Medically-unexplained fatigue states are prevalent and often disabling in the general population. These include chronic fatigue syndrome (CFS) and post-cancer fatigue (PCF). These syndromes are characterised by debilitating fatigue, neurocognitive difficulties, muscle pain as well as sleep -wake cycle and mood disturbance. A growing evidence base suggests that a multi-disciplinary intervention incorporating cognitive -behavioural therapy (CBT), activity pacing, and graded exercise therapy (GET) provides the most promising current treatment for reducing symptoms and improving functional status.
155 patients with CFS or PCF provided informed written consent and were recruited into the fatigue clinic outcome study. Patients completed the 12 -week intervention which involved sessions with clinical psychologists and exercise physiologists. Modules of treatment included CBT for CFS/PCF, activity pacing, GET, sleep-wake cycle and neurocognitive intervention (cognitive exercise). Additionally, subjects received treatment for depression, anxiety, and adjustment as required. Data was collected via routine outcome measures at baseline, 12 -weeks, and 24 -weeks.
Subjects included 106 women (68%) and 49 (32%) men, with a mean age of 36 years, a mean duration of illness of 5.2 years, and the majority unable to work. Both by intention-to-treat and complete dataset analyses, significant improvements were recorded at 12 and 24 weeks in self -reported fatigue (p<0.05) and role limitation due to impairments in physical functioning (p<0.05). Self -reported psychological distress was also reduced (p<0.05). Logistic regression showed that older age and higher levels of pain were negative predictors of treatment response.
This modularized, multi-disciplinary approach based on CBT and GET principles is effective in reducing symptoms and improving functional status amongst patients with fatigue syndromes. Ongoing research will focus on identifying predictors of outcome including examining the effect of motivation on treatment response.
