Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: An updated systematic review.

Journal: Journal of the Royal Society of Medicine. October 2006. Vol. 99, #10, pp 506-520 Authors and Affiliations: Duncan Chambers,1 Anne-Marie Bagnall,2 Susanne Hempel,1 Carol Forbes.1 1) Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK; 2) School of Health and Community Care, Leeds Metropolitan University, Leeds, LS1 3HE, UK. Correspondence to Duncan Chambers [E-mail: ]

[Note: This systematic review was commissioned by the UK’s National Institute for Health and Clinical Excellence (NICE) to inform the development of their guidelines for the diagnosis and management of CFS/ME in adults and children. The full text of the document is available at]

Objectives: To determine whether any particular intervention or combination of interventions is effective in the treatment, management and rehabilitation of adults and children with a diagnosis of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).

Design: Substantive update of a systematic review published in 2002. Randomized (RCTs) and non-randomized controlled trials of any intervention or combination of interventions were eligible for inclusion. Study participants could be adults or children with a diagnosis of CFS/ME based on any criteria. We searched eleven electronic databases, reference lists of articles and reviews, and textbooks on CFS/ME. Additional references were sought by contact with experts.

Results: Seventy studies met the inclusion criteria. Studies on behavioural, immunological, pharmacological and complementary therapies, nutritional supplements and miscellaneous other interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs. For most other interventions, evidence of effectiveness was inconclusive and some interventions were associated with significant adverse effects.

Conclusions: Over the last five years, there has been a marked increase in the size and quality of the evidence base on interventions for CFS/ME. Some behavioural interventions have shown promising results in reducing the symptoms of CFS/ME and improving physical functioning. There is a need for research to define the characteristics of patients who would benefit from specific interventions and to develop clinically relevant objective outcome measures.

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