Radboud University Nijmegen Medical Centre, Expert Centre for Chronic Fatigue, 4628, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Consult Clin Psychol. 2010 Oct;78(5):724-31. doi: 10.1037/a0020052.
In this randomized noninferiority study, the effectiveness and efficiency of stepped care for chronic fatigue syndrome (CFS) was compared to care as usual. Stepped care was formed by guided self-instruction, followed by cognitive behavior therapy (CBT) if the patient desired it. Care as usual encompassed CBT after a waiting period.
A total of 171 CFS patients were randomly allocated to stepped care or care as usual. Patients in both conditions were assessed 3 times: at baseline, after guided self-instruction or the waiting period, and after CBT. The primary outcome variables were fatigue severity (Checklist Individual Strength) and disabilities (Sickness Impact Profile and Medical Outcomes Survey Short Form-36).
An intention to treat analysis showed that stepped care (N = 84) for CFS is noninferior to care as usual (N = 85). Both conditions were equivalent in reducing fatigue severity, reducing disabilities, and increasing physical functioning. The treatment results of both conditions were in accordance with those of previous randomized controlled trials testing the effectiveness of CBT for CFS. The total therapist time needed to treat a patient was significantly less in the stepped care condition.
Stepped care is as effective as CBT and is more time efficient for the therapist.
在这项随机非劣效性研究中，比较了慢性疲劳综合征（CFS）的阶梯式护理与常规护理的效果和效率。阶梯式护理由指导性自我指导组成，如果患者需要，可随后进行认知行为疗法（CBT）。常规护理在等待期后提供 CBT。
共纳入 171 例 CFS 患者，随机分配至阶梯式护理或常规护理组。所有患者在基线、指导性自我指导或等待期后、CBT 后接受 3 次评估。主要结局变量为疲劳严重程度（个体力量检查表）和残疾程度（疾病影响量表和医疗结局研究简表 36 项）。
意向治疗分析显示，CFS 的阶梯式护理（N=84）与常规护理（N=85）等效。两种护理方式均能降低疲劳严重程度、减少残疾程度、提高身体机能。两种护理方式的治疗效果均与先前测试 CBT 对 CFS 有效性的随机对照试验结果一致。阶梯式护理治疗每位患者所需的总治疗师时间明显更少。
阶梯式护理与 CBT 同样有效，且对治疗师来说更节省时间。
