Article: Home-based pragmatic rehabilitation - effects were not sustained at 1 year


Senior Member
Evid Based Nurs. 2010 Jul 28. [Epub ahead of print]
Nurse-delivered, home-based pragmatic rehabilitation has a short-term effect on improving fatigue in people with chronic fatigue syndrome compared with usual GP care, but effects were not sustained at 1 year.

Armes J.

Results indicate that at the end of the pragmatic rehabilitation, there was a statistically significant small improvement in fatigue, sleep and depression, but not in physical functioning, when compared to treatment as usual. However, no statistically significant differences between the two groups were noted a year later, although there was a trend for improved fatigue. While no differences were found for fatigue between those allocated to supportive listening and treatment as usual, the former was associated with poorer physical functioning. Reported levels of fatigue and physical functioning were similar for the two groups at 1-year follow-up. The authors conclude that while pragmatic rehabilitation is effective in the short term, long-lasting benefits were not demonstrated.
I have concerns about the economic viability of pragmatic rehabilitation for CFS as it was delivered in this study, especially given the current economic situation. Each patient received 5 and a half hours therapy in their own home on five occasions, resulting, no doubt, in significant costs in terms of nurse traveling time. Visits were supplement by 5 half hour sessions delivered via the telephone. Combine this with time for clinical supervision and training, and it begins to look somewhat expensive. On the basis of this study, I would not recommend that clinicians rush to change their practice.
God bless them for trying and the honest evaluation is very much appreciated but maybe the problem is that the disease is organic in nature. All of the support in the world is only going to have a very minor effect and in the case of supportive listening, what we really benefit from is a good nap, not another appointment/obligation.