Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial
Open accessAbstract
Background Trial findings show cognitive behaviour therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome, but patients' organisations have reported that these treatments can be harmful and favour pacing and specialist health care. We aimed to assess effectiveness and safety of all four treatments.Methods In our parallel-group randomised trial, patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive specialist medical care (SMC) alone or with adaptive pacing therapy (APT), CBT, or GET. Primary outcomes were fatigue (measured by Chalder fatigue questionnaire score) and physical function (measured by short form-36 subscale score) up to 52 weeks after randomisation, and safety was assessed primarily by recording all serious adverse events, including serious adverse reactions to trial treatments. Primary outcomes were rated by participants, who were necessarily unmasked to treatment assignment; the statistician was masked to treatment assignment for the analysis of primary outcomes. We used longitudinal regression models to compare SMC alone with other treatments, APT with CBT, and APT with GET. The final analysis included all participants for whom we had data for primary outcomes. This trial is registered at http://isrctn.org, number ISRCTN54285094.Findings We recruited 641 eligible patients, of whom 160 were assigned to the APT group, 161 to the CBT group, 160 to the GET group, and 160 to the SMC-alone group. Compared with SMC alone, mean fatigue scores at 52 weeks were 3·4 (95% CI 1·8 to 5·0) points lower for CBT (p = 0·0001) and 3·2 (1·7 to 4·8) points lower for GET (p = 0·0003), but did not differ for APT (0·7 [-0·9 to 2·3] points lower; p = 0·38). Compared with SMC alone, mean physical function scores were 7·1 (2·0 to 12·1) points higher for CBT (p = 0·0068) and 9·4 (4·4 to 14·4) points higher for GET (p = 0·0005), but did not differ for APT (3·4 [-1·6 to 8·4] points lower; p=0·18). Compared with APT, CBT and GET were associated with less fatigue (CBT p = 0·0027; GET p = 0·0059) and better physical function (CBT p=0·0002; GET p<0·0001). Subgroup analysis of 427 participants meeting international criteria for chronic fatigue syndrome and 329 participants meeting London criteria for myalgic encephalomyelitis yielded equivalent results. Serious adverse reactions were recorded in two (1%) of 159 participants in the APT group, three (2%) of 161 in the CBT group, two (1%) of 160 in the GET group, and two (1%) of 160 in the SMC-alone group.Interpretation CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome, but APT is not an effective addition.Funding UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions.
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Cognitive-behavioural therapy (CBT) has been shown to reduce symptoms and increase functioning in adults with FSS.
“Cognitive–behavioural therapy (CBT) has been shown to reduce symptoms and increase functioning in adults with FSS,27–30”
From Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial (2016) · cites this paper as [28]
The Results report less fatigue and better physical function after CBT than after specialist medical care alone in adults with chronic fatigue syndrome. The trial studied chronic fatigue syndrome specifically, so it does not establish the claim for adults with FSS more broadly. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCBT improves physical functioning and fatigue reduction immediately and some time after treatment in patients with CFS.
“Research has shown that CBT improves physical functioning and fatigue reduction immediately and some time after treatment [9,10].”
From Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism. (2013) · cites this paper as [9]
The Results report less fatigue and better physical function after CBT than after adaptive pacing therapy or specialist medical care alone, including at 52 weeks. Methods > Procedures identifies 24 weeks as the post-therapy assessment, but the available Results passage does not state the CBT effects separately at that immediate post-treatment point. The claim’s later effect is supported; its immediate effect is not established by these passages. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCBT aimed at increasing functioning, and its objective and content are comparable with manuals of other CBT trials.
“CBT aimed at increasing functioning, and its objective and content are comparable with manuals of other CBT trials [9,12].”
From Cognitive behavior therapy in patients with chronic fatigue syndrome: The role of illness acceptance and neuroticism. (2013) · cites this paper as [9]
The Discussion describes CBT as encouraging gradual increases in activity, and the Results report improved physical function after CBT, supporting the account of its aim. The Methods > Procedures and Results discuss adherence to the PACE treatment manuals, but our copy does not compare their objectives or content with manuals from other CBT trials. Page numbers were not available in the indexed passages. (LLM, conf=0.84)
Experimental — accuracy not yet measuredGraded exercise is considered an important element in treatment and has been found effective for chronic fatigue syndrome.
“The introduction to graded exercise as a means of moderating maladaptive illness behaviour and increasing physical function is also considered an important element in the treatment and has been found effective for chronic fatigue syndrome [21].”
From Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial (2023) · cites this paper as [21]
CBT has been adapted and tested with CFS patients yielding superior results compared to standard medical treatment, relaxation, and adaptive pacing therapy, with moderate effect sizes (d = 0.48).
“CBT has been adapted and tested with CFS patients yielding superior results compared to standard medical treatment, relaxation, and adaptive pacing therapy (Sharpe et al., 1996; Deale et al., 1997; White et al., 2011), with moderate effect sizes (d = 0.48) (Malouff et al., 2008).”
From The relationship between improvement in insomnia severity and long-term outcomes in the treatment of chronic fatigue (2018) · cites this paper as White et al., 2011
In the first study, CBT and GET has been found to improve subjective sleep-disturbance significantly more than control-conditions at 1-year follow-up.
“In the first study, CBT and GET has been found to improve subjective sleep-disturbance significantly more than control-conditions at 1-year follow-up (White et al., 2011).”
From The relationship between improvement in insomnia severity and long-term outcomes in the treatment of chronic fatigue (2018) · cites this paper as White et al., 2011
Post-exertional malaise could not be systematically aggregated as it was seldom assessed and not uniformly reported.
“However, post-exertional malaise – which has been proposed as a cardinal symptom for myalgic encephalomyelitis/CFS in the latest NICE-guidelines [14]– could not be systematically aggregated as it was seldom assessed and not uniformly reported [29, 35, 42].”
From Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis. (2024) · cites this paper as [42]
The Methods > Outcomes passage says the PACE trial assessed postexertional malaise, and the Results passage reports that outcome. Neither passage addresses whether post-exertional malaise was seldom assessed or inconsistently reported across studies, or whether it could be systematically aggregated; searches for those points found no such discussion in our copy. Page numbers were not provided. (LLM, conf=0.72)
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
MCHORNEY, C. A., JOHNE, W., & ANASTASIAE, R. (1993) · Medical Care · doi:10.1097/00005650-199303000-00006 · Cited by 6,681 · see citing works
Development of a fatigue scale
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(93)90081-p · Cited by 3,032 · see citing works
Self-citationThe Work and Social Adjustment Scale: a simple measure of impairment in functioning
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.5.461 · Cited by 2,515 · see citing works
Two-, six-, and 12-minute walking tests in respiratory disease.
Butland, R. J., Pang, J., Gross, E. R., Woodcock, A. A., & Geddes, D. M. (1982) · BMJ · doi:10.1136/bmj.284.6329.1607 · Cited by 1,668 · see citing works
Methods to Explain the Clinical Significance of Health Status Measures
Guyatt, G. H., Osoba, D., Wu, A. W., Wyrwich, K. W., & Norman, G. R. (2002) · Mayo Clinic Proceedings · doi:10.4065/77.4.371 · Cited by 1,507 · see citing works
A scale for the estimation of sleep problems in clinical research
Jenkins, C. D., Stanton, B.-A., Niemcryk, S. J., & Rose, R. M. (1988) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(88)90138-2 · Cited by 1,216 · see citing works
A report—Chronic fatigue syndrome: Guidelines for research
Sharpe, M. C. (1991) · Journal of the Royal Society of Medicine · doi:10.1177/014107689108400224 · Cited by 1,026 · see citing works
Self-citationPrins, J. B., van der Meer, J. W., & Bleijenberg, G. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68073-2 · Cited by 974 · see citing works
Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial
Prins, J. B., Bleijenberg, G., Bazelmans, E., Elving, L. D., de Boo, T. M., Severens, J. L., van der Wilt, G. J., Spinhoven, P., & van der Meer, J. W. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04198-2 · Cited by 531 · see citing works
Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial.
Sharpe, M., Hawton, K., Simkin, S., Surawy, C., Hackmann, A., Klimes, I., Peto, T., Warrell, D., & Seagroatt, V. (1996) · BMJ · doi:10.1136/bmj.312.7022.22 · Cited by 528 · see citing works
Self-citationCognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial.
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.3.408 · Cited by 491 · see citing works
Self-citationReeves, W. C., Lloyd, A. R., Vernon, S. D., Klimas, N. G., Jason, L. A., Bleijenberg, G., Evengård, B., White, P. D., Nisenbaum, R. A., Unger, E. R., et al. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-25 · Cited by 475 · see citing works
Self-citationExercise therapy for chronic fatigue syndrome
Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003200.pub7 · Cited by 470 · see citing works
Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome
Fulcher, K. Y., & White, P. D. (1997) · BMJ · doi:10.1136/bmj.314.7095.1647 · Cited by 431 · see citing works
Self-citationCognitive behaviour therapy for chronic fatigue syndrome in adults
Price, J. R., Mitchell, E., Tidy, E., & Hunot, V. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001027.pub2 · Cited by 401 · see citing works
A systematic review describing the prognosis of chronic fatigue syndrome.
Cairns, R., & Hotopf, M. (2005) · Occupational Medicine · doi:10.1093/occmed/kqi013 · Cited by 395 · see citing works
Measuring fatigue in clinical and community settings
Cella, M., & Chalder, T. (2009) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.10.007 · Cited by 380 · see citing works
Self-citationBowling, A., Bond, M., Jenkinson, C., & Lamping, D. L. (1999) · Journal of Public Health · doi:10.1093/pubmed/21.3.255 · Cited by 289 · see citing works
Bansell, J. C., & Valtueña, J. P. (2020) · Nursing Management · doi:10.1097/01.numa.0000719220.85627.ef · Cited by 276 · see citing works
Wearden, A. J., Morriss, R. K., Mullis, R., Strickland, P., Pearson, D. J., Appleby, L., Campbell, I. T., & Morris, J. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.172.6.485 · Cited by 249 · see citing works
Moss-Morris, R. E., Sharon, C., Tobin, R., & Baldi, J. C. (2005) · Journal of Health Psychology · doi:10.1177/1359105305049774 · Cited by 242 · see citing works
Mania and Recovery from Chronic Fatigue Syndrome
Sharpe, M., Johnson, B. A., & McCann, J. (1991) · Journal of the Royal Society of Medicine · doi:10.1177/014107689108400123 · Cited by 235 · see citing works
Self-citationEfficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis
Malouff, J. M., Thorsteinsson, E. B., Rooke, S. E., Bhullar, N., & Schutte, N. S. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.10.004 · Cited by 212 · see citing works
Exercise therapy for chronic fatigue syndrome
Edmonds, M., McGuire, H., & Price, J. R. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003200.pub2 · Cited by 165 · see citing works
the PACE trial group, White, P. D., Sharpe, M., Chalder, T., DeCesare, J. C., & Walwyn, R. E. A. (2007) · BMC Neurology · doi:10.1186/1471-2377-7-6 · Cited by 145 · see citing works
Self-citationMeasurement in clinical trials: A neglected issue for statisticians?
Senn, S., & Julious, S. (2009) · Statistics in Medicine · doi:10.1002/sim.3603 · Cited by 136 · see citing works
Wearden, A. J., Dowrick, C., Chew-Graham, C., Bentall, R. P., Morriss, R. K., Peters, S., Riste, L., Richardson, G., Lovell, K., Dunn, G., et al. (2010) · BMJ · doi:10.1136/bmj.c1777 · Cited by 116 · see citing works
Non-pharmacologic Interventions for CFS: A Randomized Trial
Jason, L. A., Torres-Harding, S., Friedberg, F., Corradi, K., Njoku, M. G., Donalek, J., Reynolds, N., Brown, M., Weitner, B. B., Rademaker, A., et al. (2007) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-007-9090-7 · Cited by 107 · see citing works
Chronic fatigue syndrome – Authors' reply
Prins, J., Bleijenberg, G., & van der Meer, J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68689-3 · Cited by 63 · see citing works
Possible Detrimental Effects of Cognitive Behaviour Therapy for Chronic Fatigue Syndrome
Heins, M. J., Knoop, H., Prins, J. B., Stulemeijer, M., van der Meer, J. W. M., & Bleijenberg, G. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000315130 · Cited by 47 · see citing works
An Empirical Investigation of the Envelope Theory
Pesek, J., Jason, L. A., & Taylor, R. R. (2000) · Journal of Human Behavior in the Social Environment · doi:10.1300/j137v03n01_04 · Cited by 40 · see citing works
Bagnall, A. W., Hempel, S., Chambers, D., Orton, V., & Forbes, C. A. (2007) · White Rose Research Online (University of Leeds, The University of Sheffield, University of York) · Cited by 28 · see citing works
The experience of therapy supervision within a UK multi‐centre randomized controlled trial
Cox, D. L., & Araoz, G. (2009) · Learning in Health and Social Care · doi:10.1111/j.1473-6861.2009.00218.x · Cited by 18 · see citing works
Self-citationWearden, A. J., Riste, L., Dowrick, C. F., Chew-Graham, C. A., Bentall, R. P., Morriss, R. K., Peters, S., Dunn, G., Richardson, G. A., Lovell, K., et al. (2010) · Research Explorer (The University of Manchester) · Cited by 13 · see citing works
Piehl, J. H., Green, S., & McDonald, S. J. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-2 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [14]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV-TR axis I disorders, research version, patient edition with psychotic screen (SCID-I/P W/ PSY SCREEN) 2002 Biometrics Research, New York State Psychiatric Institute New York
Cited by
Sorted by citations
More than 50 long-term effects of COVID-19: a systematic review and meta-analysis
Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., & Villapol, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-95565-8 · Cited by 2,757 · see citing works
Townsend, L., Dyer, A. H., Jones, K., Dunne, J., Mooney, A., Gaffney, F., O'Connor, L., Leavy, D., O'Brien, K., Dowds, J., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0240784 · Cited by 911 · see citing works
Exercise therapy for chronic fatigue syndrome
Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003200.pub7 · Cited by 470 · see citing works
Physiotherapy for functional motor disorders: a consensus recommendation
Nielsen, G., Stone, J., Matthews, A., Brown, M., Sparkes, C., Farmer, R., Masterton, L., Duncan, L., Winters, A., Daniell, L., et al. (2014) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2014-309255 · Cited by 427 · see citing works
Exercise therapy for fatigue in multiple sclerosis
Heine, M., van de Port, I. G. L., Rietberg, M. B., van Wegen, E. E. H., & Kwakkel, G. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009956.pub2 · Cited by 322 · see citing works
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review
Rivera, M. C., Mastronardi, C. A., Silva, C., Arcos‐Burgos, M., & Lidbury, B. A. (2019) · Diagnostics · doi:10.3390/diagnostics9030091 · Cited by 316 · see citing works
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management
Bateman, L., Bested, A. C., Bonilla, H. F., Chheda, B., Chu, L., Curtin, J. M., Dempsey, T. T., Dimmock, M. E., Dowell, T. G., Felsenstein, D., et al. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.07.004 · Cited by 302 · see citing works
Sarcoidosis-associated fatigue
Drent, M., Lower, E. E., & Vries, J. D. (2012) · European Respiratory Journal · doi:10.1183/09031936.00002512 · Cited by 285 · see citing works
Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome
Blease, C., Carel, H., & Geraghty, K. (2017) · Journal of Medical Ethics · doi:10.1136/medethics-2016-103691 · Cited by 276 · see citing works
Silverberg, N., & Iverson, G. (2013) · The journal of head trauma rehabilitation · doi:10.1097/htr.0b013e31825ad658 · Cited by 261 · see citing works
Brurberg, K. G., Fønhus, M. S., Larun, L., Flottorp, S. A., & Malterud, K. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-003973 · Cited by 260 · see citing works
Croft, P., Altman, D. G., Deeks, J. J., Dunn, K. M., Hay, A. D., Hemingway, H., LeResche, L., Peat, G., Perel, P., Petersen, S. E., et al. (2015) · BMC Medicine · doi:10.1186/s12916-014-0265-4 · Cited by 250 · see citing works
Self-citationMore Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-AnalysisPreprint
López‐León, S., Wegman-Ostrosky, T., Perelman, C., Sepúlveda, R., Rebolledo, P. A., Cuapio, A., & Villapol, S. (2021) · Research Square · doi:10.21203/rs.3.rs-266574/v1 · Cited by 244 · see citing works
Teodoro, T., Edwards, M. J., & Isaacs, J. D. (2018) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317823 · Cited by 241 · see citing works
Lakhan, S. E., & Schofield, K. L. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071834 · Cited by 233 · see citing works
Interventions for post-stroke fatigue
Wu, S., Kutlubaev, M. A., Chun, H.-Y. Y., Cowey, E., Pollock, A., Macleod, M. R., Dennis, M. S., Keane, E., Sharpe, M., & Mead, G. E. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007030.pub3 · Cited by 206 · see citing works
Self-citationSchneider, K., Iverson, G. L., Emery, C. A., McCrory, P. R., Herring, S. A., & Meeuwisse, W. H. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092190 · Cited by 205 · see citing works
Cook, J. A., Julious, S. A., Sones, W., Hampson, L. V., Hewitt, C., Berlin, J. A., Ashby, D., Emsley, R., Fergusson, D. A., Walters, S. J., et al. (2018) · Trials · doi:10.1186/s13063-018-2884-0 · Cited by 197 · see citing works
Nijs, J., Roussel, N. A., Oosterwijck, J. V., Kooning, M. D., Ickmans, K., Struyf, F., Meeus, M., & Lundberg, M. (2013) · Clinical Rheumatology · doi:10.1007/s10067-013-2277-4 · Cited by 177 · see citing works
Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis
Castell, B. D., Kazantzis, N., & Moss-Morris, R. E. (2011) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2011.01262.x · Cited by 176 · see citing works
D'Cruz, R. F., Waller, M. D., Perrin, F., Periselneris, J. N., Norton, S., Smith, L., Patrick, T., Walder, D., Heitmann, A., Lee, K. N., et al. (2020) · ERJ Open Research · doi:10.1183/23120541.00655-2020 · Cited by 173 · see citing works
Model of understanding fatigue after stroke
Wu, S., Mead, G., Macleod, M., & Chalder, T. (2015) · Stroke · doi:10.1161/strokeaha.114.006647 · Cited by 169 · see citing works
Self-citationKéri, S., Szabó, C., & Kelemen, O. (2014) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2014.03.020 · Cited by 165 · see citing works
Activity Pacing in Chronic Pain: Concepts, Evidence, and Future Directions
Nielson, W., Jensen, M., Karsdorp, P., & Vlaeyen, J. (2013) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e3182608561 · Cited by 154 · see citing works
Goudsmit, E. M., Nijs, J., Jason, L. A., & Wallman, K. E. (2011) · Disability and Rehabilitation · doi:10.3109/09638288.2011.635746 · Cited by 160 · see citing works
Howell, D., Keller–Olaman, S., Oliver, T. K., Hack, T. F., Broadfield, L., Biggs, K., Chung, J., Gravelle, D., Green, E., Hamel, M., et al. (2013) · Current Oncology · doi:10.3747/co.20.1302 · Cited by 158 · see citing works
Prescribing exercise interventions for patients with chronic conditions
Hoffmann, T., Maher, C. G., Briffa, T. G., Sherrington, C., Bennell, K. L., Alison, J. A., Singh, M. F., & Glasziou, P. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.150684 · Cited by 158 · see citing works
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Overview
Deumer, U.-S., Varesi, A., Floris, V., Savioli, G., Mantovani, E., López-Carrasco, P., Rosati, G. M., Prasad, S., & Ricevuti, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204786 · Cited by 153 · see citing works
Cook, J. A., Julious, S. A., Sones, W., Hampson, L. V., Hewitt, C., Berlin, J. A., Ashby, D., Emsley, R., Fergusson, D. A., Walters, S. J., et al. (2018) · BMJ · doi:10.1136/bmj.k3750 · Cited by 148 · see citing works
Fjorback, L. O., Arendt, M., Ørnbøl, E., Walach, H., Rehfeld, E., Schröder, A., & Fink, P. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.09.006 · Cited by 144 · see citing works
Smith, M. E. B., Haney, E., McDonagh, M., Pappas, M., Daeges, M., Wasson, N., Fu, R., & Nelson, H. D. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0114 · Cited by 142 · see citing works
Morris, G., & Maes, M. H. J. (2014) · Current Neuropharmacology · doi:10.2174/1570159x11666131120224653 · Cited by 139 · see citing works
Castro‐Marrero, J., Sáez‐Francàs, N., Santillo, D., & Alegre, J. (2017) · British Journal of Pharmacology · doi:10.1111/bph.13702 · Cited by 142 · see citing works
Interventions for the management of long covid (post-covid condition): living systematic review
Zeraatkar, D., Ling, M., Kirsh, S., Jassal, T., Shahab, M., Movahed, H., Talukdar, J. R., Walch, A., Chakraborty, S. P., Turner, T., et al. (2024) · BMJ · doi:10.1136/bmj-2024-081318 · Cited by 149 · see citing works
Nguyen, S., Wong, D. K., McKay, A., Rajaratnam, S. M. W., Spitz, G., Williams, G. P., Mansfield, D. R., & Ponsford, J. L. (2017) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2017.1326945 · Cited by 136 · see citing works
Chalder, T., Goldsmith, K. A., White, P. D., Sharpe, M., & Pickles, A. R. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00069-8 · Cited by 134 · see citing works
Self-citationOperant Learning Theory in Pain and Chronic Pain Rehabilitation
Gatzounis, R., Schrooten, M. G. S., Crombez, G., & Vlaeyen, J. W. S. (2012) · Current Pain and Headache Reports · doi:10.1007/s11916-012-0247-1 · Cited by 128 · see citing works
Nguyen, S., McKay, A., Wong, D. K., Rajaratnam, S. M. W., Spitz, G., Williams, G. P., Mansfield, D. R., & Ponsford, J. L. (2017) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.02.031 · Cited by 131 · see citing works
Wilshire, C. E., Kindlon, T., Courtney, R. H., Matthees, A., Tuller, D., Geraghty, K., & Levin, B. L. (2018) · BMC Psychology · doi:10.1186/s40359-018-0218-3 · Cited by 129 · see citing works
Exercise therapy for chronic fatigue syndrome
Larun, L., Brurberg, K. G., Odgaard‐Jensen, J., & Price, J. R. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003200.pub8 · Cited by 129 · see citing works
Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major health-care burden
Fedorowski, A., Fanciulli, A., Raj, S. R., Sheldon, R. S., Shibao, C. A., & Sutton, R. (2024) · Nature Reviews Cardiology · doi:10.1038/s41569-023-00962-3 · Cited by 135 · see citing works
Recovery from chronic fatigue syndrome after treatments given in the PACE trial
White, P. D., Goldsmith, K., Johnson, A. L., Chalder, T., & Sharpe, M. (2013) · Psychological Medicine · doi:10.1017/s0033291713000020 · Cited by 124 · see citing works
Self-citationNielsen, M., Keefe, F. J., Bennell, K. L., & Jull, G. A. (2013) · Physical Therapy · doi:10.2522/ptj.20130047 · Cited by 120 · see citing works
Chronic fatigue syndrome: diagnosis and treatment.
Yancey, J. R., & Thomas, S. M. (2012) · PubMed · Cited by 117 · see citing works
Wormgoor, M. E. A., & Rodenburg, S. C. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-020-02683-4 · Cited by 117 · see citing works
Crawley, E. M., Emond, A. M., & Sterne, J. A. C. (2011) · BMJ Open · doi:10.1136/bmjopen-2011-000252 · Cited by 115 · see citing works
Chu, L., Valencia, I. J., Garvert, D. W., & Montoya, J. G. (2018) · PLoS ONE · doi:10.1371/journal.pone.0197811 · Cited by 130 · see citing works
Christensen, S. S., Frostholm, L., Ørnbøl, E., & Schröder, A. (2015) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.12.005 · Cited by 111 · see citing works
Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial
Sharpe, M., Goldsmith, K. A., Johnson, A. L., Chalder, T., Walker, J., & White, P. D. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00317-x · Cited by 108 · see citing works
Self-citationMyalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease
Arron, H. E., Marsh, B. D., Khan, M. A., Jaeger, B., Kell, D., & Pretorius, E. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1386607 · Cited by 111 · see citing works
Chronic fatigue syndrome: understanding a complex illness
Holgate, S. T., Komaroff, A. L., Mangan, D. F., & Wessely, S. C. (2011) · Nature reviews. Neuroscience · doi:10.1038/nrn3087 · Cited by 101 · see citing works
Rimes, K. A., & Wingrove, J. (2013) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.793 · Cited by 99 · see citing works
Goldsmith, K. A., MacKinnon, D. P., Chalder, T., White, P. D., Sharpe, M., & Pickles, A. (2018) · Psychological Methods · doi:10.1037/met0000154 · Cited by 99 · see citing works
Self-citationPaciaroni, M., & Acciarresi, M. (2019) · Stroke · doi:10.1161/strokeaha.119.023552 · Cited by 98 · see citing works
Functional neurological disorders: mechanisms and treatment
Lehn, A., Gelauff, J., Hoeritzauer, I., Ludwig, L., McWhirter, L., Williams, S., Gardiner, P., Carson, A. J., & Stone, J. (2015) · Journal of Neurology · doi:10.1007/s00415-015-7893-2 · Cited by 96 · see citing works
Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial
Schröder, A., Rehfeld, E., Ørnbøl, E., Sharpe, M., Licht, R. W., & Fink, P. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.098681 · Cited by 95 · see citing works
Self-citationCollin, S. M., Crawley, E. M., May, M., Sterne, J. A. C., Hollingworth, W., & Database, U. C. N. O. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-217 · Cited by 94 · see citing works
Parker, M., Sawant, H. B., Flannery, T., Tarrant, R., Shardha, J., Bannister, R., Ross, D. H., Halpin, S. J., Greenwood, D. C., & Sivan, M. (2022) · Journal of Medical Virology · doi:10.1002/jmv.28373 · Cited by 93 · see citing works
More than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-AnalysisPreprint
López‐León, S., Wegman-Ostrosky, T., Perelman, C., Sepúlveda, R., Rebolledo, P. A., Cuapio, A., & Villapol, S. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3769978 · Cited by 92 · see citing works
Landau, S., & Stahl, D. R. (2012) · Statistical Methods in Medical Research · doi:10.1177/0962280212439578 · Cited by 88 · see citing works
Effort, exaggeration and malingering after concussion: Figure 1
Silver, J. (2012) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-302078 · Cited by 85 · see citing works
McCrone, P., Sharpe, M., Chalder, T., Knapp, M. R. J., Johnson, A. L., Goldsmith, K., & White, P. D. (2012) · PLoS ONE · doi:10.1371/journal.pone.0040808 · Cited by 84 · see citing works
Self-citationKim, D.-Y., Lee, J., Park, S.-Y., Kim, S., & Son, C. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-019-02196-9 · Cited by 83 · see citing works
Estévez‐López, F., Mudie, K., Wang, X., Bakken, I. J., Ivanovs, A., Castro‐Marrero, J., Nacul, L., Alegre, J., Zalewski, P., Słomko, J., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9051557 · Cited by 79 · see citing works
Fatigue after Stroke: The Patient's Perspective
Barbour, V. L., & Mead, G. E. (2011) · Stroke Research and Treatment · doi:10.1155/2012/863031 · Cited by 81 · see citing works
Clark, L., Pesola, F., Thomas, J. M., Vergara-Williamson, M., Beynon, M., & White, P. D. (2017) · The Lancet · doi:10.1016/s0140-6736(16)32589-2 · Cited by 78 · see citing works
Self-citationMorris, G., & Maes, M. H. J. (2017) · Current Rheumatology Reports · doi:10.1007/s11926-017-0628-x · Cited by 75 · see citing works
Sanal‐Hayes, N. E. M., Mclaughlin, M., Hayes, L. D., Mair, J. L., Ormerod, J. A., Carless, D., Hilliard, N., Meach, R., Ingram, J., & Sculthorpe, N. F. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04587-5 · Cited by 90 · see citing works
Pedersen, M., Asprusten, T. T., Godang, K., Leegaard, T. M., Osnes, L., Skovlund, E., Tjade, T., Øie, M. G., & Wyller, V. B. (2018) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2018.09.023 · Cited by 73 · see citing works
Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty
Bransfield, R. C., & Friedman, K. J. (2019) · Healthcare · doi:10.3390/healthcare7040114 · Cited by 75 · see citing works
Chronic fatigue syndrome: progress and possibilities
Sandler, C. X., & Lloyd, A. R. (2020) · The Medical Journal of Australia · doi:10.5694/mja2.50553 · Cited by 74 · see citing works
Self-Reported Fatigue and Associated Factors Six Years after Stroke
Elf, M., Eriksson, G. M., Johansson, S., von Koch, L., & Ytterberg, C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0161942 · Cited by 73 · see citing works
Janse, A., Worm-Smeitink, M., Bleijenberg, G., Donders, R., & Knoop, H. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2017.22 · Cited by 72 · see citing works
Geraghty, K., Hann, M., & Kurtev, S. (2017) · Journal of Health Psychology · doi:10.1177/1359105317726152 · Cited by 72 · see citing works
Exercise therapy for chronic fatigue syndrome
Larun, L., Brurberg, K. G., Odgaard-Jensen, J., & Price, J. R. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003200.pub3 · Cited by 69 · see citing works
Fatigue and Depression in Sick-Listed Chronic Low Back Pain Patients
Snekkevik, H., Eriksen, H. R., Tangen, T., Chalder, T., & Rème, S. E. (2014) · Pain Medicine · doi:10.1111/pme.12435 · Cited by 69 · see citing works
Self-citationChilcot, J., Norton, S., Kelly, M. E., & Moss-Morris, R. E. (2015) · Multiple Sclerosis Journal · doi:10.1177/1352458515598019 · Cited by 70 · see citing works
Geraghty, K., & Blease, C. R. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1481149 · Cited by 68 · see citing works
Myalgic encephalomyelitis or chronic fatigue syndrome: how could the illness develop?
Morris, G., Maes, M. H. J., Berk, M., & Puri, B. K. (2019) · Metabolic Brain Disease · doi:10.1007/s11011-019-0388-6 · Cited by 66 · see citing works
Dismissing chronic illness: A qualitative analysis of negative health care experiences
McManimen, S. L., McClellan, D., Stoothoff, J., Gleason, K. D., & Jason, L. A. (2019) · Health Care For Women International · doi:10.1080/07399332.2018.1521811 · Cited by 68 · see citing works
The role of acceptance in chronic fatigue syndrome
Brooks, S. K., Rimes, K. A., & Chalder, T. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.08.001 · Cited by 65 · see citing works
Self-citationPostacute/Long COVID in Pediatrics
Morrow, A. K., Ng, R., Vargas, G., Jashar, D. T., Henning, E., Stinson, N., & Malone, L. A. (2021) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001896 · Cited by 68 · see citing works
Physical activity and the drive to exercise in anorexia nervosa
Keyes, A., Woerwag‐Mehta, S., Bartholdy, S., Koskina, A., Middleton, B., Connan, F., Webster, P. M., Schmidt, U. H., & Campbell, I. C. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22354 · Cited by 67 · see citing works
Basing psychiatric classification on scientific foundation: Problems and prospects
Uher, R., & Rutter, M. L. (2012) · International Review of Psychiatry · doi:10.3109/09540261.2012.721346 · Cited by 67 · see citing works
Jones, D. E., Hollingsworth, K. G., Jakovljević, D. G., Fattakhova, G. V., Pairman, J., Blamire, A. M., Trenell, M. I., & Newton, J. L. (2011) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2011.02567.x · Cited by 65 · see citing works
Brown, A. E., Jones, D. E., Walker, M., & Newton, J. L. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122982 · Cited by 64 · see citing works
Metabolism in Chronic Fatigue Syndrome
Armstrong, C. W., McGregor, N., Butt, H. L., & Gooley, P. R. (2014) · Advances in clinical chemistry · doi:10.1016/b978-0-12-801401-1.00005-0 · Cited by 66 · see citing works
Psychological profile of individuals presenting with chronic cough
Hulme, K., Deary, V., Dogan, S., & Parker, S. (2017) · ERJ Open Research · doi:10.1183/23120541.00099-2016 · Cited by 64 · see citing works
Abonie, U. S., & Hettinga, F. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18010017 · Cited by 64 · see citing works
Multiple somatic symptoms predict impaired health status in functional somatic syndromes
Creed, F. H., Tomenson, B., Chew-Graham, C., Macfarlane, G. J., Davies, I., Jackson, J., Littlewood, A., & McBeth, J. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-012-9257-y · Cited by 63 · see citing works
‘PACE-Gate’: When clinical trial evidence meets open data access
Geraghty, K. (2016) · Journal of Health Psychology · doi:10.1177/1359105316675213 · Cited by 63 · see citing works
Chalder, T. (2013) · doi:10.1002/9781118528563.wbcbt23 · Cited by 63 · see citing works
Self-citationTate, W. P., Walker, M., Peppercorn, K., Blair, A., & Edgar, C. D. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24065124 · Cited by 60 · see citing works
Decelis, A., Jago, R., & Fox, K. R. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-664 · Cited by 62 · see citing works
Windthorst, P., Mazurak, N., Kuske, M., Hipp, A., Giel, K. E., Enck, P., Niess, A. M., Zipfel, S., & Teufel, M. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.11.014 · Cited by 78 · see citing works
The Safety of Baduanjin Exercise: A Systematic Review
Fang, J., Zhang, L., Wu, F., Ye, J., Cai, S., & Lian, X. (2021) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2021/8867098 · Cited by 61 · see citing works
Physical Activity and Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Zhang, R., Chomistek, A. K., Dimitrakoff, J. D., Giovannucci, E. L., Willett, W. C., ROSNER, B. A., & Wu, K. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000472 · Cited by 62 · see citing works
Updated NICE guidance on chronic fatigue syndrome
Turner‐Stokes, L. F., & Wade, D. T. (2020) · BMJ · doi:10.1136/bmj.m4774 · Cited by 61 · see citing works
Chalder, T., & Willis, C. (2017) · Journal of Mental Health · doi:10.1080/09638237.2017.1322187 · Cited by 59 · see citing works
Self-citationMorris, G., & Maes, M. H. J. (2012) · Medical Hypotheses · doi:10.1016/j.mehy.2012.07.034 · Cited by 60 · see citing works
- Authors
- White, P., Goldsmith, K., Johnson, A., Potts, L., Walwyn, R., DeCesare, J., Baber, H., Burgess, M., Clark, L., Cox, D., Bavinton, J., Angus, B., Murphy, G., Murphy, M., O'Dowd, H., Wilks, D., McCrone, P., Chalder, T., & Sharpe, M.
- Affiliations
- King's College London (GB)
- Queen Mary University of London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Barts Health NHS Trust (GB)
- John Radcliffe Hospital (GB)
- The Royal Free Hospital (GB)
- Western General Hospital (GB)
- University of Edinburgh (GB)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 377
- Issue
- 9768
- Pages
- 823-836
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3065633
- OpenAlex
- W2136415723
- Cited by
- 897
- References
- 37
- Citations by year
- 2026: 22 · 2025: 44 · 2024: 54 · 2023: 47 · 2022: 48 · 2021: 61 · 2020: 56 · 2019: 55 · 2018: 52 · 2017: 84 · 2016: 75 · 2015: 78 · 2014: 52 · 2013: 67 · 2012: 60
- FWCI
- 47.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Insight (University of Cumbria) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- the UK Medical Research Council (MRC G0200434)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic fatigue syndrome, cognitive behavioral therapy, graded exercise therapy, specialist care, fatigue, physical function, treatment safety, adverse events, PACE trial, treatment effectiveness comparison, patient-reported outcomes, Chalder Fatigue Questionnaire, SF-36 physical functioning, serious adverse events
- MeSH terms
- Activities of Daily Living, Adaptation, Physiological, Adult, Exercise Therapy, Female, Humans, Male, Surveys and Questionnaires, Specialization, Fatigue Syndrome, Chronic, Cognitive Behavioral Therapy, Treatment Outcome
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