Hostname: page-component-6b989bf9dc-cvxtj Total loading time: 0 Render date: 2024-04-13T02:16:22.123Z Has data issue: false hasContentIssue false

Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care

Published online by Cambridge University Press:  14 January 2004

L. RIDSDALE
Affiliation:
Departments of Neurology and General Practice, Guy's, King's and St Thomas's School of Medicine, London
L. DARBISHIRE
Affiliation:
Departments of Neurology and General Practice, Guy's, King's and St Thomas's School of Medicine, London
P. T. SEED
Affiliation:
Departments of Neurology and General Practice, Guy's, King's and St Thomas's School of Medicine, London

Abstract

Background. Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet.

Method. This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated.

Results. In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI)=−25 to −15), with no significant difference between groups (mean difference=−1·3; CI=−3·9 to 1·3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS.

Conclusions. Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier ‘to sell’. Low recovery in the CFS subgroup suggests that brief treatment is too short.

Type
Research Article
Copyright
2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)