Graded exercise therapy for patients with chronic fatigue syndrome in secondary care – a benchmarking study

We investigated the effectiveness of graded exercise therapy (GET) delivered to patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in a routine, specialist clinic by measuring patient-reported outcome data collected prospectively over several timepoints alongside therapy. Benchmarking analyses were used to compare our results with those found in randomised controlled trials (RCTs). Data were collected from patients, with a diagnosis of CFS/ME, who had been referred to a specialist clinical service in South London. Measures included Chalder Fatigue Questionnaire, Physical Functioning Subscale of the Short-Form Health Questionnaire, and the Work and Social Adjustment Scale. Change on each measure was calculated over time using linear mixed-model analyses. Within group effect sizes were calculated and compared with previous RCTs. Fatigue scores were significantly reduced by session 4 (–5.18, 95%CIs −7.90, −2.45) and at follow-up (–4.73, 95%CIs −7.60, −1.85). Work and social adjustment and physical functioning progressively improved over the course of therapy, reaching significance at discharge and maintained at follow-up (WSAS −4.97, 95%CIs −7.97, −1.97; SF-36 10.75, 95%CIs 2.19, 19.31). GET is an effective treatment for CFS/ME within clinical practice. However, effect sizes were smaller in routine clinical practice than RCTs suggesting that avenues for augmentation need to be considered.Implications for rehabilitationIt is important to assess whether patient reported outcomes of treatments that have been evaluated in the context of clinical trials are similar in routine clinical practice.This study shows fatigue severity, physical functioning, and work and social adjustment can significantly improve after graded exercise therapy for patients with chronic fatigue syndrome within a specialist service.Benchmarking methods showed clinical outcomes obtained smaller effect sizes than randomised controlled trials – techniques to maximise patient outcomes should be considered. It is important to assess whether patient reported outcomes of treatments that have been evaluated in the context of clinical trials are similar in routine clinical practice. This study shows fatigue severity, physical functioning, and work and social adjustment can significantly improve after graded exercise therapy for patients with chronic fatigue syndrome within a specialist service. Benchmarking methods showed clinical outcomes obtained smaller effect sizes than randomised controlled trials – techniques to maximise patient outcomes should be considered.

本研究针对慢性疲劳综合征/肌痛性脑脊髓炎（chronic fatigue syndrome/myalgic encephalomyelitis, CFS/ME）患者，于常规专科诊所中开展分级运动疗法（graded exercise therapy, GET）有效性评估，通过伴随治疗进程、于多个时间点前瞻性采集的患者报告结局数据开展分析。
本研究采用基准对标分析法，将所得结果与随机对照试验（randomised controlled trials, RCTs）的已有结果进行对比。
研究数据取自转诊至伦敦南部专科临床服务机构的CFS/ME确诊患者。
本次研究采用的评估工具包括：查尔疲劳量表（Chalder Fatigue Questionnaire）、简明健康调查问卷（Short-Form Health Questionnaire, SF-36）躯体功能子量表，以及工作与社会适应量表（Work and Social Adjustment Scale, WSAS）。
采用线性混合模型分析法，计算各项评估指标随时间的变化情况。
计算组内效应量，并与既往随机对照试验结果进行对比。
至第4次治疗时，患者疲劳评分即出现显著降低（均差=-5.18，95%置信区间：-7.90~-2.45）；随访阶段该评分仍维持显著下降（均差=-4.73，95%置信区间：-7.60~-1.85）。
患者的工作与社会适应能力及躯体功能在治疗过程中逐步改善，至治疗结束时达到统计学显著性水平，并在随访阶段得以维持（WSAS均差=-4.97，95%置信区间：-7.97~-1.97；SF-36躯体功能子量表均差=10.75，95%置信区间：2.19~19.31）。
本研究证实，分级运动疗法在临床实践中可有效治疗CFS/ME。但常规临床实践中的效应量小于随机对照试验，提示需探索优化治疗效果的可行路径。
康复学启示
评估经临床试验验证的治疗方案，其患者报告结局在常规临床实践中是否保持一致，具有重要意义。
本研究表明，在专科医疗服务体系下接受分级运动疗法的慢性疲劳综合征患者，其疲劳严重程度、躯体功能及工作与社会适应能力均可获得显著改善。
基准对标分析结果显示，本研究所得临床结局的效应量小于随机对照试验，因此需探索可最大化患者获益的优化策略。
评估经临床试验验证的治疗方案，其患者报告结局在常规临床实践中是否保持一致，具有重要意义。
本研究表明，在专科医疗服务体系下接受分级运动疗法的慢性疲劳综合征患者，其疲劳严重程度、躯体功能及工作与社会适应能力均可获得显著改善。
基准对标分析结果显示，本研究所得临床结局的效应量小于随机对照试验，因此需探索可最大化患者获益的优化策略。