Randomised Controlled Trial of Patient Education to Encourage Graded Exercise in Chronic Fatigue Syndrome.

Powell P, Bentall RP, Nye FJ, Edwards RH (Regional Infectious Diseases Unit, University Hospital, Aintree, Liverpool; Department of Psychology, University of Manchester, Manchester; Department of Medicine, University of Liverpool, Liverpool, United Kingdom), BMJ. 2001; 322:387-390.

This study sought to determine the efficacy of an intervention that explained the symptoms of chronic fatigue syndroxne and encouraged graded exercise in patients with this condition.

The authors examined 148 patients with chronic fatigue syndrome and randomly placed them into 1 of 4 groups. The control group (n=34; 24 women, 10 men; mean age=34 [+ or -] 10.5 years) received standard medical care, including a medical examination and a booklet that encouraged graded activity. Patients in all 3 intervention groups received a medical examination and 2 sessions totaling 3 hours that provided an explanation of the symptoms (focusing on circadian dysrhythmia, physical conditioning, and sleep disturbance) and an individualized exercise program. The minimum intervention group (n=37; 28 women, 9 men; mean age=34 [+ or -] 10.7 years) did not receive any further planned contact, the telephone intervention group (n=39; 33 women, 6 men; mean age = 32 [+ or -] 9.5 years) received 7 telephone follow-up sessions, and the maximum intervention group (n=38; 31 women, 7 men; mean age = 33 [+ or -] 10.7 years) received 7 one-hour face-to-face follow-up sessions.

The primary outcomes measurements were obtained using the physical functioning subscale of the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) (range=10-30, with 10 indicating maximal functional limitation and 30 indicating no limitation) and a fatigue scale (range=0-11, with scores greater than 3 indicating excessive fatigue). Secondary outcome measurements included scores on the Hospital Anxiety and Depression Scale, a 4-item questionnaire on sleep problems, and a global improvement scale. All data were collected by questionnaires given at enrollment in the study and at 3, 6, and 12 months.

Mean baseline scores on the SF-36 physical functioning subscale were: 16.3 for the control group, 16.0 for the minimum intervention group, 15.8 for the telephone intervention group, and 16.0 for the maximum intervention group. At 12 months, mean scores were 16.9 for the control group, 25.1 for the minimum intervention group, 24.3 for the telephone intervention group, and 24.9 for the maximum intervention group.

Mean baseline fatigue scale scores were: 10.6 for the control group, 10.4 for the minimum intervention group, 9.9 for the telephone group, and 10.2 for the maximum intervention group. At 12 months, mean scores were: 10.1 for the control group, 3.2 for the minimum intervention group, 3.5 for the telephone intervention group, and 3.1 for the maximum intervention group. For both measures, authors found a significant difference between the 12-month scores for the control group and the scores for all 3 intervention groups; however, no difference was noted among the intervention groups. Similar results were noted for all secondary measures.

The authors concluded that their interventions were more effective in improving the physical functioning, fatigue, mood, and sleep status of patients with chronic fatigue syndrome than standard medical care. They also concluded that the follow-up given in the telephone and maximum intervention group did not produce improvements that were greater than those seen in the minimum intervention group.

Todd A Forman, PT
Holliston, Mass