Positive Health Online

Abstract

WHITING and colleagues, National Health Service Centre for Reviews and Dissemination, University of York, York, UK, pfw2@york.ac.uk, evaluated available data (57 references) on the effectiveness of interventions used in treating or managing chronic fatigue syndrome (CFS) in adults and children.

Background

Treatment and management of CFS has involved a range of interventions, for which effectiveness remains an issue of debate.

Methodology

The reviewers searched 19 specialist databases up to January or July 2000 (and updated using PubMed to end-October 2000), and obtained further information from other sources including citations, Internet, experts and on-line requests for articles. Studies evaluated were randomized (RCTs) or non-randomized (CTs) controlled trials investigating interventions in patients diagnosed with CFS according to any criteria. Two reviewers independently assessed study inclusion. 44 studies (36 RCTs and 8 CTs) out of an initial 350 identified met the inclusion criteria. Data was extracted by one reviewer and checked by a second. Two reviewers carried out validity assessment; disagreements were resolved by consensus. Evaluation was by a qualitative synthesis . Studies were grouped according to type of intervention and outcomes assessed.

Results

Individual trials included between 12 and 326 subjects (a total of 2801 in the 44 trials). 38 different outcomes were evaluated by approximately 130 different scales or types of measurement. Studies were grouped into 6 different categories: behavioural, immunological, pharmaceutical, supplements, complementary/alternative, and other interventions . In the behavioural trials, there were positive findings for graded exercise and cognitive-behavioural therapy ; these also scored highly on the validity assessment . In immunological trials, some limited effects were seen with immunoglobulin and hydrocortisone ; the overall evidence was, however, inconclusive. There was insufficient evidence on which to assess the effectiveness of the other 4 trial categories.

Conclusion

The interventions used to treat or manage CFS showed mixed results in terms of effectiveness, and conclusions about effectiveness need to be considered alongside the methodological inadequacies of the studies. Graded exercise therapy and cognitive-behavioural therapy showed promising results . Further research is needed into these and other interventions using standardized outcome measures.

References

Whiting P et al. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. Journal of the American Medical Association (JAMA) 286 (11): 1360-8. Sep 2001.

Comment

Now that the medical profession in the UK has finally acknowledged the existence of chronic fatigue syndrome (CFS), perhaps they might take on board the not insignificant number of trials referred to in the above research; however, in view of the dissent from the psychiatric profession, who still think CFS is a psychological disorder, I for one will not be holding my breath.