基于互联网的认知行为疗法（互联网上青少年疲劳）对常规临床护理中慢性疲劳综合征青少年的疗效：观察性研究。
Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study.
机构信息
Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
出版信息
J Med Internet Res. 2021 Aug 13;23(8):e24839. doi: 10.2196/24839.
BACKGROUND
Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability.
OBJECTIVE
We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark.
METHODS
Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered.
RESULTS
Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ=3.5, P=.06; physical functioning: 4.1% vs 11.4%, χ=3.3, P=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations.
CONCLUSIONS
IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.
背景
基于互联网的认知行为疗法（I-CBT）已被证明对青少年慢性疲劳综合征/肌痛性脑脊髓炎（CFS/ME）有效，这一结果来自一项随机对照试验（RCT；青少年网络疲劳研究[FITNET]）。FITNET 可以显著减轻疲劳和残疾。
目的
我们旨在研究 FITNET 治疗是否在常规临床护理中同样有效，以 FITNET RCT 的结果作为基准。
方法
比较 2012 年 10 月至 2018 年 3 月期间作为常规临床护理一部分开始接受 IMP-FITNET 治疗的 CFS/ME 青少年患者的结果与 FITNET RCT 的结果。主要结局是治疗后疲劳严重程度的评估。次要结局是自我报告的身体功能、学校出勤率和恢复率。治疗后评估临床相关恶化情况，对于这一结果，使用面对面认知行为治疗试验作为基准。通过半结构化访谈评估治疗师对 IMP-FITNET 可用性的态度。IMP-FITNET 期间的面对面咨询次数也进行了登记。
结果
384 名转诊的 CFS/ME 青少年中，244 名（63.5%）开始接受 IMP-FITNET，84 名（21.9%）开始接受面对面认知行为治疗，56 名（14.6%）不符合认知行为治疗的条件。治疗后疲劳严重程度（平均值 26.0，标准差 13.8）、身体功能（平均值 88.2，标准差 15.0）和全勤（平均值 84.3，标准差 26.5）的评分均在 FITNET RCT 的 95%置信区间内。在 IMP-FITNET 治疗后，疲劳和身体功能恶化的发生率分别为 1.2%（n=3）和 4.1%（n=10），与等待名单条件相当（疲劳：1.2%比 5.7%，χ=3.5，P=.06；身体功能：4.1%比 11.4%，χ=3.3，P=.07）。此外，41 名（16.8%）IMP-FITNET 患者使用了面对面咨询。
结论
IMP-FITNET 是一种在常规临床护理中治疗青少年 CFS/ME 的有效且安全的方法。
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