title: Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial.
abstract: 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 12-18 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.
  
  
  RESULTS
  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-full school attendance (50 [75%] vs 10 [16%], relative risk 4·8, 95% CI 2·7-8·9; p<0·0001), absence of severe fatigue (57 [85%] vs 17 [27%], 3·2, 2·1-4·9; p<0·0001), and normal physical functioning (52 [78%] vs 13 [20%], 3·8, 2·3-6·3; p<0·0001). No serious adverse events were reported.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Netherlands Organisation for Health Research and Development.
authors.affiliation: Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands. s.l.nijhof@umcutrecht.nl
authors.forename: Sanne L
authors.initials: SL
authors.lastname: Nijhof
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
authors.forename: Cuno S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: Jan L L
authors.initials: JL
authors.lastname: Kimpen
authors.forename: Elise M
authors.initials: EM
authors.lastname: van de Putte
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D009426:Netherlands; D010349:Patient Compliance; D012016:Reference Values; D012720:Severity of Illness Index; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome