Een studie van Ridsdale en kollega's naar de effecten van GET, psychologische ondersteuning en standaardhulp (wel met een fraaie CBT-brochure!) toont aan
dat GET niet effectiever is dan psychologische begeleiding en "standaardzorg" en
dat ca. 50-60% van de patiŽnten ontevreden was met de drie vormen van "zorg".
De uitsmijter is wat mij betreft de konstatering dat als deze "therapieŽn" niet helpen,
andere behandelvormen met de patiŽnten besproken moeten worden.
In het (bio)psychosociale gedachtegoed is toch geen plaats voor "andere" behandelvormen?
Observed outcomes by therapy
Wearden et al. (2010) published a trial from primary care
in which they recruited only patients with more severe CFS.
Therapies consisted of pragmatic rehabilitation and supportive listening,
implemented by nurses with additional training
rather than the physiotherapists and counsellors working in our trial.
The nurse interventions also had
non-significant effects on fatigue at the 1-year follow-up.
We found patients who had experienced prolonged fatigue symptoms before the trial were more likely to report dissatisfaction.
It seems likely that, when not offered a therapeutic intervention,
dissatisfaction persists or increases.
From the current evidence,
we propose that after assessment of patients
who present with fatigue in primary care,
doctors offer to reassess them in 6 months.
If fatigue symptoms persist,
the practitioner and patient may discuss further therapy options.
The effect of counselling, graded exercise and usual care
for people with chronic fatigue in primary care: a randomized trial.
Psychological Medicine, FirstView Article : 1-8. doi:10.1017/S0033291712000256.
L. Ridsdale, M. Hurley, M. King, P. McCrone, N. Donaldson.
the effectiveness of
graded exercise therapy (GET),
counselling (COUNS) and
usual care plus a cognitive behaviour therapy (CBT) booklet (BUC)
for people presenting with chronic fatigue in primary care.
A randomized controlled trial
in general practice.
The main outcome measure was
the change in the Chalder fatigue score
between baseline and 6 months.
Secondary outcomes included a measure of global outcome,
including anxiety and depression, functional impairment and satisfaction.
The reduction in mean Chalder fatigue score
at 6 months was
8.1 [95% confidence interval (CI) 6.6Ė10.4] for BUC,
10.1 (95% CI 7.5Ė12.6) for GET and
8.6 (95% CI 6.5Ė10.8) for COUNS.
There were no significant differences in change scores between the three groups
at the 6- or 12-month assessment.
Dissatisfaction with care was high.
In relation to the BUC group,
the odds of dissatisfaction at the 12-month assessment
were less for
the GET [odds ratio (OR) 0.11, 95% CI 0.02Ė0.54, p=0.01] and
COUNS groups (OR 0.13, 95% CI 0.03Ė0.53, p=0.004).
Our evidence suggests that
fatigue presented to general practitioners (GPs)
tends to remit over 6 months
to a greater extent than found previously.
Compared to BUC,
those treated with
graded exercise or counselling therapies
were not significantly better
with respect to the primary fatigue outcome,
although they were less dissatisfied at 1 year.
This evidence is generalizable nationally and internationally.
We suggest that
GPs ask patients to return at 6 months
if their fatigue does not remit,
when therapy options can be discussed further.
Met dank aan Rob en anderen.