The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial

L Akker, H Beckerman, E H Collette, J Twisk, G Blijenberg, H Knoop, J Dekker, V Groot

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: MS-related fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation. Literature suggests that Cognitive Behavioral Therapy (CBT) alleviates MS-related fatigue, but evidence is inconclusive. The study objective was to evaluate the effectiveness of CBT to improve MS-related fatigue and participation in patients with MS. Methods: In a multicenter, assessor-masked, randomized-controlled trial in 3 Dutch healthcare institutions, participants with severe MS-related fatigue were assigned to the CBT or control study group. The CBT study group received twelve individual face-to-face sessions with a certified psychologist; the control study group received 3 individual sessions with an MS-nurse, both for a duration of 16 weeks. Assessments took place at baseline, 8, 16 (i.e. post-intervention), 26 and 52 weeks follow-up. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r-fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed with the intention-to-treat principle using Mixed Model Analysis. The Controlled Trials registration number is ISRCTN58583714. Findings: Between December 2011 and August 2014, 91 patients were randomly assigned to the CBT (n=44) or to the MS-nurse study group (n=47). The between-group analysis showed a positive post-intervention effect for CBT on the CIS20r-fatigue (T16: -6*7 [95%CI -10*7; -2*7] points) that diminished during follow up (T26: -3*5 [95%CI -7*4; 0*5]; T52: 0*5 [95%CI -3*6; 4*4]). No clinically relevant effects were found on societal participation. Post-intervention (T16), 22 out of 39 in the CBT, and 9 out of 37 patients in the control study group showed a clinically-relevant improvement of 8-points or more on the CIS20r-fatigue, leading to a number needed to treat of 3*3 (95%CI 1*9;10*6). Interpretation: Severe MS-related fatigue can be reduced effectively with CBT. However, effects wear off after cessation of treatment, societal participation does not improve
Original languageEnglish
Pages (from-to)395-396
Number of pages2
JournalMultiple Sclerosis
VolumeConference
Publication statusPublished - 2016

Cite this

Akker, L ; Beckerman, H ; Collette, E H ; Twisk, J ; Blijenberg, G ; Knoop, H ; Dekker, J ; Groot, V. / The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial. In: Multiple Sclerosis. 2016 ; Vol. Conference. pp. 395-396.
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title = "The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial",
abstract = "Background: MS-related fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation. Literature suggests that Cognitive Behavioral Therapy (CBT) alleviates MS-related fatigue, but evidence is inconclusive. The study objective was to evaluate the effectiveness of CBT to improve MS-related fatigue and participation in patients with MS. Methods: In a multicenter, assessor-masked, randomized-controlled trial in 3 Dutch healthcare institutions, participants with severe MS-related fatigue were assigned to the CBT or control study group. The CBT study group received twelve individual face-to-face sessions with a certified psychologist; the control study group received 3 individual sessions with an MS-nurse, both for a duration of 16 weeks. Assessments took place at baseline, 8, 16 (i.e. post-intervention), 26 and 52 weeks follow-up. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r-fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed with the intention-to-treat principle using Mixed Model Analysis. The Controlled Trials registration number is ISRCTN58583714. Findings: Between December 2011 and August 2014, 91 patients were randomly assigned to the CBT (n=44) or to the MS-nurse study group (n=47). The between-group analysis showed a positive post-intervention effect for CBT on the CIS20r-fatigue (T16: -6*7 [95{\%}CI -10*7; -2*7] points) that diminished during follow up (T26: -3*5 [95{\%}CI -7*4; 0*5]; T52: 0*5 [95{\%}CI -3*6; 4*4]). No clinically relevant effects were found on societal participation. Post-intervention (T16), 22 out of 39 in the CBT, and 9 out of 37 patients in the control study group showed a clinically-relevant improvement of 8-points or more on the CIS20r-fatigue, leading to a number needed to treat of 3*3 (95{\%}CI 1*9;10*6). Interpretation: Severe MS-related fatigue can be reduced effectively with CBT. However, effects wear off after cessation of treatment, societal participation does not improve",
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author = "L Akker and H Beckerman and Collette, {E H} and J Twisk and G Blijenberg and H Knoop and J Dekker and V Groot",
year = "2016",
language = "English",
volume = "Conference",
pages = "395--396",
journal = "Multiple Sclerosis",
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Akker, L, Beckerman, H, Collette, EH, Twisk, J, Blijenberg, G, Knoop, H, Dekker, J & Groot, V 2016, 'The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial' Multiple Sclerosis, vol. Conference, pp. 395-396.

The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial. / Akker, L; Beckerman, H; Collette, E H; Twisk, J; Blijenberg, G; Knoop, H; Dekker, J; Groot, V.

In: Multiple Sclerosis, Vol. Conference, 2016, p. 395-396.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The positive effect of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: results of a randomized controlled trial

AU - Akker, L

AU - Beckerman, H

AU - Collette, E H

AU - Twisk, J

AU - Blijenberg, G

AU - Knoop, H

AU - Dekker, J

AU - Groot, V

PY - 2016

Y1 - 2016

N2 - Background: MS-related fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation. Literature suggests that Cognitive Behavioral Therapy (CBT) alleviates MS-related fatigue, but evidence is inconclusive. The study objective was to evaluate the effectiveness of CBT to improve MS-related fatigue and participation in patients with MS. Methods: In a multicenter, assessor-masked, randomized-controlled trial in 3 Dutch healthcare institutions, participants with severe MS-related fatigue were assigned to the CBT or control study group. The CBT study group received twelve individual face-to-face sessions with a certified psychologist; the control study group received 3 individual sessions with an MS-nurse, both for a duration of 16 weeks. Assessments took place at baseline, 8, 16 (i.e. post-intervention), 26 and 52 weeks follow-up. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r-fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed with the intention-to-treat principle using Mixed Model Analysis. The Controlled Trials registration number is ISRCTN58583714. Findings: Between December 2011 and August 2014, 91 patients were randomly assigned to the CBT (n=44) or to the MS-nurse study group (n=47). The between-group analysis showed a positive post-intervention effect for CBT on the CIS20r-fatigue (T16: -6*7 [95%CI -10*7; -2*7] points) that diminished during follow up (T26: -3*5 [95%CI -7*4; 0*5]; T52: 0*5 [95%CI -3*6; 4*4]). No clinically relevant effects were found on societal participation. Post-intervention (T16), 22 out of 39 in the CBT, and 9 out of 37 patients in the control study group showed a clinically-relevant improvement of 8-points or more on the CIS20r-fatigue, leading to a number needed to treat of 3*3 (95%CI 1*9;10*6). Interpretation: Severe MS-related fatigue can be reduced effectively with CBT. However, effects wear off after cessation of treatment, societal participation does not improve

AB - Background: MS-related fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation. Literature suggests that Cognitive Behavioral Therapy (CBT) alleviates MS-related fatigue, but evidence is inconclusive. The study objective was to evaluate the effectiveness of CBT to improve MS-related fatigue and participation in patients with MS. Methods: In a multicenter, assessor-masked, randomized-controlled trial in 3 Dutch healthcare institutions, participants with severe MS-related fatigue were assigned to the CBT or control study group. The CBT study group received twelve individual face-to-face sessions with a certified psychologist; the control study group received 3 individual sessions with an MS-nurse, both for a duration of 16 weeks. Assessments took place at baseline, 8, 16 (i.e. post-intervention), 26 and 52 weeks follow-up. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r-fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed with the intention-to-treat principle using Mixed Model Analysis. The Controlled Trials registration number is ISRCTN58583714. Findings: Between December 2011 and August 2014, 91 patients were randomly assigned to the CBT (n=44) or to the MS-nurse study group (n=47). The between-group analysis showed a positive post-intervention effect for CBT on the CIS20r-fatigue (T16: -6*7 [95%CI -10*7; -2*7] points) that diminished during follow up (T26: -3*5 [95%CI -7*4; 0*5]; T52: 0*5 [95%CI -3*6; 4*4]). No clinically relevant effects were found on societal participation. Post-intervention (T16), 22 out of 39 in the CBT, and 9 out of 37 patients in the control study group showed a clinically-relevant improvement of 8-points or more on the CIS20r-fatigue, leading to a number needed to treat of 3*3 (95%CI 1*9;10*6). Interpretation: Severe MS-related fatigue can be reduced effectively with CBT. However, effects wear off after cessation of treatment, societal participation does not improve

KW - Checklist

KW - Checklist Individual Strength fatigue subscale

KW - Fatigue

KW - ISRCTN58583714

KW - Impact on Participation and Autonomy

KW - Impact on Participation and Autonomy questionnaire

KW - Multiple Sclerosis

KW - Patients

KW - Sclerosis

KW - analysis

KW - clinical trial

KW - cognitive behavioral therapy

KW - comparative effectiveness

KW - controlled clinical trial

KW - controlled study

KW - follow up

KW - human

KW - major clinical study

KW - methods

KW - model

KW - multicenter study

KW - nurse

KW - patient

KW - psychologist

KW - questionnaire

KW - randomized controlled trial

KW - registration

KW - registration DOI: 10.1177/1352458516663081

KW - study

KW - symptom

KW - therapy

M3 - Article

VL - Conference

SP - 395

EP - 396

JO - Multiple Sclerosis

JF - Multiple Sclerosis

SN - 1352-4585

ER -