Internet-Based Cognitive Behavioral Therapy for Chronic Fatigue Syndrome Integrated in Routine Clinical Care: Implementation Study

摘要: Background In a clinical trial, internet-based cognitive behavioral therapy (I-CBT) embedded in stepped care was established as noninferior to face-to-face (CBT) for chronic fatigue syndrome (CFS). However, treatment effects observed trials may not necessarily be retained after implementation. Objective This study aimed investigate whether CFS starting with I-CBT, followed by CBT, if needed, also effective routine care. Another objective explore the role of therapists' attitudes toward electronic health (eHealth) and manualized on outcome. Methods I-CBT implemented five mental centers (MHCs) nine sites throughout Netherlands. All patients were offered CBT still severely fatigued or disabled I-CBT. Outcomes Checklist Individual Strength, physical social functioning (Short-Form 36), limitations daily according Work Social Adjustment Scale. The change scores (pre post care) compared benchmark: from randomized controlled trial (RCT) testing this format. We calculated correlations eHealth reduction severity. Results Overall, 100 referred centers. Of them, 79 started 20 commenced directly one did start at all. After 48 met step-up criteria; 11 up CBT. Increase (score 13.4), (20.4), (10.3) delivered fell within benchmarks RCT (95% CIs: 12.8-17.6; 25.2-7.8; 7.4-9.8, respectively). Reduction severity MHCs smaller (12.6) than CI 13.2-16.5). only, (13.2) benchmark alone 11.1-14.2). Twenty therapists treated between 18 patients. Therapists divided into two groups: largest median smallest. Patients first group had significantly larger (15.7 vs 9.0; t=2.42; P=.02). There no (statistically significant) fatigue. Conclusions is evaluate step Although disabilities reduced, appeared trial. Further development should aim avoiding dropout encouraging stepping limited results. Median varied largely therapists. research will help understand