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Wait six months before treating fatigue, GPs told
By Rhiannon Smith | 08 Mar 2012
GPs should advise patients with chronic fatigue to wait and see if
their tiredness resolves itself with six months, recommend UK
researchers who looked at the time course of symptoms.
NICE guidelines currently advise treatment for chronic fatigue
syndrome after four months of symptoms, but this trial in 222 patients
found fatigue can =91improve substantially' within six months and should
be left alone.
The researchers studied patients reporting fatigue for over three
months to their GP, and randomised them to 'usual care' =96 providing a
booklet describing causes of fatigue and self-help techniques based on
cognitive behavioural therapy =96 or NICE-approved therapies such as
counselling and graded exercise.
They found fatigue symptoms in patients treated with graded exercise
therapy or counselling were no better during this time than those who
had been managed with usual care. Of the 222 participants, those who
were given the CBT booklet had a reduction in mean Chalder fatigue
score at six months of 8.1, compared with 10.1 for those using graded
exercise therapy and 8.6 for counselling.
A mixed multiple linear regression analysis showed that there was a
mean improvement in the Chalder fatigue score over time =96 of 9.2
between baseline and six months =96 regardless of which treatment group
patients were in. The improvement between six month and 12 month
follow-up was not significantly different between those receiving
usual care and those receiving either graded exercise therapy or
counselling.
In general, dissatisfaction with care was high. But there was no
significant difference between the three groups at six months - with
57.3% of the booklet group reporting that they were either very,
moderately or slightly dissatisfied, compared with 60.6% of the graded
exercise group and 61.8% of the counselling group. However, there was
a difference in dissatisfaction between groups at 12 months, with
those in the booklet group being more dissatisfied (65.3%, 52.1% and
54% respectively).
Study lead, Professor Leone Ridsdale, professor of neurology and
general practice at King's College London,said: =91Our findings suggest
that many patients improve substantially in the first six months.'
=91From the current evidence, we propose that after assessment of
patients who present with fatigue in primary care, doctors offer to
reassess them in six months. If fatigue symptoms persist, the
practitioner and patient may discuss further therapy options.'
-
Change in fatigue scores at six months
Usual care =96 8.1
Graded exercise therapy -10.1
Counselling -8.6
-
Psychological Medicine 2012, published online28 February
http://journals.cambridge.org/action/displayAbstract?fromPage=3Donline&aid=
=3D8501666
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