that was published in BMC Neurology on February 19, 2011. It is common
for university researchers to rephrase and republish their own work,
tailoring it for different academic journals and newspaper articles,
to disseminate their work to the widest possible interested public,
however in general approximately half of the newly published research
should be new information. The 2011 BMC study indicated that a
follow-up assessment would be made after 12 months.
These authors defined CFS using the 1994 Fukuda criteria. This
criteria, unlike Carruthers et al 2011 ME criteria, does not make post
exertional malaise mandatory so it is unknown whether the teenagers in
the study actually have ME or PEM which is considered a cardinal
symptom. This study does not specify the type of fatigue experienced.
In the 2011 study the following predictors of response to treatment
and measures of processes of change were obtained by the primary
investigator (SN) both for adolescent and parent(s) Possible
predictors of response to treatment in adolescents are: (a) Depression
score (validated Dutch translation of the Child Depression Inventory,
CDI) [21,22], (b) Anxiety (Dutch translation of the Spielberger
State-Trait Anxiety Inventory for Children, STAIC) [23,24], (c) Number
and severity of other somatic symptoms measured by a validated Dutch
translation of the Children's Somatisation Inventory (CSI). Other
methods include the use of an actometer.
Psychosocial interventions, when appropriate, only address those
symptoms to the extent they are mediated by psychosocial overlays as
is the case in any disease.
This particular therapy also focuses on the role of the parent. The
study states possible parental predictors of response to treatment
are: (a) Parental fatigue (Checklist Individual Strength-20), (b)
Parental psychological distress measured by the Symptom Checklist
(SCL-90), (c) Parental focussing on bodily symptoms by the subscale
private body consciousness of the Body Consciousness Scale, (d)
EMBU-P, the parental version of the Egna Minnen Betr=E4ffende
Uppfostran, (e) parental causal attributions to the origin of CFS
(Causal Attribution List, CAL).
Another possible way of looking at it is whether ME and CFS have a
genetic component and may run in families in some subgroups. Parents
may be relying on biomedical research studies of ME and CFS in the
peer-reveiwed literature as well as individual history for their
causal attributions. The available research indicates that recovery in
children and adolescents may be more likely than in adults. It is
possible that some of the patients in this study would recover or
partially recover regardless of the treatment used making it more
difficult to attribute a specific treatment to the recovery of the
patient.
The Lancet, Early Online Publication, 1 March 2012
doi:10.1016/S0140-6736(12)60025-7Cite or Link Using DOI
Effectiveness of internet-based cognitive behavioural treatment for
adolescents with chronic fatigue syndrome (FITNET): a randomised
controlled trial
Dr Sanne L Nijhof MD a , Prof Gijs Bleijenberg PhD c, Cuno SPM
Uiterwaal PhD b, Prof Jan LL Kimpen PhD a, Elise M van de Putte PhD a
Summary
Background
Chronic fatigue syndrome is characterised by persistent fatigue and
severe disability. Cognitive behavioural therapy seems to be a
promising treatment, but its availability is restricted. We developed
Fatigue In Teenagers on the interNET (FITNET), the first dedicated
internet-based therapeutic program for adolescents with this disorder,
and compared its effectiveness with that of usual care.
Methods
Adolescents aged 12=9718 years with chronic fatigue syndrome were
assigned to FITNET or usual care in a 1:1 ratio at one tertiary
treatment centre in the Netherlands by use of a computer-generated
blocked randomisation allocation schedule. The study was open label.
Primary outcomes were school attendance, fatigue severity, and
physical functioning, and were assessed at 6 months with computerised
questionnaires. Analysis was by intention to treat. Thereafter, all
patients were offered FITNET if needed. This trial is registered,
number ISRCTN59878666.
Findings
68 of 135 adolescents were assigned to FITNET and 67 to usual care,
and 67 and 64, respectively, were analysed. FITNET was significantly
more effective than was usual care for all dichotomised primary
outcomes at 6 months=97full school attendance (50 [75%] vs 10 [16%],
relative risk 4=B78, 95% CI 2=B77=978=B79; p<0=B70001), absence of severe
fatigue (57 [85%] vs 17 [27%], 3=B72, 2=B71=974=B79; p<0=B70001), and norma=
l
physical functioning (52 [78%] vs 13 [20%], 3=B78, 2=B73=976=B73; p<0=B7000=
1).
No serious adverse events were reported.
Interpretation
FITNET offers a readily accessible and highly effective treatment for
adolescents with chronic fatigue syndrome. The results of this study
justify implementation on a broader scale.
Funding
Netherlands Organisation for Health Research and Development.
Further information on Fatigue In Teenagers on the interNET - The
FITNET Trial. A randomized clinical trial of web-based cognitive
behavioural therapy for adolescents with chronic fatigue syndrome:
study protocol. [ISRCTN59878666] can be found here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049137/?tool=3Dpubmed
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