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Rehabilitative therapies for chronic fatigue syndrome: A secondary mediation analysis of the PACE trial

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Rehabilitative therapies for chronic fatigue syndrome : A secondary mediation analysis of the PACE trial. / Chalder, Trudie; Goldsmith, Kimberley A.; White, Peter D.; Sharpe, Michael; Pickles, Andrew R.

In: The Lancet Psychiatry, Vol. 2, No. 2, 01.02.2015, p. 141-152.

Research output: Contribution to journalArticle

Harvard

Chalder, T, Goldsmith, KA, White, PD, Sharpe, M & Pickles, AR 2015, 'Rehabilitative therapies for chronic fatigue syndrome: A secondary mediation analysis of the PACE trial', The Lancet Psychiatry, vol. 2, no. 2, pp. 141-152. https://doi.org/10.1016/S2215-0366(14)00069-8

APA

Chalder, T., Goldsmith, K. A., White, P. D., Sharpe, M., & Pickles, A. R. (2015). Rehabilitative therapies for chronic fatigue syndrome: A secondary mediation analysis of the PACE trial. The Lancet Psychiatry, 2(2), 141-152. https://doi.org/10.1016/S2215-0366(14)00069-8

Vancouver

Chalder T, Goldsmith KA, White PD, Sharpe M, Pickles AR. Rehabilitative therapies for chronic fatigue syndrome: A secondary mediation analysis of the PACE trial. The Lancet Psychiatry. 2015 Feb 1;2(2):141-152. https://doi.org/10.1016/S2215-0366(14)00069-8

Author

Chalder, Trudie ; Goldsmith, Kimberley A. ; White, Peter D. ; Sharpe, Michael ; Pickles, Andrew R. / Rehabilitative therapies for chronic fatigue syndrome : A secondary mediation analysis of the PACE trial. In: The Lancet Psychiatry. 2015 ; Vol. 2, No. 2. pp. 141-152.

Bibtex Download

@article{2981bb5e780143ca98fefd507f9ac868,
title = "Rehabilitative therapies for chronic fatigue syndrome: A secondary mediation analysis of the PACE trial",
abstract = "Background: Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms. Methods: We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator-outcome relations by treatment group. Findings: The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue -1.22, 95% CI -0.52 to -1.97, physical function 1.54, 0.86 to 2.31; GET vs APT, fatigue -1.86, -0.80 to -2.89, physical function 2.35, 1.35 to 3.39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue -1.37, 95% CI -0.76 to -2.21, physical function 1.90, 1.10 to 2.91), but not CBT. Interpretation: Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome. Funding: UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King's College London.",
author = "Trudie Chalder and Goldsmith, {Kimberley A.} and White, {Peter D.} and Michael Sharpe and Pickles, {Andrew R.}",
year = "2015",
month = feb,
day = "1",
doi = "10.1016/S2215-0366(14)00069-8",
language = "English",
volume = "2",
pages = "141--152",
journal = "The Lancet Psychiatry",
issn = "2215-0366",
publisher = "Elsevier",
number = "2",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Rehabilitative therapies for chronic fatigue syndrome

T2 - A secondary mediation analysis of the PACE trial

AU - Chalder, Trudie

AU - Goldsmith, Kimberley A.

AU - White, Peter D.

AU - Sharpe, Michael

AU - Pickles, Andrew R.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms. Methods: We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator-outcome relations by treatment group. Findings: The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue -1.22, 95% CI -0.52 to -1.97, physical function 1.54, 0.86 to 2.31; GET vs APT, fatigue -1.86, -0.80 to -2.89, physical function 2.35, 1.35 to 3.39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue -1.37, 95% CI -0.76 to -2.21, physical function 1.90, 1.10 to 2.91), but not CBT. Interpretation: Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome. Funding: UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King's College London.

AB - Background: Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms. Methods: We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator-outcome relations by treatment group. Findings: The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue -1.22, 95% CI -0.52 to -1.97, physical function 1.54, 0.86 to 2.31; GET vs APT, fatigue -1.86, -0.80 to -2.89, physical function 2.35, 1.35 to 3.39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue -1.37, 95% CI -0.76 to -2.21, physical function 1.90, 1.10 to 2.91), but not CBT. Interpretation: Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome. Funding: UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King's College London.

UR - http://www.scopus.com/inward/record.url?scp=84922794350&partnerID=8YFLogxK

U2 - 10.1016/S2215-0366(14)00069-8

DO - 10.1016/S2215-0366(14)00069-8

M3 - Article

AN - SCOPUS:84922794350

VL - 2

SP - 141

EP - 152

JO - The Lancet Psychiatry

JF - The Lancet Psychiatry

SN - 2215-0366

IS - 2

ER -

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