Research theme 3: Education

The only evidence-based management strategies for chronic fatigue states are cognitive behavioural therapy (CBT),^1,2 graded exercise therapy (GET),^1,3  and cognitive retraining (referred to here as cognitive exercise therapy; CET).^1,4  These interventions aim to gain better control of symptoms, and to improve the functional capacity of patients with chronic fatigue states.

The key healthcare providers for the safe and effective implementation of these interventions for patients with chronic fatigue states are allied health professionals, such as clinical psychologists, exercise physiologists, physiotherapists, and occupational therapists. Yet uptake of these evidence-based management programs by allied health professionals is low,⁵ which is likely to reflect allied health professionals lacking the knowledge and skills to provide appropriate care, and potentially also the negative effects of the controversy regarding the PACE trial.⁶ To resolve this knowledge and skills gap, our research team has developed an online training program and evaluated the efficacy in a randomised controlled trial.⁷ The online learning activity was well accepted, adhered to and was effective in increasing knowledge and confidence of allied health professionals in the management of chronic fatigue states (awaiting publication).

For patients, implementing CBT / GET / CET requires significant regular dialogue with clinicians regarding the biological basis of the illness and the evidence-based approaches to managing fatigue. Typically, these conversations are supported by education materials, such as the paper-based education information booklet currently provided to patients attending the UNSW Fatigue Clinic. Making these education resources in an online format and therefore more widely available to patients with chronic fatigue states, and with some capacity to identify the most relevant aspects of the education resources for each individual, may enhance the effectiveness and reach of CBT/GET/CET interventions. These resources are under development and evaluation.

¹  _{Sandler CX, Lloyd AR. Chronic fatigue syndrome: progress and possibilities? Medical Journal of Australia 2020; in press. Accepted mja19.00733.R2 (21.11.2019).}

²  _{Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews. 2008 Jul 16;(3):CD001027.}

³  _{Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews. 2019 Oct 2;10:CD003200.}

⁴  _{McBride RL, Horsfield S, Sandler CX, Cassar J, Casson S, Cvejic E, Vollmer-Conna U, Lloyd AR. Cognitive remediation training improves performance in patients with chronic fatigue syndrome. Psychiatry Research. 2017 Nov;257:400-405.}

⁵  _{Broughton J, Harris S, Beasant , Crawley E2, Collin SM. Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England. BMC Health Services Research. 2017 Jun 2;17(1):384.}

⁶  _{Petrie KJ, Weinman J. The PACE trial: It's time to broaden perceptions and move on. Journal of Health Psychology. 2017 Aug;22(9):1198-1200.}

⁷  _{Li, S. H., Sandler, C. X., Casson, S. M., Cassar, J., Bogg, T., Lloyd, A. R., & Barry, B. K. Randomised controlled trial of online continuing education for health professionals to improve the management of chronic fatigue syndrome: A study protocol. BMJ Open. 2017 7(5), e014133.}