Efficacy of two delivery modes of behavioral self-management in severe chronic fatigue syndrome

ABSTRACT

Purpose: To assess the efficacy of fatigue self-management for severe chronic fatigue syndrome (CFS).

Methods: This randomized trial enrolled 137 patients with severe CFS. Participants were randomized to one of three conditions: fatigue self-management with web diaries and actigraphs (FSM:ACT); fatigue self-management with less expensive paper diaries and pedometers (FSM:CTR); or an usual care control condition (UC). The primary outcome assessed fatigue severity at 3-month follow-up. Analysis was by intention-to-treat.

Results: At 3-month follow-up, the FSM:CTR condition showed significantly greater reduction in fatigue severity compared to UC (p = .03; d = .58). No significant improvement was found at 12-month follow-up for the FSM:ACT or the FSM:CTR condition as compared to UC (p > .10). The combined active treatment conditions revealed significantly reduced fatigue at 3-month follow-up (p = .03), but not at 12-month follow-up (p = .24) compared to UC. Clinically significant improvements were found for 24–28% of the intervention groups as compared to 9% of the UC group. Attrition at 12-month follow-up was low (< 8%).

Conclusion: Home-based self-management for severe CFS appeared to be less effective in comparison to findings reported for higher functioning groups. Home-based management may be enhanced by remotely delivered interventional feedback.

KEYWORDS:

• Fatigue self-management
• chronic fatigue syndrome
• unexplained chronic fatigue
• cognitive-behavior therapy
• home-based self-management

Acknowledgements

We wish to thank Dr Lucinda Bateman and Dr Charles Lapp for allowing our research group to advertise the study to their patients. We also wish to thank Joseph Schwartz, PhD for his assistance with the data analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The project described was supported by NIH [grant number 3R42NR010496] (National Institute of Nursing Research; PI: F. Friedberg).

Notes on contributors

Fred Friedberg

Fred Friedberg, PhD is research associate professor in the psychiatry department at Stony Brook University Health Sciences Center.

Jenna Adamowicz

Jenna Adamowicz, MA is research associates at Stony Brook University.

Indre Caikauskaite

Indre Caikauskaite, MA is research associates at Stony Brook University.

Viktoria Seva

Viktoria Seva, MA is a research assistant at Stony Brook University.

Anthony Napoli

Anthony Napoli, PhD is professor of psychology at Suffolk County Community College.