Chronic fatigue self-management in primary care: a randomized trial.
OBJECTIVE
To assess the efficacy of brief fatigue self-management (FSM) for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care.


METHODS
A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to two sessions of FSM, two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3 and 12 months after treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention to treat (multiple imputation) and also by per protocol.


RESULTS
A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group (p < .023) and the UC group (p < .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d = 0.46) and the UC group (d = 0.40). The per-protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12-month follow-up were high (42%-53%), perhaps attributable to the burden of monthly telephone calls to assess health care use.


CONCLUSIONS
A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning. Trial Registration clinicaltrials.gov Identifier: NCT00997451.
Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA. fred.friedberg@stonybrookmedicine.edu
Fred
F
Friedberg
Anthony
A
Napoli
Janna
J
Coronel
Jenna
J
Adamowicz
Viktoria
V
Seva
Indre
I
Caikauskaite
Man Chi
MC
Ngan
Jeremy
J
Chang
Hongdao
H
Meng
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D001288:Attention; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008499:Medical Records; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors
chronic fatigue syndrome; cognitive-behavior therapy; fatigue self-management; nurse-delivered intervention; primary care; unexplained chronic fatigue