Expert Center for Chronic Fatigue, Amsterdam University Medical Centers, Department of Medical Psychology, VU University, Amsterdam Public Health research institute, Amsterdam, The Netherlands; Amsterdam University Medical Centers, Department of Medical Psychology, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Radboud university medical center, Nijmegen, The Netherlands.
J Psychosom Res. 2019 Jun;121:93-99. doi: 10.1016/j.jpsychores.2019.03.017. Epub 2019 Mar 19.
To determine which variables predicted long-term outcome after cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS).
A cohort of 511 CFS patients from four different CBT for CFS studies, i.e. two cohort studies and two RCT's. Before treatment, all patients fulfilled the 2003 US CDC criteria for CFS and treated with CBT, were assessed at long-term follow-up, up to 10 years after end of treatment. We tried to predict fatigue severity and physical functioning at follow-up with demographics, cognitive-behavioral perpetuating factors, and CFS characteristics as predictors in linear regression analyses. Logistic regression analysis was used to explore significant predictors of fatigue scores within normal limits at long-term follow-up.
Lower fatigue severity at long-term follow-up was predicted by a shorter duration of CFS symptoms and lower fatigue levels at baseline, and lower frustration in response to fatigue and lower fatigue levels directly post-treatment. Fatigue scores within normal limits at follow-up was predicted by lower fatigue severity and lower levels of frustration in response to fatigue, both assessed directly post-treatment. Better physical functioning at follow-up was predicted by higher sense of control over fatigue, better physical functioning at post-treatment, and being younger at baseline. In some of the additional analysis pain at baseline also predicted physical functioning at follow-up.
The finding that lower fatigue severity and higher physical functioning at long-term follow-up were positively associated with its outcomes at post-treatment underline the importance of fully maximizing the positive effects of CBT for the sustainment of outcomes. Furthermore, augmenting sense of control and starting treatment sooner after diagnosing CFS could positively influence long-term outcome. Interventions aimed at pain management deserve more attention in research.
确定哪些变量可以预测慢性疲劳综合征（CFS）认知行为疗法（CBT）后的长期结局。
本研究纳入了来自四项不同 CFS-CBT 研究的 511 例 CFS 患者，包括两项队列研究和两项 RCT。所有患者在治疗前均符合美国疾病控制与预防中心（CDC）2003 年的 CFS 标准，并接受 CBT 治疗，在治疗结束后长达 10 年的长期随访中进行评估。我们尝试通过线性回归分析将人口统计学因素、认知行为持续因素和 CFS 特征作为预测因子，预测随访时的疲劳严重程度和身体功能。采用逻辑回归分析探讨长期随访时疲劳评分处于正常范围的显著预测因子。
较低的长期随访时疲劳严重程度可由 CFS 症状持续时间较短、基线时疲劳水平较低、对疲劳的反应受挫程度较低以及直接治疗后疲劳水平较低来预测。随访时疲劳评分处于正常范围可由直接治疗后疲劳严重程度较低和对疲劳的反应受挫程度较低来预测。较高的对疲劳的控制感、治疗后更好的身体功能和基线时更年轻可预测随访时更好的身体功能。在一些额外的分析中，基线时的疼痛也可预测随访时的身体功能。
长期随访时疲劳严重程度较低和身体功能较高与治疗后结局呈正相关，这强调了充分发挥 CBT 的积极作用以维持治疗效果的重要性。此外，增强对疲劳的控制感和在诊断出 CFS 后尽快开始治疗可能会对长期结局产生积极影响。在研究中，应更加关注针对疼痛管理的干预措施。
