Chronic fatigue self-management in primary care: a randomized trial

Abstract

Objective: To assess the efficacy of brief fatigue self-management (FSM) for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care.

Methods: A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to two sessions of FSM, two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3 and 12 months after treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention to treat (multiple imputation) and also by per protocol.

Results: A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group (p < .023) and the UC group (p < .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d = 0.46) and the UC group (d = 0.40). The per-protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12-month follow-up were high (42%-53%), perhaps attributable to the burden of monthly telephone calls to assess health care use.

Conclusion: A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning. Trial Registration clinicaltrials.gov Identifier: NCT00997451.

Keywords: chronic fatigue syndrome; cognitive-behavior therapy; fatigue self-management; nurse-delivered intervention; primary care; unexplained chronic fatigue.

Figures

Figure 1

Study Flow-Chart. FSM = fatigue self-management; AC = symptom monitoring Support; UC = usual care condition.

Figure 2

Profile Plot of FSS Means by Time and Study Condition. Study Condition: FSM=Fatigue Self-Management; AC= Symptom Monitoring Support Attention Control; UC=Usual Care Control; FSS=Fatigue Severity Scale.