Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 8, 2020
Date Accepted: Jun 30, 2021
Date Submitted to PubMed: Aug 16, 2021
Effectiveness of internet-based cognitive behaviour therapy (FITNET) for adolescents with chronic fatigue syndrome in routine clinical care: Observational Study
ABSTRACT
Background:
Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome (CFS/ME) has been shown to be effective in a randomized clinical trial (Fatigue in Teenagers on the internet; FITNET). FITNET lead to a significant reduction of fatigue and disability.
Objective:
We aimed to investigate whether FITNET treatment implemented in routine clinical care (I-FITNET) was as effective, using the outcomes of the FITNET RCT as benchmark.
Methods:
Outcomes of CFS/ME adolescents who started I-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes of the FITNET RCT. The primary outcome was fatigue severity assessed at post-treatment. Secondary outcomes were self-reported physical functioning, school-attendance, and recovery rates. Clinically relevant deterioration was assessed post-treatment and for this outcome a face-to-face CBT trial was used as benchmark. The attitude of therapists towards the usability of I-FITNET was assessed through semi-structured interviews. The number of face-to-face consultations during I-FITNET was registered.
Results:
Of the 384 referred adolescents with CFS/ME, 244 started I-FITNET (64%), 84 started face-to-face CBT (22%) and 56 (15%) were not eligible for CBT. Post-treatment scores for fatigue severity (Mean=26·0 (13·8)), physical functioning (Mean=88·2 (15·0)) and full school-attendance (Mean=84·3 (26·5)) fell within the 95% confidence intervals of the FITNET RCT. Deterioration of fatigue and physical functioning after I-FITNET was observed in 1.2% and 4.1% respectively, which is comparable to a waiting list condition (fatigue: 1·2 vs. 5·7%; χ²=3.5, p=0·06; physical functioning 4·1 vs. 11·4%; χ²=3·3, p=0·07). Forty-one (8%) I-FITNET patients made use of face-to-face consultations.
Conclusions:
I-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.
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