Friday, April 23, 2010

More proof it's not just attention-seeking

23 April 2010

Published 23 April 2010, doi:10.1136/bmj.c1799
Cite this as: BMJ 2010;340:c1799


Pragmatic rehabilitation for chronic fatigue syndrome
Has a short term benefit, but supportive listening does not

First 150 words (subscription required for full editorial)


Published 23 April 2010, doi:10.1136/bmj.c1777
Cite this as: BMJ 2010;340:c1777

Nurse led, home based self help treatment for patients in primary care with
chronic fatigue syndrome: randomised controlled trial

Free [Abstract] [Full Text] [PDF]


Alison J Wearden, reader in psychology1, Christopher Dowrick, professor of
primary medical care2, Carolyn Chew-Graham, professor of primary care3,
Richard P Bentall, professor of clinical psychology4, Richard K Morriss,
professor of psychiatry and community mental health5, Sarah Peters, senior
lecturer in psychology1, Lisa Riste, FINE trial manager1, Gerry Richardson,
senior research fellow in health economics6,7, Karina Lovell, professor of
mental health8, Graham Dunn, professor of biomedical statistics3, on behalf
of the Fatigue Intervention by Nurses Evaluation (FINE) trial writing group
and the FINE trial group

1 School of Psychological Sciences, University of Manchester, Manchester, 2
School of Population, Community and Behavioural Sciences, University of
Liverpool, Liverpool, 3 School of Community Based Medicine, University of
Manchester, Manchester, 4 School of Psychology, University of Bangor,
Adeilad Brigantia, Bangor, Gwynedd, 5 School of Community Health Sciences,
Institute of Mental Health, University of Nottingham, Nottingham, 6 Centre
for Health Economics, University of York, York, 7 Hull York Medical School,
University of York, Heslington, York, 8 School of Nursing, Midwifery and
Social Work, University of Manchester, Manchester

Correspondence to: A J Wearden [email protected]

Objective To evaluate the effectiveness of home delivered pragmatic
rehabilitation-a programme of gradually increasing activity designed
collaboratively by the patient and the therapist-and supportive
listening-an approach based on non-directive counselling-for patients in
primary care with chronic fatigue syndrome/myalgic encephalomyelitis or
encephalitis (CFS/ME).
Design Single blind, randomised, controlled trial.

Setting 186 general practices across the north west of England between
February 2005 and May 2007.

Participants 296 patients aged 18 or over with CFS/ME (median illness
duration seven years) diagnosed using the Oxford criteria.

Interventions Participants were randomly allocated to pragmatic
rehabilitation, supportive listening, or general practitioner treatment as
usual. Both therapies were delivered at home in 10 sessions over 18 weeks
by one of three adult specialty general nurses who had received four
training, including supervised practice, in each of the interventions. GP
treatment as usual was unconstrained except that patients were not to be
referred for systematic psychological therapies during the treatment

Main outcome measures The primary clinical outcomes were fatigue and
physical functioning at the end of treatment (20 weeks) and 70 weeks from
recruitment compared with GP treatment as usual. Lower fatigue scores and
higher physical functioning scores denote better outcomes.

Results A total of 257 (87%) of the 296 patients who entered the trial were
assessed at 70 weeks, the primary outcome point. Analysis was on an
intention to treat basis, with robust treatment effects estimated after
adjustment for missing data using probability weights. Immediately after
treatment (at 20 weeks), patients allocated to pragmatic rehabilitation
(n=95) had significantly improved fatigue (effect estimate -1.18, 95%
confidence interval -2.18 to -0.18; P=0.021) but not physical functioning
(-0.18, 95% CI -5.88 to +5.52; P=0.950) compared with patients allocated to
treatment as usual (n=100). At one year after finishing treatment (70
weeks), there were no statistically significant differences in fatigue or
physical functioning between patients allocated to pragmatic rehabilitation
and those on treatment as usual (-1.00, 95% CI -2.10 to +0.11; P=0.076 and
+2.57, 95% CI 3.90 to +9.03; P=0.435). At 20 weeks, patients allocated to
supportive listening (n=101) had poorer physical functioning than those
allocated to treatment as usual (-7.54, 95% CI -12.76 to -2.33; P=0.005)
and no difference in fatigue. At 70 weeks, patients allocated to supportive
listening did not differ significantly from those allocated to treatment as
usual on either primary outcome.

Conclusions For patients with CFS/ME in primary care, pragmatic
rehabilitation delivered by trained nurse therapists improves fatigue in
the short term compared with unconstrained GP treatment as usual, but the
effect is small and not statistically significant at one year follow-up.
Supportive listening delivered by trained nurse therapists is not an effective treatment for CFS/ME.

Trial registration International Standard Randomised Controlled Trial
Number IRCTN74156610.

© Wearden et al 2010
This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-commercial License, which permits use,
distribution, and reproduction in any medium, provided the original work is
properly cited, the use is non commercial and is otherwise in compliance
with the license. See: and


(FINE Trial Protocol, published 2006)

Suzy Chapman

[email protected]

For information on the proposed structure of ICD-11, the Content Model and
iCAT, see key documents on ICD-11 Revision site:
* * *
If I suggested counseling/talk therapy as the cure for cancer or AIDS, I'd be laughed off the planet.  Yet they're still trying to talk us out of having the CFS virus!

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