Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
Mult Scler. 2017 Oct;23(11):1542-1553. doi: 10.1177/1352458517709361. Epub 2017 May 22.
Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive.
To evaluate the effectiveness of CBT to improve MS-related fatigue and participation.
In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis.
Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: -6.7 (95% confidence interval (CI) = -10.7; -2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = -3.6; 4.4)). No clinically relevant effects were found on societal participation.
Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
疲劳是多发性硬化症（MS）的常见症状，常限制患者参与社会活动。认知行为疗法（CBT）可能缓解 MS 相关疲劳，但文献中的证据尚无定论。
评估 CBT 改善 MS 相关疲劳和参与度的效果。
在一项多中心、评估者设盲、随机对照试验中，严重 MS 相关疲劳的参与者被分配到 CBT 或对照治疗组。CBT 包括 12 次个体咨询，由接受过 CBT 培训的心理学家进行，对照治疗组包括三次与 MS 护士的咨询，均在 16 周内完成。评估在基线、8 周、16 周（即干预后）、26 周和 52 周时进行。主要结局指标是清单个体强度-疲劳分量表（CIS20r 疲劳）和对参与和自主影响问卷（IPA）。数据根据意向治疗原则进行分析，采用混合模型分析。
2011 年至 2014 年期间，91 名患者被随机分配（CBT：n=44；对照：n=47）。组间分析显示，CBT 对 CIS20r 疲劳的干预后效果呈阳性（T16：-6.7（95%置信区间（CI）= -10.7；-2.7）点），在随访期间减弱（T52：0.5（95%CI=-3.6；4.4））。对社会参与没有发现有临床意义的影响。
CBT 可在短期内有效减轻严重的 MS 相关疲劳。需要进一步研究如何在长期内维持这种效果。
