title: The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial.
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.
  
  
  METHODS
  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) 6.6-10.4] for BUC, 10.1 (95% CI 7.5-12.6) for GET and 8.6 (95% CI 6.5-10.8) 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 0.02-0.54, p=0.01] and COUNS groups (OR 0.13, 95% CI 0.03-0.53, p=0.004).
  
  
  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.
authors.affiliation: Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Academic Neuroscience Centre, London, UK. leone.ridsdale@kcl.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Ridsdale
authors.forename: M
authors.initials: M
authors.lastname: Hurley
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: P
authors.initials: P
authors.lastname: McCrone
authors.forename: N
authors.initials: N
authors.lastname: Donaldson
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome