Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care

Outcomes at post-treatment and long-term follow-up

A. Janse, A. van Dam, C. Pijpers, J. Wiborg, G. Bleijenberg, M. Tummers, J. Twisk, S. Nikolaus, H. Knoop

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background:Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.Aims:(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.Method:An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.Results:Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).Conclusion:Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.
Original languageEnglish
Pages (from-to)548-558
JournalBehavioural and Cognitive Psychotherapy
Volume47
Issue number5
DOIs
Publication statusPublished - 2019

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Chronic Fatigue Syndrome
Mental Health
Delivery of Health Care
Community Mental Health Centers

Keywords

  • ACCESS
  • COGNITIVE-BEHAVIOR THERAPY
  • DISORDERS
  • PAIN
  • RECOVERY
  • SF-36
  • chronic fatigue syndrome
  • cognitive behavioural therapy
  • implementation
  • minimal intervention
  • stepped care

Cite this

Janse, A. ; van Dam, A. ; Pijpers, C. ; Wiborg, J. ; Bleijenberg, G. ; Tummers, M. ; Twisk, J. ; Nikolaus, S. ; Knoop, H. / Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care : Outcomes at post-treatment and long-term follow-up. In: Behavioural and Cognitive Psychotherapy. 2019 ; Vol. 47, No. 5. pp. 548-558.
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title = "Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care: Outcomes at post-treatment and long-term follow-up",
abstract = "Background:Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.Aims:(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.Method:An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.Results:Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78{\%}) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).Conclusion:Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.",
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Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care : Outcomes at post-treatment and long-term follow-up. / Janse, A.; van Dam, A.; Pijpers, C.; Wiborg, J.; Bleijenberg, G.; Tummers, M.; Twisk, J.; Nikolaus, S.; Knoop, H.

In: Behavioural and Cognitive Psychotherapy, Vol. 47, No. 5, 2019, p. 548-558.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care

T2 - Outcomes at post-treatment and long-term follow-up

AU - Janse, A.

AU - van Dam, A.

AU - Pijpers, C.

AU - Wiborg, J.

AU - Bleijenberg, G.

AU - Tummers, M.

AU - Twisk, J.

AU - Nikolaus, S.

AU - Knoop, H.

PY - 2019

Y1 - 2019

N2 - Background:Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.Aims:(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.Method:An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.Results:Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).Conclusion:Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.

AB - Background:Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated.Aims:(1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre.Method:An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis.Results:Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1–6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01).Conclusion:Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.

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KW - COGNITIVE-BEHAVIOR THERAPY

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KW - PAIN

KW - RECOVERY

KW - SF-36

KW - chronic fatigue syndrome

KW - cognitive behavioural therapy

KW - implementation

KW - minimal intervention

KW - stepped care

U2 - 10.1017/S1352465819000110

DO - 10.1017/S1352465819000110

M3 - Article

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SP - 548

EP - 558

JO - Behavioural and Cognitive Psychotherapy

JF - Behavioural and Cognitive Psychotherapy

SN - 1469-1833

IS - 5

ER -