CBT for chronic fatigue syndrome: predictors of treatment outcome (Prins et al)

[Dolphin]

Free full text can be found in her PhD:

http://dare.ubn.kun.nl/handle/2066/19294
or
http://repository.ubn.ru.nl/handle/2066/19294

Cognitive behaviour therapy for chronic fatigue syndrome: predictors of treatment outcome.

Prins, J.B.; Bazelmans, E.; van der Werf, S.; van der Meer, J.W.M.; Bleijenberg, G.

International Congress Series vol. 1241 September, 2002. p. 131-135

Although cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) is effective in several RCTs, little is known about predictors of treatment outcome.

With the data of our RCT, where CBT for CFS was significantly more effective in improving fatigue severity and functional impairment than guided support groups and natural course, the predictive value of activity pattern, disability claims and psychiatric comorbidity was tested for outcome of CBT.

Patients with a passive activity pattern and patients who were engaged in a legal procedure concerning financial benefits had a worse outcome.

Psychiatric comorbidity was not a predictor.

For patients with a passive activity pattern, another type of CBT has to be offered. CBT should not be offered to patients during their engagement in legal procedures of disability claims.

Keywords: Cognitive behaviour therapy; Predictors; Randomised controlled trial
ISSN: 0531-5131.

 

[Dolphin]

These points are not very exciting - I just wanted to post them somewhere.
I have just realised that the main thing I thought that I had spotted is not true so this is even less interesting that I first planned to write!

Background:
This study looks at the data from the Prins et al CBT study that was published in the Lancet in 2001.
This was hyped as a great success. However Ellen Goudsmit & Bart Stouten found that data was presented in 2002 that showed there was no difference between the groups in terms of change in activity. However the Nijmegen chose not to publish this until the Wiborg et al paper in 2010!

"Clinical improvement in fatigue severity was defined as a reliable change index greater than >1.64and a score of <=36 indicating that the patient had moved to the range of a healthy individual"

(again I do not think this is likely to be a good threshold for a "healthy individual"). (Fatigue was measured by the fatigue subscale of the Checklist individual strength (CIS)).

Point of minor interest #1:
Anyway, it was interesting to see that none of those in the passive activity pattern improved following CBT! That's pretty dramatic give the lose definition. At follow-up 6 months later (14 months), 20% had reached the threshold. Looking at the original data, 13% in the support group and 17% in the natural course group (of the total group) were at that threshold at 14 months.

Point of minor interest #2:
The paper actually gives some data on all 270 people i.e. also those in the support group and in the natural course group. However when saying that the people who were loyal to the legal procedure to try to claim financial benefits did worse, which happened for both the overall groups and the CBT groups, they only give us the percentage "clinically improved" for the CBT group even though they give the Chi^2 and p-values for both straight after i.e. normally you would give the percentages for both but perhaps they were hiding them for some reason.

Point of minor interest #3:
They again say that recovery is the aim of CBT:

"Our conclusion was that CBT will not be offered a more capacious engaging in the claim during the time of the legal procedure. These patients have to prove that they are disabled in order to gain financial benefits. This is incompatible with recovery, the main goal of CBT"