- Jul 2018
-
europepmc.org europepmc.org
-
On 2013 Oct 27, Tom Kindlon commented:
"Recovery" (from fatigue) does not necessarily mean recovery from CFS (in terms, for example, of activity levels)
In this paper, some variant of the word "recovered" is used 12 times, generally to describe some of the Chronic Fatigue Syndrome (CFS) patients who had taken part in a cognitive behaviour therapy (CBT) trial for CFS[1].
Actometer data from this study has subsequently been released[2]. This paper reported that CBT did not cause an increase in physical activity at the end of treatment. Before CBT, the patients did a mean 67.4 units of activity (standard deviation(SD): 21.8); following CBT, patients did 68.8 units of activity (SD: 25.2). The authors report that a previous study [3] found healthy controls had a mean Actometer score of 91 (S.D.=25). There was also no increase in activity levels in two other CBT trials examined[4,5].
The authors[2] also found that in the three CBT studies, changes in physical activity were not related to changes in fatigue. So "recovery from fatigue" does not necessarily mean recovery from CFS in terms of achieving normal activity levels.
In another Dutch CBT study[6], 37% of patients were said to be recovered from fatigue, where recovery was defined as no longer scoring on any of the 3 negative factors of the Fatigue Quality List (FQL). However when low scores on other questionnaires were also required to fulfil "full recovery", only 23% of the sample were said to be in "full recovery". Note that only subjective measures were used in that definition of full recovery - a return to a normal level of activity, as measured by an actometer, was not required.
Incidentally, a paper was subsequently published which also examined language used to describe fatigue by CFS patients and healthy controls[7]. It is slightly different as phrases rather than adjectives were used to describe the fatigue e.g. "Mentally tired after the slightest effort", "Lack the energy to talk to anyone", etc. Factor analyses revealed a five-factor structure for participants with ME/CFS but only a one-factor solution for the control group. The five factors for fatigue in ME/CFS participants were described as: "Post-Exertional", "Wired", "Brain-Fog", "Energy" and "Flu-Like".
References:
[1] Prins JB, Bleijenberg G, Bazelmans E, Elving L, de Boo Th, Severens JL, van der Wilt GJ, Spinhoven Ph, van der Meer JWM: Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial. Lancet 2001, 357:841-847.
[2] Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Jan 5:1 -7. [Epub ahead of print]
[3] van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373–379.
[4] Knoop H, van der Meer JW, Bleijenberg G (2008). Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial. British Journal of Psychiatry 193, 340-341.
[5] Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G (2005). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 330. Published online : 7 December 2004. doi :10.1136/bmj.38301.587106.63.
[6] Knoop H, Bleijenberg G, Gielissen MFM, Van der Meer JWM, White PD: Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom 2007, 76:171-176.
[7] Jason, L.A., Jessen, T., Porter, N., Boulton, A., Njoku, M.G., & Friedberg, F. Examining types of fatigue among individuals with ME/CFS. Disability Studies Quarterly, 2009, 29, 3. Full text at: http://www.dsq-sds.org/article/view/938/1113
This comment, imported by Hypothesis from PubMed Commons, is licensed under CC BY.
-
- Feb 2018
-
europepmc.org europepmc.org
-
On 2013 Oct 27, Tom Kindlon commented:
"Recovery" (from fatigue) does not necessarily mean recovery from CFS (in terms, for example, of activity levels)
In this paper, some variant of the word "recovered" is used 12 times, generally to describe some of the Chronic Fatigue Syndrome (CFS) patients who had taken part in a cognitive behaviour therapy (CBT) trial for CFS[1].
Actometer data from this study has subsequently been released[2]. This paper reported that CBT did not cause an increase in physical activity at the end of treatment. Before CBT, the patients did a mean 67.4 units of activity (standard deviation(SD): 21.8); following CBT, patients did 68.8 units of activity (SD: 25.2). The authors report that a previous study [3] found healthy controls had a mean Actometer score of 91 (S.D.=25). There was also no increase in activity levels in two other CBT trials examined[4,5].
The authors[2] also found that in the three CBT studies, changes in physical activity were not related to changes in fatigue. So "recovery from fatigue" does not necessarily mean recovery from CFS in terms of achieving normal activity levels.
In another Dutch CBT study[6], 37% of patients were said to be recovered from fatigue, where recovery was defined as no longer scoring on any of the 3 negative factors of the Fatigue Quality List (FQL). However when low scores on other questionnaires were also required to fulfil "full recovery", only 23% of the sample were said to be in "full recovery". Note that only subjective measures were used in that definition of full recovery - a return to a normal level of activity, as measured by an actometer, was not required.
Incidentally, a paper was subsequently published which also examined language used to describe fatigue by CFS patients and healthy controls[7]. It is slightly different as phrases rather than adjectives were used to describe the fatigue e.g. "Mentally tired after the slightest effort", "Lack the energy to talk to anyone", etc. Factor analyses revealed a five-factor structure for participants with ME/CFS but only a one-factor solution for the control group. The five factors for fatigue in ME/CFS participants were described as: "Post-Exertional", "Wired", "Brain-Fog", "Energy" and "Flu-Like".
References:
[1] Prins JB, Bleijenberg G, Bazelmans E, Elving L, de Boo Th, Severens JL, van der Wilt GJ, Spinhoven Ph, van der Meer JWM: Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial. Lancet 2001, 357:841-847.
[2] Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Jan 5:1 -7. [Epub ahead of print]
[3] van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373–379.
[4] Knoop H, van der Meer JW, Bleijenberg G (2008). Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial. British Journal of Psychiatry 193, 340-341.
[5] Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G (2005). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 330. Published online : 7 December 2004. doi :10.1136/bmj.38301.587106.63.
[6] Knoop H, Bleijenberg G, Gielissen MFM, Van der Meer JWM, White PD: Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom 2007, 76:171-176.
[7] Jason, L.A., Jessen, T., Porter, N., Boulton, A., Njoku, M.G., & Friedberg, F. Examining types of fatigue among individuals with ME/CFS. Disability Studies Quarterly, 2009, 29, 3. Full text at: http://www.dsq-sds.org/article/view/938/1113
This comment, imported by Hypothesis from PubMed Commons, is licensed under CC BY.
-