Ridsdale L, Godfrey E, Chalder T, Seed P, King M, Wallace P, Wessely S
Department of General Practice, Guy's, King's and St Thomas's School of Medicine, King's College, 5 Lambeth Walk, London SE11 6SP.
Br J Gen Pract. 2001 Jan;51(462):19-24.
Fatigue is a common symptom for which patients consult their doctors in primary care. With usual medical management the majority of patients report that their symptoms persist and become chronic. There is little evidence for the effectiveness of any fatigue management in primary care.
To compare the effectiveness of cognitive behaviour therapy (CBT) with counselling for patients with chronic fatigue and to describe satisfaction with care.
Randomised trial with parallel group design.
Ten general practices located in London and the South Thames region of the United Kingdom recruited patients to the trial between 1996 and 1998. Patients came from a wide range of socioeconomic backgrounds and lived in urban, suburban, and rural areas.
Data were collected before randomisation, after treatment, and six months later. Patients were offered six sessions of up to one hour each of either CBT or counselling. Outcomes include: self-report of fatigue symptoms six months later, anxiety and depression, symptom attributions, social adjustment and patients' satisfaction with care.
One hundred and sixty patients with chronic fatigue entered the trial, 45 (28%) met research criteria for chronic fatigue syndrome; 129 completed follow-up. All patients met Chalder et al's standard criteria for fatigue. Mean fatigue scores were 23 on entry (at baseline) and 15 at six months' follow-up. Sixty-one (47%) patients no longer met standard criteria for fatigue after six months. There was no significant difference in effect between the two therapies on fatigue (1.04 [95% CI = -1.7 to 3.7]), anxiety and depression or social adjustment outcomes for all patients and for the subgroup with chronic fatigue syndrome. Use of antidepressants and consultations with the doctor decreased after therapy but there were no differences between groups.
Counselling and CBT were equivalent in effect for patients with chronic fatigue in primary care. The choice between therapies can therefore depend on other considerations, such as cost and accessibility.
疲劳是一种常见症状，患者会因此在初级保健中咨询医生。采用常规医疗管理，大多数患者报告其症状持续并转为慢性。几乎没有证据表明初级保健中任何疲劳管理措施的有效性。
比较认知行为疗法（CBT）与咨询对慢性疲劳患者的有效性，并描述对护理的满意度。
平行组设计的随机试验。
1996年至1998年间，位于英国伦敦和南泰晤士地区的十家普通诊所招募患者参与试验。患者来自广泛的社会经济背景，居住在城市、郊区和农村地区。
在随机分组前、治疗后及六个月后收集数据。患者可接受六次每次长达一小时的CBT或咨询。结果包括：六个月后疲劳症状的自我报告、焦虑和抑郁、症状归因、社会适应以及患者对护理的满意度。
160名慢性疲劳患者进入试验，45名（28%）符合慢性疲劳综合征的研究标准；129名完成随访。所有患者均符合查尔德等人的疲劳标准。入组时（基线）平均疲劳评分为23分，六个月随访时为15分。61名（47%）患者在六个月后不再符合疲劳标准。两种疗法在所有患者以及慢性疲劳综合征亚组的疲劳（1.04 [95%可信区间 = -1.7至3.7]）、焦虑和抑郁或社会适应结果方面效果无显著差异。治疗后抗抑郁药的使用和与医生的会诊次数减少，但组间无差异。
在初级保健中，咨询和CBT对慢性疲劳患者的效果相当。因此，疗法的选择可取决于其他因素，如成本和可及性。
