Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU Medical Centre, Amsterdam, The Netherlands.
Academic Medical Centre (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, The Netherlands.
Behav Cogn Psychother. 2019 Sep;47(5):548-558. doi: 10.1017/S1352465819000110. Epub 2019 Mar 12.
Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.
(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.
An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.
Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1-6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).
Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.
认知行为疗法（CBT）是一种针对慢性疲劳综合征（CFS）的循证治疗方法。在 CFS 专家中心进行测试时，发现阶梯式治疗对 CFS 有效，该治疗包括一个最低限度的干预措施，然后是面对面的 CBT。在社区心理健康中心（MHC）实施的阶梯式护理尚未得到评估。
（1）测试在 MHC 中实施的 CFS 阶梯式护理在治疗后和长期随访时的有效性；（2）比较在 MHC 中实施的阶梯式护理的治疗后结果与 CFS 专家中心的治疗结果。
使用非对照研究来测试 MHC 中实施的阶梯式护理的有效性（n = 123）。实施护理的结果与之前研究报告的专家护理的结果（n = 583）进行了比较。实施的阶梯式护理的结果数据在治疗后和长期随访时收集。混合模型被用作分析方法。
实施阶梯式护理后，疲劳感明显减轻，身体机能明显改善（均 p <.001）。在治疗后 1-6 年内，有 94 名患者（78%）完成了随访。治疗效果持续到随访。与 CFS 专家中心的患者相比，MHC 中的患者在接受阶梯式护理后直接改善较小（p <.01）。
在 MHC 中实施的针对 CFS 的阶梯式护理有效，长期随访时治疗效果持续。与 CFS 专家中心的结果相比，仍有改进的空间。对如何改进阶梯式护理提出了一些建议。
