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van patiŽnten

met NICE-richtlijnen

is terecht!






Een studie van Ridsdale en kollega's naar de effecten van GET, psychologische ondersteuning en standaardhulp (wel met een fraaie CBT-brochure!) toont aan

dat GET niet effectiever is dan psychologische begeleiding en "standaardzorg" en

dat ca. 50-60% van de patiŽnten ontevreden was met de drie vormen van "zorg".




[P]atients with chronic fatigue

have expressed dissatisfaction with management (NICE, 2007),

and this is supported by our evidence.




De uitsmijter is wat mij betreft de konstatering dat als deze "therapieŽn" niet helpen,

andere behandelvormen met de patiŽnten besproken moeten worden.

In het (bio)psychosociale gedachtegoed is toch geen plaats voor "andere" behandelvormen?





Table 3.

Observed outcomes by therapy







Chalder total score, mean (S.D.)





23.4 (4.5)

24.8 (4.9)

24.8 (4.7)

6 months

15.3 (8.0)

14.6 (8.5)

16.2 (8.2)

12 months

13.8 (7.7)

14.5 (7.7)

15.2 (8.4)

At 6 months





Global outcome: How satisfied are you with your treatment? n (%) 

At 6 months




Very/moderately/slightly satisfied

16 (21.3)

15 (21.1)

16 (21)


16 (21.3)

13 (18.3)

13 (17.1)

Very/moderately/slightly dissatisfied

43 (57.3)

43 (60.6)

47 (61.8)

At 12 months




Very/moderately/slightly satisfied

16 (21.3)

25 (35.2)

27 (35.5)


10 (13.3)

9 (12.7)

8 (10.5)

Very/moderately/slightly dissatisfied

49 (65.3)

37 (52.1)

41 (54.0)







Wearden et al. (2010) published a trial from primary care

in which they recruited only patients with more severe CFS.


Therapies consisted of pragmatic rehabilitation and supportive listening,

implemented by nurses with additional training

rather than the physiotherapists and counsellors working in our trial.


The nurse interventions also had

non-significant effects on fatigue at the 1-year follow-up.





We found patients who had experienced prolonged fatigue symptoms before the trial were more likely to report dissatisfaction.





It seems likely that, when not offered a therapeutic intervention,

dissatisfaction persists or increases.





From the current evidence,

we propose that after assessment of patients

who present with fatigue in primary care,

doctors offer to reassess them in 6 months.


If fatigue symptoms persist,

the practitioner and patient may discuss further therapy options.







The effect of counselling, graded exercise and usual care

for people with chronic fatigue in primary care: a randomized trial.

Psychological Medicine, FirstView Article : 1-8. doi:10.1017/S0033291712000256.

L. Ridsdale, M. Hurley, M. King, P. McCrone, N. Donaldson.








To evaluate

the effectiveness of

graded exercise therapy (GET),

counselling (COUNS) and

usual care plus a cognitive behaviour therapy (CBT) booklet (BUC)

for people presenting with chronic fatigue in primary care.





A randomized controlled trial in general practice.


The main outcome measure was

the change in the Chalder fatigue score

between baseline and 6 months.


Secondary outcomes included a measure of global outcome,

including anxiety and depression, functional impairment and satisfaction.





The reduction in mean Chalder fatigue score

at 6 months was

8.1 [95% confidence interval (CI) 6.6Ė10.4] for BUC,

10.1 (95% CI 7.5Ė12.6) for GET and

8.6 (95% CI 6.5Ė10.8) for COUNS.


There were no significant differences in change scores between the three groups

at the 6- or 12-month assessment.


Dissatisfaction with care was high.


In relation to the BUC group,

the odds of dissatisfaction at the 12-month assessment

were less for

the GET [odds ratio (OR) 0.11, 95% CI 0.02Ė0.54, p=0.01] and

COUNS groups (OR 0.13, 95% CI 0.03Ė0.53, p=0.004).





Our evidence suggests that

fatigue presented to general practitioners (GPs)

tends to remit over 6 months

to a greater extent than found previously.


Compared to BUC,

those treated with

graded exercise or counselling therapies

were not significantly better

with respect to the primary fatigue outcome,

although they were less dissatisfied at 1 year.


This evidence is generalizable nationally and internationally.


We suggest that

GPs ask patients to return at 6 months

if their fatigue does not remit,

when therapy options can be discussed further.




Met dank aan Rob en anderen.