which can be effective in help patients with any organic disease to
cope with their disease. Dr. Nancy Klimas notes that in this way ME
and CFS patients are no different than patients with other disaeses.
This also assumes the patient does not already have sufficient coping
skills. Many of the CBT trials to date have used varrious definitions
and results are difficult to extrapolate from one definition to
another.
In this trial, the authors do not specifically state in the abstract
whether disease severity is a reason why patients were unable to
travel to the hospital, nor do they note whether this reason might be
coorelated with those patients who dropped out of the therapy or
whether patient disatisfaction was a factor. Nor do they say how many
participants there were or how many dropped out.
The most important problem during the performance of the clinical
trial is the occurrence of the dropout. Measurements obtained before
the patient dropped out can be used to establish the unknown
measurement at the end of the study using a method called the
Last-Observation-Carried-Forward (LOCF) allowing for the analysis of
the data. However, recent research shows that this method gives a
biased estimate of the treatment effect and underestimates the
variability of the estimated result.
The key distinguishing feature of the usual RCT is that study
subjects, after assessment of eligibility and recruitment, but before
the intervention to be studied begins, are randomly allocated to
receive one or other of the alternative treatments under study. A
parallel-group RCT is one in which each participant is randomly
assigned to a group, and all the participants in the group receive (or
do not receive) an intervention. Blinding of participants is generally
used to eliminate bias.
Behav Cogn Psychother. 2011 Sep 20:1-17. [Epub ahead of print]
Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults:
Face to Face versus Telephone Treatment - A Randomized Controlled
Trial.
Burgess M, Andiappan M, Chalder T.
South London & Maudsley Trust, London, UK.
Abstract
Background: Previous research has shown that face to face cognitive
behaviour therapy (CBT) is an effective treatment for chronic fatigue
syndrome (CFS)/Myalgic Encephalomyelitis (ME). However, some patients
are unable to travel to the hospital for a number of reasons.
Aims: The aim of this study was to assess whether face to face CBT was
more effective than telephone CBT (with face to face assessment and
discharge appointment) for patients with CFS.
Method: Patients aged 18-65 were recruited from consecutive referrals
to the Chronic Fatigue Syndrome (CFS) Research and Treatment Unit at
The South London and Maudsley NHS Trust in London. Participants were
randomly allocated to either face to face CBT or telephone CBT by a
departmental administrator. Blinding of participants and care givers
was inappropriate for this trial.
A parallel-groups randomised controlled trial was used to compare the
two treatments.
The primary outcomes were physical functioning and fatigue.
Results: Significant improvements in the primary outcomes of physical
functioning and fatigue occurred and were maintained to one year
follow-up after discharge from treatment. Improvements in social
adjustment and global outcome were noted and patient satisfaction was
similar in both groups.
Conclusions: Results from this study indicate that telephone CBT with
two face to face appointments is a mild to moderately effective
treatment for CFS and may be offered to patients where face to face
treatment is not a viable option. Despite these encouraging
conclusions, dropout was relatively high and therapists should be
aware of this potential problem.
PMID: 21929831 [PubMed - as supplied by publisher]
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