The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
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
(1976) · Medical Entomology and Zoology · Cited by 8,899
MCHORNEY, C. A., JOHNE, W., & ANASTASIAE, R. (1993) · Medical Care · doi:10.1097/00005650-199303000-00006 · Cited by 6,681
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
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
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
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 1,525
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
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
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
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
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
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
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 485
Reeves, 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 484
Self-citationRandomised 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
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
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
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 392
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
Bansell, J. C., & Valtueña, J. P. (2020) · Nursing Management · doi:10.1097/01.numa.0000719220.85627.ef · Cited by 277
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
Moss-Morris, R. E., Sharon, C., Tobin, R., & Baldi, J. C. (2005) · Journal of Health Psychology · doi:10.1177/1359105305049774 · Cited by 242
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
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
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
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
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
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
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
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
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
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
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
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
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
Piehl, J. H., Green, S., & McDonald, S. J. (2003) · BMC Health Services Research · doi:10.1186/1472-6963-3-2 · Cited by 12
Research works printed but not linked: 1
- White, 2007, BioMed Cent Neurol, 7, 6
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
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
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 485
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
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 356
Metadata
- 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 › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
