Outcomes and predictors of response from an optimised, multidisciplinary intervention for chronic fatigue states.
BACKGROUND
Medically unexplained chronic fatigue states are prevalent and challenging to manage. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are effective in clinical trials. The evaluation of delivery in a standard healthcare setting is rare. An integrated treatment programme with individualised allocation of resources to patients' needs was developed and implemented through an academic outpatient clinic. It was hypothesised that the programme would result in similar responses to those observed in the clinical trials.


OBJECTIVE
To evaluate the outcomes of an integrated, 12-week CBT and GET programme delivered by exercise physiologists and clinical psychologists.


METHODS
Consecutive eligible patients (n = 264) who met the diagnostic criteria for chronic fatigue syndrome or post-cancer fatigue were evaluated with self-report measures of fatigue, functional capacity and mood disturbance at baseline, end-of-treatment (12 weeks) and follow-up (24 weeks). A semi-structured interview recording the same parameters was conducted pre- and post-treatment by an independent clinician. Primary outcome was analysed by repeated measures analysis of variance and predictors of response were analysed by logistic regression.


RESULTS
The intervention produced sustained improvements in symptom severity and functional capacity. A substantial minority of patients (35%) gained significant improvement, with male gender and higher pain scores at baseline predicting non-response. A small minority of patients (3%) worsened.


CONCLUSIONS
The manualised protocol of integrated CBT and GET was successfully implemented, confirming the generally positive findings of clinical trials. Assessment and treatment protocols are available for dissemination to allow standardised management. The beneficial effects described here provide the basis for ongoing studies to optimise the intervention further and better identify those most likely to respond.
Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.|National Centre for Cancer Survivorship, University of New South Wales, Sydney, New South Wales, Australia.
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Sandler
Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
B A
BA
Hamilton
Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
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Horsfield
National Centre for Cancer Survivorship, University of New South Wales, Sydney, New South Wales, Australia.
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Bennett
Department of Human Behaviour, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
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Vollmer-Conna
Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
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Tzarimas
Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.|National Centre for Cancer Survivorship, University of New South Wales, Sydney, New South Wales, Australia.|Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
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Lloyd
D000328:Adult; D015928:Cognitive Behavioral Therapy; D003695:Delivery of Health Care; D003863:Depression / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D015397:Program Evaluation; D011788:Quality of Life; D057566:Self Report; D013001:Somatoform Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
chronic fatigue syndrome; cognitive behaviour therapy; exercise therapy; post-cancer fatigue