A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome

Tom Ingman; Abigail Smakowski; Kimberley Goldsmith; Trudie Chalder

doi:10.1017/S0033291722002471

A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome

Tom Ingman, Abigail Smakowski, Kimberley Goldsmith, Trudie Chalder

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

This systematic review investigated randomized controlled trials evaluating cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1990 participants. Following CBT, and at short-term to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8-26% more favorable compared to control conditions. Two-thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short-term to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002).

Original language	English
Pages (from-to)	2917-2929
Number of pages	13
Journal	Psychological medicine
Volume	52
Issue number	14
Early online date	5 Sept 2022
DOIs	https://doi.org/10.1017/S0033291722002471
Publication status	Published - 5 Oct 2022

Keywords

chronic fatigue syndrome
literature review
prognosis;
cognitive behavioral therapy
graded exercise therapy

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10.1017/S0033291722002471Licence: CC BY

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@article{bbffadaeb24f4ef48739c3fdbc036429,

title = "A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome",

abstract = "This systematic review investigated randomized controlled trials evaluating cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1990 participants. Following CBT, and at short-term to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8-26% more favorable compared to control conditions. Two-thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short-term to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002).",

keywords = "chronic fatigue syndrome, literature review, prognosis;, cognitive behavioral therapy, graded exercise therapy",

author = "Tom Ingman and Abigail Smakowski and Kimberley Goldsmith and Trudie Chalder",

note = "Funding Information: This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. KG from KCL is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King{\textquoteright}s College Hospital NHS Foundation Trust. The NIHR had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors thank Donna Ciliska, Lucy Clark, Marcia Tummers, Margreet Worm-Smeitink, Peter White, Richard Bentall, and Rona Moss-Morris for providing additional information about, and clarification regarding, studies in which they were involved. The authors also thank Kim Poole-White for her guidance and advise in drafting this manuscript. Funding Information: TC has received ad hoc payments for conducting workshops on evidence-based treatments for persistent physical symptoms, and expenses (i.e. travel and accommodation) for workshops delivered on behalf of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the Improved Access to Psychological Therapies (IAPT) service, which is part of the National Health Service (NHS) in the UK. TC has also received grants from the National Institute for Health Research (NIHR), the Health Technology Assessment (HTA) program, the Research for Patient Benefit (RfPB) program, Guy's and St Thomas Charity, the King's Challenge Fund, and is the author of several self-help books on chronic fatigue and has received royalties from these in the past. For other projects, KG has received grants from the National Institute for Health Research (NIHR), UK Research and Innovation (UKRI), the Juvenile Diabetes Foundation, the Stroke Association, and the National Institutes of Health (NIH). TC and KC are the authors of two studies included in this review (White et al., , ) and TC is the author of a further included study (Deale et al, ). All other authors declare that they have no conflicts of interest. Publisher Copyright: Copyright {\textcopyright} The Author(s), 2022. Published by Cambridge University Press.",

year = "2022",

month = oct,

day = "5",

doi = "10.1017/S0033291722002471",

language = "English",

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journal = "Psychological medicine",

issn = "0033-2917",

publisher = "Cambridge University Press (CUP)",

number = "14",

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T1 - A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome

AU - Ingman, Tom

AU - Smakowski, Abigail

AU - Goldsmith, Kimberley

AU - Chalder, Trudie

N1 - Funding Information: This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. KG from KCL is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The NIHR had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors thank Donna Ciliska, Lucy Clark, Marcia Tummers, Margreet Worm-Smeitink, Peter White, Richard Bentall, and Rona Moss-Morris for providing additional information about, and clarification regarding, studies in which they were involved. The authors also thank Kim Poole-White for her guidance and advise in drafting this manuscript. Funding Information: TC has received ad hoc payments for conducting workshops on evidence-based treatments for persistent physical symptoms, and expenses (i.e. travel and accommodation) for workshops delivered on behalf of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the Improved Access to Psychological Therapies (IAPT) service, which is part of the National Health Service (NHS) in the UK. TC has also received grants from the National Institute for Health Research (NIHR), the Health Technology Assessment (HTA) program, the Research for Patient Benefit (RfPB) program, Guy's and St Thomas Charity, the King's Challenge Fund, and is the author of several self-help books on chronic fatigue and has received royalties from these in the past. For other projects, KG has received grants from the National Institute for Health Research (NIHR), UK Research and Innovation (UKRI), the Juvenile Diabetes Foundation, the Stroke Association, and the National Institutes of Health (NIH). TC and KC are the authors of two studies included in this review (White et al., , ) and TC is the author of a further included study (Deale et al, ). All other authors declare that they have no conflicts of interest. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press.

PY - 2022/10/5

Y1 - 2022/10/5

N2 - This systematic review investigated randomized controlled trials evaluating cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1990 participants. Following CBT, and at short-term to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8-26% more favorable compared to control conditions. Two-thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short-term to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002).

AB - This systematic review investigated randomized controlled trials evaluating cognitive behavioral therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1990 participants. Following CBT, and at short-term to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8-26% more favorable compared to control conditions. Two-thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short-term to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002).

KW - chronic fatigue syndrome

KW - literature review

KW - prognosis;

KW - cognitive behavioral therapy

KW - graded exercise therapy

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DO - 10.1017/S0033291722002471

M3 - Article

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SP - 2917

EP - 2929

JO - Psychological medicine

JF - Psychological medicine

IS - 14

ER -

A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome

Abstract

Keywords

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