary Care: A Randomized Trial

Discussion in 'Latest ME/CFS Research' started by Bob, Aug 13, 2013.

  1. Bob

    Bob

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  2. Bob

    Bob

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    I haven't read the full paper, but judging only by the results in the abstract, the study seems to suggest that "fatigue self-management" (FSM) is at least as effective as CBT/GET were found to be in the PACE trial. And more effective by some measures. And it seems "fatigue self-management" would be significantly cheaper to implement than CBT/GET as it only involves a 'brief' intervention.

    But that's only judging by the abstract, so take it with a pinch of salt, until the methodology and analysis is scrutinised.

    I'm trying to find out what exactly "fatigue self-management" involves.

    Dr. Friedberg, lead author, is President of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME.)


    (Edited)
  3. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    Notice that is says "Chronic Fatigue", not "Chronic Fatigue Syndrome".
  4. Valentijn

    Valentijn Activity Level: 3

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    The first sentence of the abstract says this:
    So basically they're equating CF with CFS.
  5. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    So basically this is useless.
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  6. Bob

    Bob

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    Actually, I think they've used the term 'chronic fatigue' to refer to both unexplained chronic fatigue (UCF) and CFS. They just seem to have used an unhelpful sloppy short-hand for a 'catchy' title.

    Conclusion:
    "A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning."

    But, I agree, 'Chronic Fatigue' isn't a helpful term, and neither is the name of the intervention: "fatigue self-management', which is suggestive that CFS patients simply suffer from ordinary fatigue.
    Min and Valentijn like this.
  7. Bob

    Bob

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    I'm trying to find out what exactly "fatigue self-management" involves.

    I haven't got access to the full paper, and I'm trying to understand the exact nature of "fatigue self-management" (FSM).
    I don't know much about Dr Friedberg (lead author of the study & president of the IACFS/ME), but I had always thought that he and the IACFS/ME were not supportive of the cognitive-behavioural model of CFS/ME.

    However, I think that "fatigue self-management" is actually based on CBT. I can't find exact details, but I've found some details about 'brief self-management', which I think might be the same or similar (my emphasis added):

    Looking at Dr Friedberg's "7 steps" plan for CFS & FM, which the following website describes as a 'treatment' for CFS & FM, I'm really not impressed with the way he associates emotional problems with CFS/ME symptoms:
    http://www.cfidsselfhelp.org/library/fred-friedberg%25E2%2580%2599s-seven-step-protocol-treating-cfs-fm

    Dr Friedberg is a psychologist, which is news to me:
    http://phoenixrising.me/interviews-...with-dr-fred-friedberg-by-cort-johnson-part-i
  8. Dolphin

    Dolphin Senior Member

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    For anyone interested, the full text can now be accessed for free at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785003/
    Bob likes this.
  9. Dolphin

    Dolphin Senior Member

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    The abstract doesn't point out that the intervention was not efficacious for the three secondary outcome measures either in the intention-to-treat or per-protocol analyses.

    The main results are in this Table: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785003/table/T2/.

    Friedberg Table 2 part 1.png

    Friedberg Table 2 part 2.png

    FSS is scored 1-7 (7 is worst). SF-36 PF 0-100 (100 is best and quite a lot of people in the general population score 100).
    Last edited: Sep 20, 2014
  10. Dolphin

    Dolphin Senior Member

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    14. is an interesting trial that doesn't get referred to much. An intervention that is based on pacing (COG) did a bit better than King's College London-type CBT (i.e. Chalder-/Wessely-type CBT).

    It's free at: http://www.cfids-cab.org/cfs-inform/CFStreatment/jason.etal07.pdf

    Here's a description of COG which Friedberg et al. said was a basis for this trial:

    Jason et al 2007 Table 1 part 1 larger.png

    Jason et al 2007 Table 1 part 2 larger.png
    Last edited: Sep 20, 2014
  11. Dolphin

    Dolphin Senior Member

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    Other information from Friedberg et al (2013) on the intervention:


  12. Dolphin

    Dolphin Senior Member

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    Looks like they intended to use two more objective measures but weren't able to collect sufficient data - disappointing:
    A study on the economic costs/benefits will be published separately.
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  13. Dolphin

    Dolphin Senior Member

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    39% had CFS (Fukuda et al.)

    ---

    ---

    I believe the following means that the UCF (non-CFS) group had lower fatigue scores across the study but there wasn't a difference in response between the UCF and CFS group (however in the per protocol analyses, the sample sizes are reduced reducing the power to find differences).

    Last edited: Sep 20, 2014
  14. Dolphin

    Dolphin Senior Member

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    They used blinded assessors:
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  15. Dolphin

    Dolphin Senior Member

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    Clinically significant change:
    Threshold doesn't seem to match: 5.57 - (2 * .94) = 3.65:

  16. Scarecrow

    Scarecrow Senior Member

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    Desperate disappointing from the president of IACFS/ME.
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