Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Academic Neuroscience Centre, London, UK.
Psychol Med. 2012 Oct;42(10):2217-24. doi: 10.1017/S0033291712000256. Epub 2012 Feb 28.
To evaluate the effectiveness of graded exercise therapy (GET), counselling (COUNS) and usual care plus a cognitive behaviour therapy (CBT) booklet (BUC) for people presenting with chronic fatigue in primary care.
A randomized controlled trial in general practice. The main outcome measure was the change in the Chalder fatigue score between baseline and 6 months. Secondary outcomes included a measure of global outcome, including anxiety and depression, functional impairment and satisfaction.
The reduction in mean Chalder fatigue score at 6 months was 8.1 [95% confidence interval (CI) 6.6-10.4] for BUC, 10.1 (95% CI 7.5-12.6) for GET and 8.6 (95% CI 6.5-10.8) for COUNS. There were no significant differences in change scores between the three groups at the 6- or 12-month assessment. Dissatisfaction with care was high. In relation to the BUC group, the odds of dissatisfaction at the 12-month assessment were less for the GET [odds ratio (OR) 0.11, 95% CI 0.02-0.54, p=0.01] and COUNS groups (OR 0.13, 95% CI 0.03-0.53, p=0.004).
Our evidence suggests that fatigue presented to general practitioners (GPs) tends to remit over 6 months to a greater extent than found previously. Compared to BUC, those treated with graded exercise or counselling therapies were not significantly better with respect to the primary fatigue outcome, although they were less dissatisfied at 1 year. This evidence is generalizable nationally and internationally. We suggest that GPs ask patients to return at 6 months if their fatigue does not remit, when therapy options can be discussed further.
评估分级运动疗法（GET）、咨询（COUNS）和常规治疗加认知行为疗法（CBT）小册子（BUC）对初级保健中出现慢性疲劳的人的有效性。
在一般实践中进行的随机对照试验。主要结局测量是在基线和 6 个月之间 Chalder 疲劳评分的变化。次要结局包括整体结局测量，包括焦虑和抑郁、功能障碍和满意度。
BUC 组 6 个月时平均 Chalder 疲劳评分降低 8.1[95%置信区间（CI）6.6-10.4]，GET 组降低 10.1（95%CI 7.5-12.6），COUNS 组降低 8.6（95%CI 6.5-10.8）。三组在 6 或 12 个月评估时，变化分数之间没有显著差异。对护理的不满程度很高。与 BUC 组相比，GET 组（比值比[OR]0.11，95%CI0.02-0.54，p=0.01）和 COUNS 组（OR0.13，95%CI0.03-0.53，p=0.004）在 12 个月评估时不满的可能性较低。
我们的证据表明，与之前发现的相比，全科医生（GP）就诊的疲劳在 6 个月内更有可能缓解。与 BUC 相比，接受分级运动或咨询治疗的患者在主要疲劳结局方面没有明显改善，尽管他们在 1 年内的不满程度较低。这种证据在全国和国际上具有普遍性。我们建议，如果患者的疲劳没有缓解，GP 可以在 6 个月时要求他们回来，届时可以进一步讨论治疗选择。
