Tratamiento con ejercicios para el síndrome de fatiga crónica
Información
- DOI:
- https://doi.org/10.1002/14651858.CD003200.pub7Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 25 abril 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Trastornos mentales comunes
- Copyright:
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- Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Citado por:
Autores
Contributions of authors
LL, KGB, JO‐J: checked trials for inclusion.
LL, KGB, JO‐J: extracted data for the update.
LL, JO‐J, KGB: analysed data for the update.
LL, JO‐J, JRP, KGB: wrote the update.
Sources of support
Internal sources
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University of Oxford Department of Psychiatry, UK.
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Norwegian Knowledge Centre for Health Services, Norway.
External sources
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No sources of support supplied
Declarations of interest
LL: nothing to declare.
KGB: nothing to declare.
JO‐J: nothing to declare.
JRP: nothing to declare.
Acknowledgements
We would like to thank Peter White and Paul Glasziou for advice and additional information provided. We would also like to thank Kathy Fulcher, Richard Bentall, Alison Wearden, Karen Wallman and Rona Moss‐Morris for providing additional information from trials in which they were involved, as well as the CCDAN editorial base for providing support and advice and Sarah Dawson for conducting the searches. In addition, we would like to thank Jane Dennis, Ingvild Kirkehei, Hugh McGuire and Melissa Edmonds for their valuable contributions, and Elisabet Hafstad for assistance with the search.
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Oct 02 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price | |
| 2017 Apr 25 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard‐Jensen, Jonathan R Price | |
| 2016 Dec 20 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G. Brurberg, Jan Odgaard‐Jensen, Jonathan R Price | |
| 2016 Jun 24 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G. Brurberg, Jan Odgaard‐Jensen, Jonathan R Price | |
| 2016 Feb 07 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G. Brurberg, Jan Odgaard‐Jensen, Jonathan R Price | |
| 2015 Feb 10 | Exercise therapy for chronic fatigue syndrome | Review | Lillebeth Larun, Kjetil G. Brurberg, Jan Odgaard‐Jensen, Jonathan R Price | |
| 2004 Jul 19 | Exercise therapy for chronic fatigue syndrome | Review | Melissa Edmonds, Hugh McGuire, Jonathan R Price | |
| 2001 Jul 23 | Exercise therapy for chronic fatigue syndrome | Protocol | Melissa Edmonds, Hugh F McGuire, Jonathan JR Price | |
Differences between protocol and review
Changes made to the original review are stated below.
Objectives have been changed from '(1) To systematically review all randomised controlled trials of exercise therapy for adults with CFS, and (2) To investigate the relative effectiveness of exercise therapy alone or as part of a treatment plan' in the 2004 version to 'The objective of this review was to determine the effects of exercise therapy (ET) for patients with chronic fatigue syndrome (CFS) as compared with any other intervention or control' in this update.
Comparisons have been changed from: '(1) Exercise therapy versus treatment as usual or relaxation plus flexibility, (2) Exercise therapy versus pharmacotherapy (fluoxetine), (3) Exercise therapy alone versus exercise therapy plus pharmacotherapy (fluoxetine) and (4) Exercise therapy alone versus exercise therapy plus patient education' in the 2004 version to the following in this update.
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'"Passive control": treatment as usual/waiting‐list control/relaxation/flexibility.
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"Treatment as usual" comprises medical assessments and advice given on a naturalistic basis. "Relaxation" consists of techniques that aim to increase muscle relaxation (e.g. autogenic training, listening to a relaxation tape). "Flexibility" includes stretches performed according to selected exercises given.
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Psychological therapies: cognitive‐behavioural therapy (CBT)/cognitive treatment/supportive therapy/behavioural therapies/psychodynamic therapies.
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Adaptive pacing therapy.
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Pharmacological therapy (e.g. antidepressants).'
We have revised and reordered the list of secondary outcomes for clarity and have added self‐reported changes in overall health as a new outcome, while moving adverse effects from a secondary outcome to a primary outcome.
We have updated the methods according to recommendations provided in the 2011 version of the Cochrane Handbook for Systematic Reviews of Interventions. For the first version of this review (2004), assessment of methodological quality was conducted according to contemporary criteria of the handbook of The Cochrane Collaboration (Alderson 2004).The adequacy of allocation concealment was rated as adequate (A), unclear (B) or inadequate (C) or as not used (D), and the CCDAN Quality Rating System (Moncrieff 2001) was applied. For this update, we reextracted data on risk of bias to comply with current recommendations, and we used concealment of allocation as the main quality criterion for included studies.
To explore possible differences between studies using different treatment strategies, control conditions and diagnostic criteria, we decided to perform post hoc subgroup analyses when applicable. We also performed post hoc subgroup analyses excluding Powell 2001, as the results reported in this trial seem to have introduced considerable heterogeneity into the analysis. Moreover, in the protocol it is stated, "where results for continuous outcomes were presented using different scales or different versions of the same scale, we used standardised mean differences (SMDs)." We realise that the standardised mean difference (SMD) is much more difficult to conceptualise and interpret than the normal mean difference (MD); therefore we decided to report both MDs and SMDs in the Results section. In general, MDs are reported in the main Results section, whereas SMDs are supplied under the "Sensitivity and subgroup analysis" subheading.
Planned methods not used in this review
Cluster trials
Studies often employ 'cluster randomisation' (such as randomisation by clinician or practice), but analysis and pooling of clustered data pose problems. First, study authors often fail to account for intraclass correlation in clustered studies, leading to a 'unit of analysis' error (Bland 1997) whereby P values are spuriously low, confidence intervals unduly narrow and statistical significance overestimated. This causes type I errors (Bland 1997; Gulliford 1999).
No cluster RCTs were identified in this version of the review. Should such studies be identified in future updates, we will use the following methodological approach. When clustering has not been accounted for in primary studies, we will present data in a table, with a (*) symbol to indicate the presence of a probable unit of analysis error. We will seek to contact first authors of studies to obtain intraclass correlation co‐efficients for their clustered data and to adjust for this by using accepted methods (Gulliford 1999). When clustering is incorporated, we will present the data as if from a parallel‐group randomised study, but adjusted for the clustering effect. We will additionally exclude such studies in a sensitivity analysis.
If cluster studies are appropriately analysed by taking into account intraclass correlation co‐efficients and relevant data documented in the report, synthesis with other studies will be possible using the generic inverse variance technique.
Cross‐over trials
A major concern of cross‐over trials is the potential for carry‐over effect. This occurs when an effect (e.g. pharmacological, physiological, psychological) of treatment in the first phase is carried over to the second phase. As a consequence of entry to the second phase, participants can differ systematically from their initial state despite a wash‐out phase. For the same reason, cross‐over trials are not appropriate when the condition of interest is unstable (Elbourne 2002). As both effects are very likely in CFS/ME, randomised cross‐over studies were eligible but only when data up to the point of first cross‐over were used. Data from the subsequent (second) period of the cross‐over trial were not considered for analysis.
Studies with multiple treatment groups
Multiple dose groups
Some studies may address the effects of different levels of supervision and follow‐up with regards to the exercise intervention and the comparator (e.g. sessions for designing exercise therapy, sessions for designing exercise therapy and planned telephone contacts, sessions for designing exercise therapy and seven face‐to‐face treatment sessions, usual care). Should we identify trials that take this approach in future updates, we will adopt the following approach. For dichotomous outcomes, we will sum up the sample sizes and the numbers of people with events across all intervention groups. For continuous outcomes, means and standard deviations will be combined using the methods described in Chapter 7 (Section 7.7.3.8) of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).
Multiple medications
Some studies may combine several interventions with one comparison group. Should we identify trials of this nature in future updates, we will analyse the effects of each intervention group versus placebo separately, but we will divide up the total number of participants in the placebo group. In the case of continuous outcomes, the total number of participants in the placebo group again will be divided up, but means and standard deviations will be left unchanged (see Chapter 16, Section 16.5.4, in Higgins 2011).
Methods intended for future reviews
If future updates identify a number of studies that enable reporting at different time points, this should be done for example at end of treatment, at short‐term follow‐up (zero to six months), at medium‐term follow‐up (seven to 12 months) and at long‐term follow‐up (over 12 months).
Notes
Cochrane’s Editor in Chief has received the revised version of the review from the author team with changes made in response to the complaint by Robert Courtney. The process has taken longer than hoped; the amended review is being finalised and it will be published during the next 2 months.
Previously published notes
March 2019
Cochrane’s editors and the review author team have jointly agreed that there will be a further period up to the end of May 2019, in which time the author team will amend the review to address changes aimed at improving the quality of reporting of the review and ensuring that the conclusions are fully defensible and valid to inform health care decision making. The changes will also address concerns raised in feedback since the Robert Courtney complaint. The amendment will not include a full update, but a decision about this will made subsequently.
November 2018
The author team has re‐submitted a revised version of this review following the complaint by Robert Courtney. The Editor in Chief and colleagues recognise that the author team has sought to address the criticisms made by Mr Courtney but judge that further work is needed to ensure that the review meets the quality standards required, and as a result have not approved publication of the re‐submission. The review is also substantially out of date and in need of updating.
Cochrane recognises the importance of this review and is committed to providing a high quality review that reflects the best current evidence to inform decisions.
The Editor in Chief is currently holding discussions with colleagues and the author team to determine a series of steps that will lead to a full update of this review. These discussions will be concluded as soon as possible.
October 2018
This review is subject to an ongoing process of review and revision following the submission of a formal complaint to the Editor in Chief. Cochrane considers all feedback and complaints carefully, and revises or updates reviews when it is appropriate. The review author team have advised us that a resubmission of this review is imminent. A decision on the status of this review will be made once this resubmission has been through editorial process, which we anticipate will be towards the end of November 2018.
February 2015
A protocol for an accompanying individual patient data review on chronic fatigue syndrome and exercise therapy has been published (Larun 2014).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Cognitive Behavioral Therapy;
- Depression [therapy];
- Exercise;
- Exercise Therapy [adverse effects, *methods];
- Fatigue Syndrome, Chronic [psychology, *therapy];
- Health Status;
- Patient Dropouts [statistics & numerical data];
- Quality of Life;
- Randomized Controlled Trials as Topic;
- Sleep Wake Disorders [therapy];
Medical Subject Headings Check Words
Adult; Humans;
PICO
PRISMA flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 1 Fatigue (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 2 Fatigue (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 3 Participants with serious adverse reactions.
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 4 Pain (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 5 Physical functioning (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 6 Physical functioning (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 7 Quality of life (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 8 Depression (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 9 Depression (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 10 Anxiety (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 11 Anxiety (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 12 Sleep (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 13 Sleep (follow‐up).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 14 Self‐perceived changes in overall health (end of treatment).
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 15 Self‐perceived changes in overall health (follow‐up).
![Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 16 Health resource use (follow‐up) [Mean no. of contacts].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-001-16.png)
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 16 Health resource use (follow‐up) [Mean no. of contacts].
![Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 17 Health resource use (follow‐up) [No. of users].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-001-17.png)
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 17 Health resource use (follow‐up) [No. of users].
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 18 Drop‐out.
Comparison 1 Exercise therapy versus treatment as usual, relaxation or flexibility, Outcome 19 Subgroup analysis for fatigue.
Comparison 2 Exercise therapy versus psychological treatment, Outcome 1 Fatigue at end of treatment (FS; 11 items/0 to 33 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 2 Fatigue at follow‐up (FSS; 1 to 7 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 3 Fatigue at follow‐up (FS; 11 items/0 to 33 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 4 Participants with serious adverse reactions.
Comparison 2 Exercise therapy versus psychological treatment, Outcome 5 Pain at follow‐up (BPI, pain severity subscale; 0 to 10 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 6 Pain at follow‐up (BPI, pain interference subscale; 0 to 10 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 7 Physical functioning at end of treatment (SF‐36, physical functioning subscale; 0 to 100 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 8 Physical functioning at follow‐up (SF‐36, physical functioning subscale; 0 to 100 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 9 Depression at end of treatment (HADS depression score; 7 items/21 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 10 Depression at follow‐up (BDI; 0 to 63 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 11 Depression at follow‐up (HADS depression score; 7 items/21 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 12 Anxiety at end of treatment (HADS anxiety; 7 items/21 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 13 Anxiety at follow‐up (BAI; 0 to 63 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 14 Anxiety at follow‐up (HADS anxiety; 7 items/21 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 15 Sleep at end of treatment (Jenkins Sleep Scale; 0 to 20 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 16 Sleep at follow‐up (Jenkins Sleep Scale; 0 to 20 points).
Comparison 2 Exercise therapy versus psychological treatment, Outcome 17 Self‐perceived changes in overall health at end of treatment.
Comparison 2 Exercise therapy versus psychological treatment, Outcome 18 Self‐perceived changes in overall health at follow‐up.
![Comparison 2 Exercise therapy versus psychological treatment, Outcome 19 Health resource use (follow‐up) [Mean no. of contacts].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-002-19.png)
Comparison 2 Exercise therapy versus psychological treatment, Outcome 19 Health resource use (follow‐up) [Mean no. of contacts].
![Comparison 2 Exercise therapy versus psychological treatment, Outcome 20 Health resource use (follow‐up) [No. of users].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-002-20.png)
Comparison 2 Exercise therapy versus psychological treatment, Outcome 20 Health resource use (follow‐up) [No. of users].
Comparison 2 Exercise therapy versus psychological treatment, Outcome 21 Drop‐out.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 1 Fatigue.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 2 Participants with serious adverse reactions.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 3 Physical functioning.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 4 Depression.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 5 Anxiety.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 6 Sleep.
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 7 Self‐perceived changes in overall health.
![Comparison 3 Exercise therapy versus adaptive pacing, Outcome 8 Health resource use (follow‐up) [Mean no. of contacts].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-003-08.png)
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 8 Health resource use (follow‐up) [Mean no. of contacts].
![Comparison 3 Exercise therapy versus adaptive pacing, Outcome 9 Health resource use (follow‐up) [No. of users].](/es/cdsr/doi/10.1002/14651858.CD003200.pub7/media/CDSR/CD003200/rel0007/CD003200/image_n/nCD003200-CMP-003-09.png)
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 9 Health resource use (follow‐up) [No. of users].
Comparison 3 Exercise therapy versus adaptive pacing, Outcome 10 Drop‐out.
Comparison 4 Exercise therapy + antidepressant placebo versus antidepressant + exercise placebo, Outcome 1 Fatigue.
Comparison 4 Exercise therapy + antidepressant placebo versus antidepressant + exercise placebo, Outcome 2 Depression.
Comparison 4 Exercise therapy + antidepressant placebo versus antidepressant + exercise placebo, Outcome 3 Drop‐out.
Comparison 5 Exercise therapy + antidepressant versus antidepressant + exercise placebo, Outcome 1 Fatigue.
Comparison 5 Exercise therapy + antidepressant versus antidepressant + exercise placebo, Outcome 2 Depression.
Comparison 5 Exercise therapy + antidepressant versus antidepressant + exercise placebo, Outcome 3 Drop‐out.
| Exercise therapy for chronic fatigue syndrome | ||||||
| Patient or population: males and females over 18 years of age with chronic fatigue syndrome Intervention: exercise therapy Comparison: standard care, waiting list or relaxation/flexibility | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Exercise | |||||
| Fatiguea: FS, Fatigue Scale (0 to 11 points) (end of treatment) | Mean fatigue in the control groups was 10.4 points | Mean fatigue in the intervention groups was | 148 | ⊕⊕⊝⊝ | Lower score indicates less fatigue | |
| Fatiguea: FS, Fatigue Scale (0 to 33 points) (end of treatment) | Mean fatigue ranged across control groups from 15.3 to 26.3 points | Mean fatigue in the intervention groups was | 540 | ⊕⊕⊕⊝ | Lower score indicates less fatigue | |
| Fatiguea: FS, Fatigue Scale (0 to 42 points) (end of treatment) | Mean fatigue ranged across control groups from 24.4 to 31.6 points | Mean fatigue in the intervention groups was 6.80 points lower (10.31 to 3.28 lower) | 152 | ⊕⊕⊕⊝ | Lower score indicates less fatigue | |
| Participants with serious adverse reactions | Study population | RR 0.99 (0.14 to 6.97) | 319 | ⊕⊕⊕⊝ | ||
| 13 per 1000 | 12 per 1000 | |||||
| Quality of Life (QOL) Scale (16 to 112 points) (follow‐up) | Mean QOL score in the control group was 72 points | Mean QOL score in the intervention groups was 9.00 points lower (19.00 lower to 1.00 higher) | 44 | ⊕⊝⊝⊝ | Higher score indicates improved QOL | |
| Physical functioning: SF‐36 subscale (0 to 100 points) (end of treatment) | Mean physical functioning score ranged from 31.1 to 55.2 points across control groups | Mean physical functioning score in the intervention groups was 13.10 points higher (1.98 to 24.22 higher) | 725 | ⊕⊕⊝⊝ Lowb,g | Higher score indicates improved physical function | |
| Depression: HADS depression score (0 to 21 points) (end of treatment) | Mean depression score ranged across control groups from 5.2 to 11.2 points | Mean depression score in the intervention groups was 1.63 points lower (3.50 lower to 0.23 higher) | 504 | ⊕⊝⊝⊝ | Lower score indicates fewer depressive symptoms | |
| Sleep: Jenkins Sleep Scale (0 to 20 points) (end of treatment) | Mean sleep score ranged across control groups from 11.7 to 12.2 points | Mean sleep score in the intervention groups was | 323 | ⊕⊕⊝⊝ | Lower score indicates improved sleep quality | |
| Self‐perceived changes in overall health (end of treatment) | Study population | RR 1.83 (1.39 to 2.40) | 489 | ⊕⊕⊕⊝ | RR higher than 1 means that more participants in exercise groups reported improvement | |
| 218 per 1000 | 399 per 1000 | |||||
| Medium‐risk population | ||||||
| 238 per 1000 | 436 per 1000 | |||||
| Drop‐out (end of treatment) | Study population | RR 1.63 (0.77 to 3.43) | 843 (6 studies) | ⊕⊕⊝⊝ | RR higher than 1 means that more participants in exercise groups dropped out from treatment | |
| 70 per 1000 | 114 per 1000 (54 to 241) | |||||
| Medium‐risk population | ||||||
| 89 per 1000 | 145 per 1000 (69 to 305) | |||||
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| aWe choose to present effect estimates as measured on the original scales rather than to transform them to standardised units. As 3 different scoring systems for fatigue were used, the outcome is presented over 3 rows. bRisk of bias (‐1): All studies were at risk of performance bias, as they were unblinded. | ||||||
| Study ID | N | Gender | Duration of illness | Depression co‐morbidity | Use of antidepressants (ADs) | Work and employment status |
| 66 | 49F/17M 65% female | 2.7 years | 20 (30%) possible cases of depression (HADS) | 30 (45%) on full‐dose AD (n = 20) or low‐dose AD (n = 10) | 26 (39%) working or studying at least part time | |
| 114 | 95F/19M 83% female | > 5.0 years | 44 (39%) with a current Axis I disorder (depression and anxiety most common) | Not stated | 52 (46%) working or studying at least part time, 24% unemployed, 6% retired, 25% on disability | |
| 49 | 34F/15M 69% female | 3.1 years | 14 (29%) possible or probable cases of depression (HADS) | Not stated | 11 (22%) were unemployed and were unable to work because of disability | |
| 148 | 116F/32M 78% female | 4.3 years | 58 (39%) possible or probable cases of depression (HADS) | 27 (18%) used AD | 50 (34%) were working, 64 (43%) were on disability | |
| 61 | 47F/14M 77% female | Not stated | Not stated | 16 (26%) used AD | Not stated | |
| 136 | 97F/39M 71% female | 2.3 years | 46 (34%) with depressive disorder according to DSM‐III‐R criteria | Not stated | 114 (84%) had recently changed occupation | |
| 296 | 230F/66M 78% female | 7.0 years | 53 (18%) had a depression diagnosis | 160 (54%) were prescribed AD in the past 6 months | Not stated | |
| 641 | 495F/146M 77% female | 2.7 years | 219 (34%) with any depressive disorder | 260 (41%) used AD | Not stated |
| Study ID | Deliverer of intervention | Explanation and materials | Type of exercise | Schedule therapist | Schedule home | Duration of activity | Initial exercise level | Increment steps | Participant self‐monitoring | Criteria for (non)‐increment |
| Exercise physiologist | Verbal explanation of deconditioning and reconditioning | Walking (encouraged to take other modes such as cycling and swimming) | Weekly (1 hour), talking only | 5 days/wk | 5 to 15 minutes increasing to 30 minutes/d | 5 to 15 minutes at 40% of peak O2 consumption (target HR of resting + 50% of HRR) | Duration increased 1 to 2 minutes per week up to 30 minutes; then intensity increased | Ambulatory heart rate monitors | If increased fatigue, continue at the same level for an extra week | |
| Physiotherapist, fitness focus | Minimal explanation; no written materials | Preferred activity (walking/jogging, some did cycling, swimming) | At week 0, 1, 2, 4, 8, 12*, 20, 26*, talking only (*evaluation visits) | 3 days/wk | 20 minutes | 75% of VO2max from bike test | Intensity increased | Borg Exertion Scale chart, before and after HR | Increase if: | |
| Senior clinical therapist | Explanations for GET, circadian dysrhythmia, deconditioning, sleep "educational information pack" | Aerobic exercise; own choice but mostly exercise bike | 9 face‐to‐face (1.5 hours each) | Tailored | Tailored to functional abilities | Tailored to functional abilities: “a level which you are capable of doing on a BAD DAY” | Varying daily increase (e.g. "5 second increase each day for the rest of the second week" to 30 minutes twice/d | Duration of exercise | Discouraged, but restart at lower level and rapidly reincrease | |
| Single physical therapist | Small laminated Borg Scale and heart rate monitor | Walking/jogging, swimming or cycling | Phone contact every 2 weeks | Every second day | From 5 to 15 minutes, increasing to 30 minutes | Initial exercise duration was between 5 and 15 minutes, and intensity was based on the mean HR value achieved midpoint during submaximal exercise tests | Duration increased by 2 to 5 minutes/2 wk | Heart rate monitoring, Borg Exertion Scale | Keep Borg within 11 to 14. Adjust every 2 weeks. Average peak HR when exercising comfortably at a typical day represents patient’s target heart rate (± 3 bpm) for future sessions | |
| Health psychology MSc student, researcher | Focused on the "downward spiral of activity reduction, deconditioning" | Walking (but could also do other preferred exercise, e.g. jogging, swimming) | Weekly for 12 weeks, talking only | 4 to 5 days/wk | Set collaboratively approx 5 to 15 minutes | HR at 40% of VO2max | Duration 3 to 5 minutes/wk Intensity increased after 6 weeks 5 bpm/wk | Ambulatory heart rate monitors | If increased fatigue, continue at the same level for an extra week | |
| Registered nurses supervised by exercise physiologist | "Behavioral goals explained, energy system education, redefining exercise" | "individualized, constructive and pleasurable activities" | Every 2 weeks (45 minutes), 13 sessions | 3 per week | Tailored | Flexibility tests Strength test (hand grip) | "Gradually increasing anaerobic activity levels" | Self‐monitoring daily exercise diary | New targets only after habituation, or if goals achieved for 2 weeks | |
| Nurses with 16 half‐days of training and supervision | Explanation of physiological symptoms and training in first session | Wide choice: walking, stairs, bicycle, dance, jog | 10 sessions over 18 weeks | Several times per day | First 90 minutes, then alternating 60 and 30 minutes | Determined collaboratively with the participant | "Increased very gradually," examples show 50% increase per day | Diary of progress on exercise programme, with note of daily activities | On "bad days," try to do same as day before | |
| Exercise therapist/physiotherapist (8 to 10 days training + ongoing supervision) | 142‐page manual: benefits of exercise and "how to" of GET; some got pedometers | Wide choice: walking, cycling, swimming, Tai Chi. Aim to build into daily activities | Weekly × 4, then fortnightly; total of 15 sessions | 5 to 6 days/wk | Negotiated, goal to get to 30 minutes per session | Test of fitness (step test. and 6‐minute walking test), perceived physical exertion, actigraphy data | "20% increases" per fortnight; increase duration to 30 minutes, then increase intensity | Exercise diary + Borg scale + “Use non‐symptoms to monitor” and heart rate monitor (for intensity increases) | Do not increase if global increase in symptoms | |
| © 9. March 2012, Paul Glasziou, Bond University, Australia | ||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Fatigue (end of treatment) Show forest plot | 7 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.1 Fatigue Scale, FS (11 items/0 to 11 points) | 1 | 148 | Mean Difference (IV, Random, 95% CI) | ‐6.06 [‐6.95, ‐5.17] |
| 1.2 Fatigue Scale, FS (11 items/0 to 33 points) | 3 | 540 | Mean Difference (IV, Random, 95% CI) | ‐2.82 [‐4.07, ‐1.57] |
| 1.3 Fatigue Scale, FS (14 items/0 to 42 points) | 3 | 152 | Mean Difference (IV, Random, 95% CI) | ‐6.80 [‐10.31, ‐3.28] |
| 2 Fatigue (follow‐up) Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2.1 Fatigue Scale, FS (11 items/0 to 11 points) | 1 | 148 | Mean Difference (IV, Random, 95% CI) | ‐7.13 [‐7.97, ‐6.29] |
| 2.2 Fatigue Scale, FS (11 items/0 to 33 points) | 2 | 472 | Mean Difference (IV, Random, 95% CI) | ‐2.87 [‐4.18, ‐1.55] |
| 2.3 Fatigue Severity Scale, FSS (9 items/1 to 7 points) | 1 | 50 | Mean Difference (IV, Random, 95% CI) | 0.15 [‐0.55, 0.85] |
| 3 Participants with serious adverse reactions Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 4 Pain (follow‐up) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.1 Brief Pain Inventory, pain severity subscale (0 to 10 points) | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.2 Brief Pain Inventory, pain interference subscale (0 to 10 points) | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5 Physical functioning (end of treatment) Show forest plot | 5 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 5.1 SF‐36, physical functioning subscale (0 to 100 points) | 5 | 725 | Mean Difference (IV, Random, 95% CI) | ‐13.10 [‐24.22, ‐1.98] |
| 6 Physical functioning (follow‐up) Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 6.1 SF‐36, physical functioning subscale (0 to 100 points) | 3 | 621 | Mean Difference (IV, Random, 95% CI) | ‐16.33 [‐36.74, 4.08] |
| 7 Quality of life (follow‐up) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 7.1 Quality of Life Scale (16 to 112 points) | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8 Depression (end of treatment) Show forest plot | 5 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.1 HADS, depression score (7 items/21 points) | 5 | 504 | Mean Difference (IV, Random, 95% CI) | ‐1.63 [‐3.50, 0.23] |
| 9 Depression (follow‐up) Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 9.1 Beck Depression Inventory (0 to 63 points) | 1 | 45 | Mean Difference (IV, Random, 95% CI) | 3.44 [‐1.00, 9.88] |
| 9.2 HADS, depression subscale (0 to 21 points) | 3 | 609 | Mean Difference (IV, Random, 95% CI) | ‐2.26 [‐5.09, 0.56] |
| 10 Anxiety (end of treatment) Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 10.1 HADS, anxiety score (0 to 21 points) | 3 | 387 | Mean Difference (IV, Random, 95% CI) | ‐1.48 [‐3.58, 0.61] |
| 11 Anxiety (follow‐up) Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 11.1 Beck Anxiety Inventory (0 to 63 points) | 1 | 45 | Mean Difference (IV, Random, 95% CI) | 0.70 [‐4.52, 5.92] |
| 11.2 HADS, anxiety score (0 to 21 points) | 3 | 607 | Mean Difference (IV, Random, 95% CI) | ‐1.01 [‐2.75, 0.74] |
| 12 Sleep (end of treatment) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 12.1 Jenkins Sleep Scale (0 to 20 points) | 2 | 323 | Mean Difference (IV, Random, 95% CI) | ‐1.49 [‐2.95, ‐0.02] |
| 13 Sleep (follow‐up) Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 13.1 Jenkins Sleep Scale (0 to 20 points) | 3 | 610 | Mean Difference (IV, Random, 95% CI) | ‐2.04 [‐3.84, ‐0.23] |
| 14 Self‐perceived changes in overall health (end of treatment) Show forest plot | 4 | 489 | Risk Ratio (M‐H, Random, 95% CI) | 1.83 [1.39, 2.40] |
| 15 Self‐perceived changes in overall health (follow‐up) Show forest plot | 3 | 518 | Risk Ratio (M‐H, Random, 95% CI) | 1.88 [0.76, 4.64] |
| 16 Health resource use (follow‐up) [Mean no. of contacts] Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 16.1 Primary care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.2 Other doctor | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.3 Healthcare professional | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.4 Inpatient | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.5 Accident and emergency | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.6 Other health/social services | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.7 Complementary health care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.8 Standardised medical care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17 Health resource use (follow‐up) [No. of users] Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 17.1 Primary care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.2 Other doctor | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.3 Healthcare professional | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.4 Inpatient | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.5 Accident and emergency | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.6 Medication | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.7 Complementary health care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.8 Other health/social services | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17.9 Standardised medical care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 18 Drop‐out Show forest plot | 6 | 843 | Risk Ratio (M‐H, Random, 95% CI) | 1.63 [0.77, 3.43] |
| 19 Subgroup analysis for fatigue Show forest plot | 7 | 840 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.68 [‐1.02, ‐0.35] |
| 19.1 Graded exercise therapy | 6 | 779 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.71 [‐1.09, ‐0.32] |
| 19.2 Exercise with self‐pacing | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.54 [‐1.05, ‐0.02] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Fatigue at end of treatment (FS; 11 items/0 to 33 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Fatigue at follow‐up (FSS; 1 to 7 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 2.1 CT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 2.2 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3 Fatigue at follow‐up (FS; 11 items/0 to 33 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 4 Participants with serious adverse reactions Show forest plot | 2 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 4.1 CBT | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.2 Suportive listening | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5 Pain at follow‐up (BPI, pain severity subscale; 0 to 10 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.2 CT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6 Pain at follow‐up (BPI, pain interference subscale; 0 to 10 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6.2 CT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 7 Physical functioning at end of treatment (SF‐36, physical functioning subscale; 0 to 100 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 7.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 7.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8 Physical functioning at follow‐up (SF‐36, physical functioning subscale; 0 to 100 points) Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 8.1 CBT | 2 | 348 | Mean Difference (IV, Random, 95% CI) | 7.92 [‐9.79, 25.63] |
| 8.2 CT | 1 | 47 | Mean Difference (IV, Random, 95% CI) | 21.37 [6.61, 36.13] |
| 8.3 Supportive listening | 1 | 171 | Mean Difference (IV, Random, 95% CI) | ‐7.55 [‐15.57, 0.47] |
| 9 Depression at end of treatment (HADS depression score; 7 items/21 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 9.1 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 10 Depression at follow‐up (BDI; 0 to 63 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 10.1 CT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 10.2 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 11 Depression at follow‐up (HADS depression score; 7 items/21 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 11.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 11.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 12 Anxiety at end of treatment (HADS anxiety; 7 items/21 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 12.1 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 13 Anxiety at follow‐up (BAI; 0 to 63 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 13.1 CT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 13.2 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 14 Anxiety at follow‐up (HADS anxiety; 7 items/21 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 14.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 14.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 15 Sleep at end of treatment (Jenkins Sleep Scale; 0 to 20 points) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 15.1 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16 Sleep at follow‐up (Jenkins Sleep Scale; 0 to 20 points) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 16.1 CBT | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 16.2 Supportive listening | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 17 Self‐perceived changes in overall health at end of treatment Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 17.1 CBT | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 18 Self‐perceived changes in overall health at follow‐up Show forest plot | 2 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 18.1 CT | 1 | 50 | Risk Ratio (M‐H, Random, 95% CI) | 0.63 [0.36, 1.10] |
| 18.2 CBT | 2 | 368 | Risk Ratio (M‐H, Random, 95% CI) | 0.71 [0.33, 1.54] |
| 19 Health resource use (follow‐up) [Mean no. of contacts] Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 19.1 Primary care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.2 Other doctor | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.3 Healthcare professional | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.4 Inpatient | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.5 Accident and emergency | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.6 Other health/social services | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.7 Complementary health care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 19.8 Standardised medical care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20 Health resource use (follow‐up) [No. of users] Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 20.1 Primary care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.2 Other doctor | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.3 Healthcare professional | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.4 Inpatient | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.5 Accident and emergency | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.6 Medication | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.7 Complementary health care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.8 Other health/social services | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 20.9 Standardised medical care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 21 Drop‐out Show forest plot | 2 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 21.1 CBT | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 21.2 Supportive listening | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Fatigue Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.1 Fatigue Scale, FS (11 items/33 points)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 1.2 Fatigue Scale, FS (11 items/33 points)—follow‐up | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Participants with serious adverse reactions Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 3 Physical functioning Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1 SF‐36, physical functioning subscale (0 to 100)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3.2 SF‐36, physical functioning subscale (0 to 100)—follow‐up | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 4 Depression Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.1 HADS, depression score (7 items/21 points)—follow‐up | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5 Anxiety Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.1 HADS, anxiety score (0 to 21 points)—follow‐up | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6 Sleep Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6.1 Jenkins Sleep Scale (0 to 20 points)—follow‐up | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 7 Self‐perceived changes in overall health Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 7.1 End of treatment | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 7.2 Follow‐up | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8 Health resource use (follow‐up) [Mean no. of contacts] Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 8.1 Primary care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.2 Other doctor | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.3 Healthcare professional | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.4 Inpatient | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.5 Accident and emergency | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.6 Other health/social services | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.7 Complementary health care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 8.8 Standardised medical care | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9 Health resource use (follow‐up) [No. of users] Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 9.1 Primary care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.2 Other doctor | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.3 Healthcare professional | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.4 Inpatient | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.5 Accident and emergency | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.6 Medication | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.7 Complementary health care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.8 Other health/social services | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 9.9 Standardised medical care | 1 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 10 Drop‐out Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Fatigue Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.1 Fatigue Scale, FS (14 items/0 to 42 points)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Depression Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 2.1 HADS, depression score (7 items/21 points)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3 Drop‐out Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Fatigue Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.1 Fatigue Scale, FS (14 items/0 to 42 points)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Depression Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 2.1 HADS, depression score (7 items/21 points)—end of treatment | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3 Drop‐out Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
