FATIGUE Trial: GET vs Counselling vs Booklet on CBT for chronic fatigue

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Given that the Oxford criteria is used for many such trials in the UK, the cohort may not be that different.

SAPC annual conference 2010 abstracts
7-9 July 2010, University of East Anglia

P033
Effectiveness of counselling, graded exercise and a booklet plus usual care for people with chronic fatigue in primary care: a randomised trial

Presenter: Leone Ridsdale
Coauthors M King, M Hurley, N Donaldson

Introduction

The research aimed to evaluate the effectiveness of Graded Exercise Therapy (GET), Counselling (COUNS) and a Booklet on CBT plus usual care (BUC) for people presenting with chronic fatigue.

Methods

A randomized controlled trial in South East England recruited patients who presented to the GP for fatigue of at least 3 months, and evaluated fatigue as a main outcome using the Chalder scale at baseline, 6 months and 1 year.

Outcomes included anxiety, depression and satisfaction measures.

Results

222 people were recruited.

Reduction in the mean Fatigue scale

at six months was 8.6 (95% c.i. 6.6 to 10.5) for BUC, 10.1 (95% c.i. 7.5 to 12.9) for GET and 8.6 (95% c.i. 6.4 to 10.8) for COUNS,

and

at one year was 10.2 (95% c.i. 8.3 to 12) for BUC, 10.7 (95% c.i. 8.6 to 12.8) for GET and 9.2 (95% c.i. 7.2 to 11.2 ) for COUNS.

There were no significant difference between the groups for main fatigue and other outcomes including anxiety and depression.

Patient satisfaction was greater in GET and COUNS groups.

Conclusions

Fatigue symptoms tend to remit over time.

One year after presentation, a CBT booklet plus usual care is associated with similarly reduced symptoms as active therapies, but the latter satisfies patients more.

(I've given each sentence its own paragraph)
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Background
(from: http://www.iop.kcl.ac.uk/departments/?locator=1029)

A Randomised Trial to Compare the Effect of Graded Exercise and Counselling With Usual Care Plus a Booklet for Patients With Fatigue in Primary Care




Purpose of the Study

General practitioners report a large number of patients approaching them describing symptoms of prolonged and unexplained fatigue.
Symptoms can range in severity from recently feeling tired for most of the time (chronic fatigue) up to fatigue of more than 6 months duration which is worsened by physical exertion and is coupled with some of the following: muscle aches, sleep disruption, poor concentration, forgetfulness, mood swings, enlarged glands, sore throat, a higher temperature, anxiety/depression, loss of appetite, nausea and feeling faint/dizzy (and thus warranting a diagnosis of Chronic Fatigue Syndrome CFS). Chronic Fatigue often starts after a period of illness (virus/infection) and has been linked to glandular fever.

Chronic fatigue and CFS (also called ME Myalgic Encephalomyelitis) has been shown to respond to certain types of intervention, namely Cognitive Behaviour Therapy (CBT), counselling and Graded Exercise Therapy (GET) (Ridsdale et al, 2001; Whiting et al, 2001). The CBT & GET treatments were most effective for the CFS group when given for longer periods (13 sessions) instead of shorter periods (6 sessions).
CBT has also proved effective when given in a booklet form after an interview with a nurse (Chalder et al, 1997).



Considering these outcomes, it was of interest to see how a comparison of treatment conditions of GET, counselling and regular GP care plus a CBT booklet influenced the fatigue outcome of patients randomised to one of those treatments (see Trial Protocol
http://www.iop.kcl.ac.uk/departments/?locator=1029&context=1102 ), following a G.P referral for unexplained fatigue of over 3 months duration (see referral guidelines for GPs
http://www.iop.kcl.ac.uk/departments/?locator=1029&context=1101 ).
Level of fatigue was measured at the start, at post treatment (6
months) and one year from the start using a questionnaire format.

Principal Investigator: Dr Leone Ridsdale

Research Worker: Dr Elizabeth Shephard.

This study is funded by the Wellcome Trust http://www.wellcome.ac.uk/

Fatigue study updated figures for May 2008 http://www.iop.kcl.ac.uk/iopweb/blob/downloads/locator/l_1029_May08_flowchart_update.doc

Downloads:
Referral Form http://www.iop.kcl.ac.uk/iopweb/blob/downloads/locator/l_1029_referralform.pdf
Patient Info Sheet
http://www.iop.kcl.ac.uk/iopweb/blob/downloads/locator/l_1029_patientinfosheet.pdf

 

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Current diagnostic criteria, diagnosis by elimination, deliberately widens the net for inclusion it firstly makes you believe that by eliminating known diagnosable conditions, you are lessening the pool population however, by using the psychiatric description model of CFS symptoms, the pool becomes so large (as it is currently estimated that 25% of the population has a mental condition with many reporting fatigue) that real cases of ME enrolled in research will be so diluted in a trial, that they will be an insignificant minority.

Is it strange that the psychiatry school do NOT want to look at the aetiology, the search for a triggering agent, the Holy Grail, is a nonsense They want to look at treatments that prior to any results, they already know they will get some positive results from the majority population that only have a mental illness causing their fatigue, this is also why they ignore ME patient reports that the fatigue they experience is not fatigue it is more than that so much more.

As real ME patients trial results are lost in the statistical analysis in the findings of researchers, no wonder the psychiatrists want to keep the current thinking alive they do not want research to find the answer to the puzzle that is ME.

To keep science from finding the cause, they have to perpetuate the current confusion that is the Oxford Criteria, the CDC criteria, Fakuda criteria, the London criteria and even the Canadian Criteria as far as the psychiatrists go, the more the merrier. As further indication of this, how many illnesses have this many labels;

ME
ME/CFS
CFS/ME
Myalgic encephalomyelitis
Myalgic encelopathy
CFS
Post Viral Fatigue Syndrome
Chronic Fatigue Post Viral syndrome
Chronic Fatigue
CFIDS (chronic fatigue immune deficiency syndrome)
Somatisation disorder
Neurathanesia
Hysteria
GWS (Gulf War Syndrome)
Fibromyalgia

This list will no doubt grow.

This is evidence of the continued plan of using orchestrated manufactured confusion.

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