Daffodil International University
Faculty of Engineering => EEE => Topic started by: Ahmed Anas Chowdhury on April 22, 2017, 03:12:20 PM
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Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.
These groups advocate exercise pacing and specialist medical care, according to the investigators.
To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.
Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.
More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.
At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:
Cognitive behavioral therapy, 59 percent
Graded exercise therapy, 61 percent
Adaptive pacing therapy, 42 percent
Specialist medical care, 45 percent
The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:
Cognitive behavioral therapy, 30 percent
Graded exercise therapy, 28 percent
Adaptive pacing therapy, 16 percent
Specialist medical care, 15 percent
Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.
Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.
White's group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.
They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.