title: No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy: Results of an RCT.
abstract: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).
  
  
  
  To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.
  
  
  
  We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.
  
  
  
  A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.
  
  
  
  Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands s.koopman@amc.uva.nl.
authors.forename: Fieke S
authors.initials: FS
authors.lastname: Koopman
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Voorn
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: de Visser
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Merel A
authors.initials: MA
authors.lastname: Brehm
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016262:Postpoliomyelitis Syndrome / Q000150:complications*; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
keywords: cognitive therapy; exercise therapy; fatigue; postpoliomyelitis syndrome; randomized controlled trial