Lizanne E van den Akker1, Heleen Beckerman1, Emma H Collette2, Jos Wr Twisk3, Gijs Bleijenberg4, Joost Dekker5, Hans Knoop6, Vincent de Groot1. 1. Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. 2. Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands. 3. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. 4. Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 5. Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands. 6. Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands/Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. OBJECTIVE: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. METHODS: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. RESULTS:Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: -6.7 (95% confidence interval (CI) = -10.7; -2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = -3.6; 4.4)). No clinically relevant effects were found on societal participation. CONCLUSION: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
RCT Entities:
BACKGROUND:Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. OBJECTIVE: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. METHODS: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. RESULTS: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: -6.7 (95% confidence interval (CI) = -10.7; -2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = -3.6; 4.4)). No clinically relevant effects were found on societal participation. CONCLUSION: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
Entities:
Keywords:
MS nurse; Multiple sclerosis; cognitive behavior therapy; fatigue; participation; randomized controlled trial; rehabilitation medicine
Authors: Lidewij D Van Gessel; Harriët J G Abrahams; Hetty Prinsen; Gijs Bleijenberg; Marianne Heins; Jos Twisk; Hanneke W M Van Laarhoven; Stans C A H H V M Verhagen; Marieke F M Gielissen; Hans Knoop Journal: J Cancer Surviv Date: 2018-04-12 Impact factor: 4.442
Authors: Arjan Malekzadeh; Ilona Bader; Julia van Dieteren; Annemieke C Heijboer; Heleen Beckerman; Jos W R Twisk; Vincent de Groot; Charlotte E Teunissen Journal: Front Neurol Date: 2020-01-28 Impact factor: 4.003
Authors: Marieke Houniet-de Gier; Heleen Beckerman; Kimberley van Vliet; Hans Knoop; Vincent de Groot Journal: Trials Date: 2020-01-20 Impact factor: 2.279