Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review.
OBJECTIVE
To determine whether any particular intervention or combination of interventions is effective in the treatment, management and rehabilitation of adults and children with a diagnosis of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME).


METHODS
Substantive update of a systematic review published in 2002. Randomized (RCTs) and non-randomized controlled trials of any intervention or combination of interventions were eligible for inclusion. Study participants could be adults or children with a diagnosis of CFS/ME based on any criteria. We searched eleven electronic databases, reference lists of articles and reviews, and textbooks on CFS/ME. Additional references were sought by contact with experts.


RESULTS
Seventy studies met the inclusion criteria. Studies on behavioural, immunological, pharmacological and complementary therapies, nutritional supplements and miscellaneous other interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs. For most other interventions, evidence of effectiveness was inconclusive and some interventions were associated with significant adverse effects.


CONCLUSIONS
Over the last five years, there has been a marked increase in the size and quality of the evidence base on interventions for CFS/ME. Some behavioural interventions have shown promising results in reducing the symptoms of CFS/ME and improving physical functioning. There is a need for research to define the characteristics of patients who would benefit from specific interventions and to develop clinically relevant objective outcome measures.
Chambers
Duncan
D
Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK. dc510@york.ac.uk
Bagnall
Anne-Marie
AM
Hempel
Susanne
S
Forbes
Carol
C
D000328:Adult; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D019587:Dietary Supplements; D015673:Fatigue Syndrome, Chronic / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic