Internet Therapy 'Highly Effective' for Teen Chronic Fatigue

Caroline Cassels

February 29, 2012

February 29, 2012 — A novel, Internet-based therapy offers a readily accessible and "highly effective" treatment for adolescents with chronic fatigue syndrome (CFS), new research shows.

A new Internet-based therapeutic program for adolescents with the disorder showed that after 6 months of treatment, 63% of teens receiving the Fatigue In Teenagers on the Internet (FITNET) intervention reported they had "recovered" — an almost 8-fold increase over their counterparts receiving usual care.

"With FITNET, effective treatment is within reach for any adolescent with chronic fatigue syndrome. These findings stress the need for proper and rapid diagnosis and making medical professionals aware of adolescent chronic fatigue syndrome and the treatment options," the study's lead author, Sanne Nijhof, MD, from the University Medical Centre Utrecht in the Netherlands, said in a release.

The study is published online March 1 in the Lancet.

Limited Treatment Options

Also known as myalgic encephalomyelitis, CFS is characterized by disabling persistent or relapsing severe unexplained fatigue that lasts longer than 6 months. It is accompanied by other symptoms, including muscle pain and poor concentration, and is a common cause of long-term absence from school in this population.

The prevalence of CFS in teens is estimated to be between 0.11% and 1.29%. Females are more frequently affected.

Treatment options are limited, and although cognitive behavioral therapy (CBT) has shown promise for the disorder, its availability is restricted owing to a lack of specialist therapists.

The researchers hypothesized that Internet-based CBT might improve access to treatment because it has been shown to be effective in patients with other types of illnesses, although mainly in adults.

FITNET was developed by the investigators as a comprehensive Internet-based application based on existing protocols and a theoretical model of effective face-to-face CBT for adolescents with CFS.

For the study, researchers recruited 135 adolescents aged 12 to 18 years who had had a diagnosis of CFS for almost 2 years. Of these participants, 68 were randomly assigned to receive FITNET, and 67 were randomly assigned to receive usual care, which involved individual or group CBT or graded exercise therapy.

The study's primary outcome measures were school attendance, fatigue severity, and physical functioning. These outcome measures were assessed at 6 months with computerized questionnaires.

At 6 months, 85% of adolescents in the FITNET group reported an absence of severe fatigue compared with 27% of those receiving usual care (relative risk [RR], 3.2; 95% confidence interval [CI], 2.1 - 4.9; P < .0001). Furthermore, 78% of participants receiving FITNET reported normal physical functioning vs 20% of participants receiving usual care (RR, 3.8; 95% CI, 2.3 - 6.3; P < .0001). Full school attendance was attained by 75% of participants receiving FITNET vs 16% of participants receiving usual care (RR, 4.8; 95% CI, 2.7 - 8.9; P < .0001). No serious adverse events were reported.

Importantly, the authors note, teens who continued FITNET treatment or switched to FITNET from usual care reported similar success at 12 months, confirming, the investigators write, the program's "intrinsic effectiveness."

Broader Implementation Warranted

Web-based treatment, the authors note, has general advantages. It is available at any time and avoids face-to-face treatment barriers, including treatment delays due to poor accessibility, inconvenience of scheduling appointments, missing school or work, and travelling to or from a clinician's office. In addition, they note, it reduces treatment time and costs.

"FITNET offers a readily accessible and highly effective treatment for adolescents with chronic fatigue syndrome. The results of this study justify implementation on a broader scale," they add.

In an accompanying editorial, psychiatrist Peter White, MD, from Queen Mary University School of London, United Kingdom, and Trudie Chalder, PhD, from King's College London, note that the researchers "should be congratulated on testing a way to deliver an already effective treatment more efficiently."

"An accessible and flexible treatment for adolescents is most welcome.... They have added to an increasing evidence base which shows that therapist-aided, internet-based cognitive behavioural therapy is an effective treatment for many similar disorders," they add.

The authors, Dr. White, and Dr. Chalder have disclosed no relevant financial relationships.

Lancet. Published online March 1, 2012.


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