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

Anthonie Janse, Arno van Dam, Coby Pijpers, Jan F. Wiborg, Gijs Bleijenberg, Marcia Tummers, Jos Twisk, Stephanie Nikolaus, Hans Knoop

Research output: Contribution to journalArticleAcademicpeer-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
JournalBehavioural and Cognitive Psychotherapy
DOIs
Publication statusPublished - 2019

Cite this

Janse, Anthonie ; van Dam, Arno ; Pijpers, Coby ; Wiborg, Jan F. ; Bleijenberg, Gijs ; Tummers, Marcia ; Twisk, Jos ; Nikolaus, Stephanie ; Knoop, Hans. / 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.
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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.",
author = "Anthonie Janse and {van Dam}, Arno and Coby Pijpers and Wiborg, {Jan F.} and Gijs Bleijenberg and Marcia Tummers and Jos Twisk and Stephanie Nikolaus and Hans Knoop",
year = "2019",
doi = "10.1017/S1352465819000110",
language = "English",
journal = "Behavioural and Cognitive Psychotherapy",
issn = "1352-4658",
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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, Anthonie; van Dam, Arno; Pijpers, Coby; Wiborg, Jan F.; Bleijenberg, Gijs; Tummers, Marcia; Twisk, Jos; Nikolaus, Stephanie; Knoop, Hans.

In: Behavioural and Cognitive Psychotherapy, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - 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

AU - Janse, Anthonie

AU - van Dam, Arno

AU - Pijpers, Coby

AU - Wiborg, Jan F.

AU - Bleijenberg, Gijs

AU - Tummers, Marcia

AU - Twisk, Jos

AU - Nikolaus, Stephanie

AU - Knoop, Hans

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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UR - https://www.ncbi.nlm.nih.gov/pubmed/30859928

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