Worm-Smeitink M, Nikolaus S, Goldsmith K, Wiborg J, Ali S, Knoop H, Chalder T
Expert Centre for Chronic Fatigue, Radboud University Medical Center, Reinier Postlaan 4 (916), 6525GC Nijmegen, The Netherlands.
Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom.
J Psychosom Res. 2016 Aug;87:43-9. doi: 10.1016/j.jpsychores.2016.06.006. Epub 2016 Jun 11.
Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes after CBT in tertiary treatment centres in the Netherlands (NL) and the United Kingdom (UK), using different treatment protocols but identical outcome measures, while controlling for differences in patient characteristics and diagnostic criteria.
Consecutively referred CFS patients who received CBT were included (NL: n=293, UK: n=163). Uncontrolled effect sizes for improvement in fatigue (Chalder Fatigue Questionnaire), physical functioning (SF-36 physical functioning subscale) and social functioning (Work and Social Adjustment Scale) were compared. Multiple regression analysis was used to examine whether patient differences explained outcome differences between centres.
Effect sizes differed between centres for fatigue (Cohen's D NL=1.74, 95% CI=1.52-1.95; UK=0.99, CI=0.73-1.25), physical functioning (NL=0.99, CI=0.81-1.18; UK=0.33, CI=0.08-0.58) and social functioning (NL=1.47, CI=1.26-1.69; UK=0.61, CI=0.35-0.86). Patients in the UK had worse physical functioning at baseline and there were minor demographic differences. These could not explain differences in centre outcome.
Effectiveness of CBT differed between treatment centres. Differences in treatment protocols may explain this and should be investigated to help further improve outcomes.
认知行为疗法（CBT）可减轻慢性疲劳综合征（CFS）患者的疲劳感并降低其残疾程度。然而，不同研究的结果存在差异，这可能是由于患者特征、治疗方案、诊断标准和结局指标不同所致。本研究旨在比较荷兰（NL）和英国（UK）三级治疗中心采用不同治疗方案但相同结局指标进行CBT治疗后的效果，同时控制患者特征和诊断标准的差异。
纳入连续转诊并接受CBT治疗的CFS患者（NL：n = 293，UK：n = 163）。比较疲劳改善情况（Chalder疲劳问卷）、身体功能（SF - 36身体功能分量表）和社会功能（工作与社会适应量表）的未控制效应量。采用多元回归分析来检验患者差异是否能解释中心间的结局差异。
中心间在疲劳（Cohen's D NL = 1.74，95% CI = 1.52 - 1.95；UK = 0.99，CI = 0.73 - 1.25）、身体功能（NL = 0.99，CI = 0.81 - 1.18；UK = 0.33，CI = 0.08 - 0.58）和社会功能（NL = 1.47，CI = 1.26 - 1.69；UK = 0.61，CI = 0.35 - 0.86）方面的效应量存在差异。英国患者在基线时身体功能较差，且存在一些微小的人口统计学差异。但这些差异无法解释中心间的结局差异。
CBT在不同治疗中心的疗效存在差异。治疗方案的差异可能是其原因，对此应进行研究以帮助进一步改善治疗效果。
