title: Implementing evidence-based practice for patients with chronic fatigue syndrome.
abstract: The aim of our study was to explore whether community-based mental health care centres (MHCs) are able to implement and sustain cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) with the help of an implementation manual. We monitored the implementation process and treatment outcome data of three Dutch MHCs that implemented or sustained CBT for CFS, one in the context of a stepped care programme. We compared these data with findings of other treatment studies conducted in the context of CBT for CFS. All three MHCs included at least 40 patients with dropout rates between 15% and 35% from intention-to-treat to second assessment. Effect sizes ranged between 0.88 and 1.76 for changes in fatigue severity and 0.43 and 1.23 for changes in physical functioning. With one exception, these outcomes were within the range of our benchmark. Contrary to original expectations, we provided additional implementation support to the two MHCs new with CBT for CFS. We concluded that our implementation manual does not seem to substitute external support for team leaders and associated professions during initial implementation of CBT for CFS but may have the potential to make this assistance more efficient. Particular attention should be paid to challenges of implementing stepped care for CFS.
  
  
  CONCLUSIONS
  Implementation of CBT for CFS in community-based MHCs was monitored. External support was provided in addition to an implementation manual during initial implementation of CBT for CFS. Participating MHCs were generally capable of successfully implementing and delivering CBT for CFS. Implementation of low-intensity interventions for CFS might better be postponed until therapists have sufficient experience with conventional CBT for CFS.
authors.affiliation: Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Wiborg
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Marcia
authors.initials: M
authors.lastname: Tummers
authors.forename: Hans
authors.initials: H
authors.lastname: Knoop
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003153:Community Health Services / Q000379:methods; D055317:Evidence-Based Practice / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000523:psychology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008605:Mental Health Services; D009426:Netherlands; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome