Chronic fatigue syndrome is an important cause of long- term absence from school. It is consequently a disorder that can severely disrupt the lives of adolescents, hindering their education as well as isolating them from friends and social activities.
Current care for chronic fatigue syndrome involves face-to-face Cognitive Behavioural Therapy (CBT) but it can be hard to deliver to all those who could benefit from it. The challenge in treating chronic fatigue syndrome is therefore to provide a treatment that has both a high success rate and easy delivery to patients who need it.
Nijhof et al’s paper, published recently in The Lancet, has sought to address this issue by devising an internet-based CBT package for chronic fatigue syndrome in adolescents called FITNET. FITNET was provided via a web portal, which both the participants and their parents had access to. There were then 21 CBT-based modules for the participants to complete, while there were also a group of trained therapists on hand to answer queries from participants, who could email them at any time (e-consultations) and especially in emergencies. There were also diaries and reviews of completed modules. The primary objective of the study was school attendance, while self-reported recovery was the secondary outcome. Participants were followed up over a period of 12 months. At both 6 and 12 months, participants on the FITNET program showed significant improvement compared to those under usual care.
The study showed impressive results, with significant improvements in school attendance, physical function, and the presence of severe fatigue, an effect that was sustained over the 12 month period. Overall, 63% of participants involved in the FITNET scheme were reported to have recovered, compared to only 8% in usual care—a success rate for FITNET that is a staggering eight times higher. These results seem to show that FITNET is vastly superior to usual care as a treatment for chronic fatigue syndrome.
But why is there such a huge difference in the results? The most obvious difference is the delivery of the treatment: FITNET is internet- based whereas usual care involves face-to-face therapy. By delivering online, FITNET is able to deliver a much higher dose of treatment to participants: indeed, they and their parents logged onto FITNET a mean number of 255 times; adolescents sent a mean number of 66.6 e-consultations, whilst their parents sent a mean of 22.8. It is therefore able to provide a more supportive care structure with participants receiving more treatment more often (it is certainly impossible to make an equivalent number of face-to-face appointments in a year). It could also be argued that providing treatment over the internet appeals more to the modern adolescent, who is comfortable working on computers and that FITNET removes any of the barriers of face-to-face treatment. The involvement of parents and availability of the service 24 hours a day is also potentially advantageous, although no data is provided to back this up.
This paper is certainly not without problems. The authors could have provided more detail about the treatment received by the usual care group, making comparisons difficult, and the authors also admit that ‘there is no universal definition of recovery in patients with chronic fatigue syndrome during therapy’, which certainly makes the figure of 63% recovery in patients more open to discussion. However, overall this is an intriguing paper that has taken a novel approach to treating chronic fatigue syndrome, with good results. Perhaps internet-based therapies and digital doctors are the future for delivery of CBT.
Tom Fletcher was born in London. He graduated from UCL with a BSc in Biomedical Sciences having specialised in Psychopharmacology and Neuroscience . He writes the blog ‘Why Science isn’t Boring’ which simplifys new research for non-scientists