رفتاردرمانی شناختی خانواده متمرکز در مقابل درمان روانی آموزشی نوجوانان مبتلا به سندرم خستگی مزمن: پیگیری طولانی مدت
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|30044||2012||7 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 50, Issue 11, November 2012, Pages 719–725
The aim of this study was to investigate the long term efficacy of family-focused cognitive behaviour therapy (CBT) compared with psycho-education in improving school attendance and other secondary outcomes in adolescents with chronic fatigue syndrome (CFS). A 24 month follow-up of a randomised controlled trial was carried out. Participants received either 13 one-hour sessions of family-focused CBT or four one-hour sessions of psycho-education. Forty-four participants took part in the follow-up study. The proportion of participants reporting at least 70% school attendance (the primary outcome) at 24 months was 90% in CBT group and 84% in psycho-education group; the difference between the groups was not statistically significant (OR = 1.29, p = 0.80). The proportion of adolescents who had recovered in the family-focused CBT group was 79% compared with 64% in the psycho-education, according to a definition including fatigue and school attendance. This difference was not statistically significant (Fisher's exact test, p = 0.34). Family-focused CBT was associated with significantly better emotional and behavioural adjustment at 24 month follow-up compared to psycho-education, as reported by both adolescents (F = 6.49, p = 0.02) and parents (F = 4.52, P = 0.04). Impairment significantly decreased in both groups between six and 24 month follow-ups, with no significant group difference in improvement over this period. Gains previously observed for other secondary outcomes at six month follow-up were maintained at 24 month follow-up with no further significant improvement or group differences in improvement. In conclusion, gains achieved by adolescents with CFS who had undertaken family-focused CBT and psycho-education generally continued or were maintained at two-year follow-up. The exception was that family-focused CBT was associated with maintained improvements in emotional and behavioural difficulties whereas psycho-education was associated with deterioration in these outcomes between six and 24-month follow-up.
Chronic fatigue syndrome (CFS) is characterised by severe disabling fatigue, present for more than 50% of the time and affecting both physical and mental functioning, which is not accounted for by organic illness. It is typically accompanied by other symptoms such as headaches, sleep problems, difficulties with concentration and musculoskeletal pain and must be present for at least six months for a diagnosis to be made (Fukuda et al., 1994). In children and adolescents the condition presents in the same way but need only be present for a minimum of three months to be diagnosed (Royal College of Physicians, 1996). Prognosis in young people has been found to be relatively good and favourable in comparison to that in adults (e.g. Joyce, Hotopf, & Wessely, 1997; Rimes et al., 2007). However CFS in children and adolescents is associated with serious impairment (Garralda & Rangel, 2004) with effects on physical, emotional and intellectual development (Royal College of Physicians, 1996). It is associated with significant absenteeism from school (Patel, Smith, Chalder, & Wessely, 2003; Wright & Cottrell, 1997) as well as withdrawal and isolation (Carter, Edwards, Kronenberger, Michalczyk, & Marshall, 1995). Cognitive behavioural models of CFS in adolescents (e.g. Chalder, Tong, & Deary, 2002) suggest that the onset of the condition is often associated with psychosocial stress along with an acute illness. Cognitive, behavioural, physiological, emotional and social factors are then seen as interacting to perpetuate symptoms and prevent recovery. Cognitive behaviour therapy (CBT) for chronic fatigue syndrome is aimed at addressing these contributory factors and typically involves planned activity and rest, a graded increase in activity, establishing a sleep routine and addressing any unhelpful beliefs (Chalder et al., 2002; Rimes & Chalder, 2005). The results of a randomised controlled trial comparing family-focused CBT with psycho-education were previously reported (Chalder, Deary, Husain, & Walwyn, 2010). This was one of only three RCTs (Chalder et al., 2010; Nijhof, Bleijenberg, Ulterwaal, Kimpen, & van de Putte, 2012; Stulemeijer, de Jong, Fiselier & Bleijenberg, 2005) investigating the effectiveness of CBT in adolescents, but the only one to compare CBT with another active treatment. Whilst adolescents receiving family-focused CBT were found to have greater improvement in school attendance at end of treatment than those receiving psycho-education, at six month follow-up both groups had improved to the same extent. There is to date only one other study investigating the long-term effectiveness of CBT for adolescents with CFS. Knoop, Stulemeijer, de Jong, Fiselier, and Bleijenberg (2008) found benefits associated with CBT in terms of fatigue, physical functioning and school attendance at two year follow-up in comparison to a group who declined CBT after a waiting list period. The present study extends previous research in including an active control intervention.
نتیجه گیری انگلیسی
Table 1 shows baseline demographic variables for both groups separately and combined. Baseline scores on questionnaire measures can be seen in Tables 2 and 3. At baseline, those in the psycho-education group had significantly more fatigue than those in the family-focused CBT group (t = 2.03), which was controlled for in the relevant analysis. Baseline group differences were found to be non-significant for length of illness (t = −0.69) and dichotomous school attendance (Fisher's exact test = 0.30). Table 2. School attendance over time. Time point Family-focused CBT ≥70% attendance (% achieving) Psycho-education ≥70% attendance (% achieving) Effect Statistic (95% confidence intervals) p-Value Baseline 21.9 9.7 Groupa 1.286 (0.183–9.021) 0.80 6 Month follow-up 65.6 66.7 CBT between 6 and 24 monthsb Exact significance 0.06 24 Month follow-up 90.0 84.2 Psycho-education between 6 and 24 monthsb Exact significance 0.38 a Logistic regression; group statistic is expressed as an odds ratio. b McNemar test. Table options Table 3. Secondary outcomes over time. Measure and time point Family-focused CBT mean (SD) Psycho-education mean (SD) Effect F-statistic (df = 1) p Value Fatigue (Chalder Fatigue Scale) Baseline 22.26 (5.71) 29.43 (4.66) Group 0.43 0.51 6 Month follow-up 13.31 (5.90) 14.16 (8.42) Time 0.03 0.86 12 Month follow-up 10.40 (5.70) 12.15 (4.79) Group × time 0.03 0.87 Physical functioning (SF-36) Baseline 51.25 (26.34) 41.67 (24.34) Group 1.05 0.32 6 Month follow-up 80.36 (20.19) 64.00 (36.38) Time 0.10 0.75 24 Month follow-up 76.79 (29.81) 71.20 (27.99) Group × time 2.71 0.12 Adjustment (child SDQ total) Baseline 15.16 (5.61) 13.52 (4.64) Group 6.49 0.02∗ 6 Month follow-up 11.63 (5.01) 11.33 (4.84) Time 2.54 0.12 24 Month follow-up 9.63 (4.28) 13.61 (4.24) Group × time 3.20 0.08 Maternal SDQ total Baseline 12.66 (4.36) 11.68 (5.47) Group 4.52 0.04∗ 6 Month follow-up 10.17 (6.45) 8.27 (4.07) Time 11.05 <0.001∗ 24 Month follow-up 8.16 (5.69) 14.00 (4.94) Group × time 10.42 <0.001∗ Impairment (SAS)a Median (IQR) Median (IQR) Z score Baseline 4.90 (3.45–5.60) 5.00 (4.40–6.50) Group −0.55 0.58 6 Month follow-up 2.40 (0.80–3.80) 3.20 (1.20–5.20) CBT over time −2.62 0.01∗ 24 Month follow-up 0.60 (0.00–2.40) 1.60 (0.65–2.95) Psycho-education over time −2.20 0.03∗ a Mann–Whitney U test ∗ Statistically significant at p ≤ 0.05. Table options Attrition Appropriate analyses were carried out in order to examine potential differences between those taking part in the 24 month follow-up and those who did not, according to baseline characteristics. Chi-squared tests found no difference between those completing measures at 24 month follow-up and those lost to follow-up in terms of dichotomous school attendance at baseline (Fisher's exact test = 1.00). Using independent t-tests, no significant differences were found between the two groups on age, fatigue, physical functioning, child SDQ or maternal SDQ (all t = <1.82). A Mann–Whitney U test showed no difference between the two groups on the social adjustment scale at baseline (z = −0.58). Further analyses were also carried out in order to investigate potential differences in outcome at six month follow-up between those participating in the 24 month follow-up and those lost to follow-up, in order to investigate attrition bias. No significant difference was found at six month follow-up between those who completed measures at 24 month follow-up and those lost to follow-up on attendance (Fisher's exact test = 0.80), fatigue, physical functioning, child SDQ, maternal SDQ (all t = <1.38), or social adjustment (z = −0.62).