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    Larun, Lillebeth Brurberg, Kjetil G. Odgaard-Jensen, Jan Price, Jonathan R and Larun, Lillebeth 2016. Cochrane Database of Systematic Reviews.


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    Larun, Lillebeth Brurberg, Kjetil G. Odgaard-Jensen, Jan Price, Jonathan R and Larun, Lillebeth 2016. Cochrane Database of Systematic Reviews.


    Oh, Seung Min Bae, Woo Kyung Choo, Se Ryung Kim, Hee Tae Kim, Hyun Ho Lee, Sang Hyun and Jeong, Han Sol 2016. Relationship between Changes in Fatigue and Exercise by Follow-Up Period. Korean Journal of Family Medicine, Vol. 37, Issue. 2, p. 78.


    Marques, M.M. De Gucht, V. Gouveia, M.J. Leal, I. and Maes, S. 2015. Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis. Clinical Psychology Review, Vol. 40, p. 123.


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The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial

  • L. Ridsdale (a1), M. Hurley (a1), M. King (a2), P. McCrone (a1) and N. Donaldson (a3)
  • DOI: http://dx.doi.org/10.1017/S0033291712000256
  • Published online: 28 February 2012
Abstract
Background

To evaluate the effectiveness of graded exercise therapy (GET), counselling (COUNS) and usual care plus a cognitive behaviour therapy (CBT) booklet (BUC) for people presenting with chronic fatigue in primary care.

Method

A randomized controlled trial in general practice. The main outcome measure was the change in the Chalder fatigue score between baseline and 6 months. Secondary outcomes included a measure of global outcome, including anxiety and depression, functional impairment and satisfaction.

Results

The reduction in mean Chalder fatigue score at 6 months was 8.1 [95% confidence interval (CI) 6.6–10.4] for BUC, 10.1 (95% CI 7.5–12.6) for GET and 8.6 (95% CI 6.5–10.8) for COUNS. There were no significant differences in change scores between the three groups at the 6- or 12-month assessment. Dissatisfaction with care was high. In relation to the BUC group, the odds of dissatisfaction at the 12-month assessment were less for the GET [odds ratio (OR) 0.11, 95% CI 0.02–0.54, p=0.01] and COUNS groups (OR 0.13, 95% CI 0.03–0.53, p=0.004).

Conclusions

Our evidence suggests that fatigue presented to general practitioners (GPs) tends to remit over 6 months to a greater extent than found previously. Compared to BUC, those treated with graded exercise or counselling therapies were not significantly better with respect to the primary fatigue outcome, although they were less dissatisfied at 1 year. This evidence is generalizable nationally and internationally. We suggest that GPs ask patients to return at 6 months if their fatigue does not remit, when therapy options can be discussed further.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Address for correspondence: Dr L. Ridsdale, Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Academic Neuroscience Centre, PO41, De Crespigny Park, Denmark Hill Campus, London SE5 8AF, UK. (Email: leone.ridsdale@kcl.ac.uk)
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T Chalder , G Berelowitz , T Pawlikowska , L Watts , S Wessely , D Wright , EP Wallace (1993). Development of a fatigue scale. Journal of Psychosomatic Research 37, 147153.

T Chalder , P Wallace , S Wessely (1997). Self-help treatment of chronic fatigue in the community: a randomized controlled trial. British Journal of Health Psychology 2, 189197.

KY Fulcher , PD White (1997). Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. British Medical Journal 314, 16471652.

KY Fulcher , PD White (1998). Chronic fatigue syndrome: a description of graded exercise treatment. Physiotherapy 84, 223226.

E Godfrey , T Chalder , L Ridsdale , P Seed , J Ogden (2007). Investigating the active ingredients of cognitive behaviour therapy and counselling for patients with chronic fatigue in primary care: developing a new process measure to assess treatment fidelity and predict outcome. British Journal of Clinical Psychology 46, 253272.

I Hickie , T Davenport , SD Vernon , R Nisenbaum , WD Reeves , D Hadzi-Pavlovic , A Lloyd ; International Chronic Fatigue Syndrome Study Group (2009). Are chronic fatigue and chronic fatigue syndrome valid clinical entities across countries and healthcare settings? Australian and New Zealand Journal of Psychiatry 43, 2535.

L Quarmby , KA Rimes , A Deale , S Wessely , T Chalder (2007). Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial. Behaviour Research and Therapy 45, 10851094.


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AJ Wearden , C Dowrick , C Chew-Graham , RP Bentall , RK Morriss , S Peters , L Riste , G Richardson , K Lovell , G Dunn ; Fatigue Intervention by Nurses Evaluation (FINE) trial writing group and the FINE trial group (2010). Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 340, c1777.

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P Whiting , AM Bagnall , AJ Sowden , JE Cornell , CD Mulrow , G Ramirez (2001). Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. Journal of the American Medical Association 286, 13601368.

AS Zigmond , RP Snaith (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361370.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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