free. I am concerned the last three secondary outcome measures are not
going to be published: http://www.controlled-trials.com/ISRCTN72136156
. In particular, the paper even gives impression outcome measure #5
was only measured at baseline: "At baseline, self-reported rating
using the European Questionnaire measuring health-related quality of
life in five dimensions with UK weights attached (EQ-5D; Dolan et al.
1995) was measured, in addition to patient=92s preferences for treatment
and other characteristics, which were measured serially." The
"certified sickness absence" result in particular would be
interesting. TK]
------------------------
http://journals.cambridge.org/action/displayAbstract?fromPage=3Donline&aid=
=3D8501666
The effect of counselling, graded exercise and usual care for people
with chronic fatigue in primary care: a randomized trial
Psychological Medicine, FirstView Article : pp 1-8
L. Ridsdalea1 c1, M. Hurleya1, M. Kinga2, P. McCronea1 and N. Donaldsona3
a1 Department of Clinical Neuroscience, King's College London,
Institute of Psychiatry, Academic Neuroscience Centre, London, UK
a2 Royal Free and University College Hospital, London, UK
a3 King's College London Dental Institute, London, UK
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=9610.4] for BUC, 10.1 (95% CI
7.5=9612.6) for GET and 8.6 (95% CI 6.5=9610.8) 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=960.54, p=3D0.01] and COUNS groups (OR 0.13, 95% CI 0.03=960.53,
p=3D0.004).
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.
(Received May 10 2011)
(Revised January 25 2012)
(Accepted January 25 2012)
Key Words:
Chronic fatigue; counselling; graded exercise; primary care;
randomized trial; therapy
Correspondence:
c1 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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