Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis

T A Kuut; L M Buffart; A M J Braamse; I Csorba; G Bleijenberg; P Nieuwkerk; R Moss-Morris; F Müller; H Knoop

doi:10.1017/S0033291723003148

Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis

Psychol Med. 2024 Feb;54(3):447-456. doi: 10.1017/S0033291723003148. Epub 2023 Nov 6.

Authors

T A Kuut^{1

2}, L M Buffart³, A M J Braamse^{1

2}, I Csorba^{1

2}, G Bleijenberg⁴, P Nieuwkerk^{1

2}, R Moss-Morris⁵, F Müller^{1

2}, H Knoop^{1

2}

Affiliations

¹ Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
² Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.

PMID: 37927223
DOI: 10.1017/S0033291723003148

Abstract

Debate is ongoing on the efficacy of cognitive behavior therapy (CBT) for myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). With an individual patient data (IPD) meta-analysis we investigated whether the effect of CBT varied by patient characteristics. These included post-exertional malaise (PEM), a central feature of ME/CFS according to many. We searched for randomized controlled trials similar with respect to comparison condition, outcomes and treatment-protocol. Moderation on fatigue severity (Checklist Individual Strength, subscale fatigue severity), functional impairment (Sickness Impact Profile-8) and physical functioning (Short Form-36, subscale physical functioning) was investigated using linear mixed model analyses and interaction tests. PROSPERO (CRD42022358245). Data from eight trials (n = 1298 patients) were pooled. CBT showed beneficial effects on fatigue severity (β = -11.46, 95% CI -15.13 to -7.79); p < 0.001, functional impairment (β = -448.40, 95% CI -625.58 to -271.23); p < 0.001; and physical functioning (β = 9.64, 95% CI 3.30 to 15.98); p < 0.001. The effect of CBT on fatigue severity varied by age (p_interaction = 0.003), functional impairment (p_interaction = 0.045) and physical activity pattern (p_interaction = 0.027). Patients who were younger, reported less functional impairments and had a fluctuating activity pattern benefitted more. The effect on physical functioning varied by self-efficacy (p_interaction = 0.025), with patients with higher self-efficacy benefitting most. No other moderators were found. It can be concluded from this study that CBT for ME/CFS can lead to significant reductions of fatigue, functional impairment, and physical limitations. There is no indication patients meeting different case definitions or reporting additional symptoms benefit less from CBT. Our findings do not support recent guidelines in which evidence from studies not mandating PEM was downgraded.

Keywords: chronic fatigue syndrome; cognitive behavior therapy; meta-analysis; moderation; patient characteristics.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Cognitive Behavioral Therapy* / methods
Exercise
Exercise Therapy / methods
Fatigue Syndrome, Chronic* / therapy
Humans