According to new research, Fatigue In Teenagers on the interNET (FITNET)*, the first web-based therapeutic programme for adolescents with chronic fatigue syndrome (CFS), is substantially more effective than treatment as usual at reducing symptoms of this debilitating disorder. The findings published Online First in The Lancet, also reveal that after just 6 months of treatment, 63% of adolescents receiving the FITNET intervention reported that they had recovered**, almost eight times as many as those given standard care.
"With FITNET, effective treatment is within reach for any adolescent with CFS. These findings stress the need for proper and rapid diagnosis and making medical professionals aware of adolescent CFS and the treatment options", explains Sanne Nijhof from the University Medical Centre Utrecht in The Netherlands, lead author of the research.
CFS causes persistent fatigue and other symptoms including poor concentration and memory, and muscle and joint pain. It is a common cause of long-term absence from school in young people. Cognitive behavioural therapy has shown promise in this age group, but its availability is restricted because of a lack of specialist therapists.
In this study, researchers in The Netherlands recruited 135 adolescents who had CFS for almost 2 years; 68 were randomly assigned to FITNET and 67 to usual care (mainly individual and group cognitive behavioural therapy or graded exercise therapy). Questionnaires were used to measure fatigue, physical functioning, and self-rated improvement, alongside an objective check on school attendance.
At 6 months, adolescents in the internet-delivered cognitive behavioural therapy group reported absence of severe fatigue (85% vs 27%) and normal physical functioning (78% vs 20%) compared with those receiving standard treatment, while full school attendance was attained in 75% vs 16%. Importantly, young people who continued FITNET treatment or switched to FITNET from usual care reported similar success at 12 months, confirming its "intrinsic effectiveness".
The authors point out: "Web-based treatment has general advantages: it is available at any time, avoids face-to-face treatment barriers (ie, treatment delay due to poor accessibility, inconvenience of scheduling appointments, missing school or work, travelling to or from a clinician's office), and reduces treatment time and costs."
They conclude: "FITNET offers a readily accessible and highly effective treatment for adolescents with chronic fatigue syndrome. The results of this study justify implementation on a broader scale."
In an accompanying Comment, Peter White from Barts and London School of Medicine and Dentistry, Queen Mary University of London, UK and Trudie Chalder from King's College London, UK say: "The investigators should be congratulated on testing a way to deliver an already effective treatment more efficiently…An accessible and flexible treatment for adolescents is most welcome…They have added to an increasing evidence base which shows that therapist-aided, internet-based cognitive behavioural therapy is an effective treatment for many similar disorders."
Dr Sanne Nijhof, University Medical Centre Utrecht, Utrecht, The Netherlands. E) s.l.nijhof@umcutrecht.nl Or via Ms Linda Minnen, Communications Department, Medical Centre Utrecht. T)+31 (0) 88 755 4555 or +31 6 2197 3415 (mobile)
Comment: Professor Peter White, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK. T) +44 (0)203 465 5696 E) p.d.white@qmul.ac.uk Or Professor Trudie Chalder, King's College London, London, UK. Via Seil Collins, Press Office, Kings College London. T) +44 (0)207 848 5377 or +44 (0)797 972 8674 (mobile) E) seil.collins@kcl.ac.uk
Notes to Editors:
* FITNET is a comprehensive internet-based programme that uses existing protocols and a theoretical model of effective face-to-face cognitive behavioural therapy for adolescents, specifically designed for those with CFS and their parents. A skilled therapist is on hand to provide support through regular email consultations.
**Recovery was defined as having a fatigue severity score of less than 40, physical functioning score of 85% or more, school absence of 10% or less in the past 2 weeks, at 6 months. Additionally, patients had to rate themselves as being completely recovered or as feeling much better.
For full Article and Comment: http://press.thelancet.com/FITNET.pdf
Journal
The Lancet