title: Internet-based therapy for adolescents with chronic fatigue syndrome: long-term follow-up.
abstract: OBJECTIVE
  Cognitive behavioral therapy (CBT) is known to be an effective treatment of adolescents with chronic fatigue syndrome (CFS), but its availability is limited. Fatigue in Teenagers on the Internet (FITNET), an Internet-based CBT program for adolescents with CFS, has been developed as an alternative to face-to-face CBT. Recently, its short-term effectiveness has been proven in a randomized clinical trial. Here we aimed to assess the long-term outcome of CFS in adolescents after FITNET treatment and after usual care. In addition, factors related to recovery at long-term follow-up (LTFU) for adolescents treated with the FITNET program were investigated.
  
  
  METHODS
  The study was an LTFU of participants of the FITNET trial. Data were completed for 112 (88.2%) of 127 approached FITNET study participants. Primary outcomes were fatigue severity (Checklist Individual Strength-20), physical functioning (87-item Child Health Questionnaire), and school/work attendance.
  
  
  RESULTS
  After a mean follow-up of 2.7 years, 66 (58.9%) adolescents had recovered from CFS. Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU. At LTFU there was no difference between the recovery rates for the different treatment strategies (original randomization: FITNET [64%] versus any form of usual care [52.8%]). Per additional month of "pretreatment disease duration," the odds for recovery were 4% lower (odds ratio: 0.96; 95% confidence interval: 0.93-0.99; P = .016), and per added point on "focus on bodily symptoms" (Body Consciousness Scale) of the mother (0-20 points) the odds for recovery were 11% lower (odds ratio: 0.89; 95% confidence interval: 0.80-0.99; P = .029).
  
  
  CONCLUSIONS
  The short-term effectiveness of Internet-based CBT on adolescent CFS is maintained at LTFU. At LTFU, usual care led to similar recovery rates, although these rates were achieved at a slower pace.
authors.affiliation: Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands. s.l.nijhof@umcutrecht.nl
authors.forename: Sanne L
authors.initials: SL
authors.lastname: Nijhof
authors.forename: Loudy P
authors.initials: LP
authors.lastname: Priesterbach
authors.forename: Cuno S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
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; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: FITNET; Fatigue in Teenagers on the Internet; Internet; adolescents; chronic fatigue; cognitive behavioral therapy; follow-up; functioning; recovery