We previously reported on routine clinical outcomes after cognitive behaviour therapy for
chronic fatigue syndrome in an NHS clinic.[1] We found that fatigue, physical functioning and social adjustment all significantly
improved, providing some evidence that results from randomised controlled trials can be
extrapolated to everyday clinical settings.Vink, Vink-Niese2 and Tack3 raised a number of issues with our paper,
which we will respond to. Although the NHS clinic sees patients with both chronic fatigue and
chronic fatigue syndrome, all patients included in this evaluation met NICE criteria for
chronic fatigue syndrome and were assessed by an experienced clinician prior to treatment.A proportion of scores on the SF-36 physical functioning scale were missing. This was not
related to dropout but due to the measure being introduced two years after the other routine
outcome data collection had started. However, the sample size was reasonable. We included this
measure as it is routinely used in trials of behavioural treatments for chronic fatigue
syndrome.The amount of cognitive behaviour therapy offered was flexible depending on patient need.
Those with missing data did not all drop out of therapy. We defined dropout as those who did
not complete any measures at discharge and follow-up at three months. As a naturalistic study,
we felt it was important to include as many participants as possible. With this in mind, we
also chose a statistical approach that manages missing data. Furthermore, we conducted a
dropout analysis and were clear about this being a limitation. We acknowledged in the paper
that dropouts were more ill at the start. However, this does not detract from the fact that
many of those who adhered to the full course of cognitive behaviour therapy for chronic
fatigue syndrome saw significant improvements. The fact that improvement occurred for a high
percentage of people who completed treatment is a useful observation for patients and
clinicians alike.We do not feel that the use of ‘subjective’ as opposed to ‘objective’ measures is a weakness.
Chronic fatigue syndrome remains defined by subjective criteria – namely symptoms, and no
‘objective’ biomarker has been found to date. Even when that happens, we continue to expect
that patient-reported outcome measures will remain as important if not more important than
objective measures. In the end, clinicians will continue to find there is no substitute to
listening to the patient when deciding the success or otherwise of management.Patients were largely satisfied with cognitive behaviour therapy, with over 90% rating their
satisfaction as at least slightly satisfied and 45% as very satisfied. These figures represent
all patients who completed self-report measures at discharge and are therefore commensurate
with all other reported figures at discharge. Although we did not report patient satisfaction
at the follow-up, satisfaction rates remained consistent with rates at discharge.In conclusion, we disagree with the conclusions of Vink, Vink-Niese and Tack. While some
patients do remain disabled, significant improvements with medium effect sizes in
self-reported measures is a positive outcome for a large number of patients who are seen in a
specialist clinic in the UK.