Intended for healthcare professionals


Pragmatic rehabilitation for chronic fatigue syndrome

BMJ 2010; 340 doi: (Published 23 April 2010) Cite this as: BMJ 2010;340:c1799
  1. Rona Moss-Morris, professor of health psychology1,
  2. William Hamilton, consultant senior lecturer2
  1. 1School of Psychology, University of Southampton, Southampton SO17 1BJ
  2. 2Primary Health Care, University of Bristol, Bristol BS8 2AA
  1. remm{at}

    Has a short term benefit, but supportive listening does not

    Each full time general practitioner in the United Kingdom has as many as 10 patients with chronic fatigue syndrome (CFS/ME) on their list.1 Many feel they have little to offer with regard to treatment.2 Patients in turn are often left feeling misunderstood and poorly cared for.

    Currently, the only evidence based treatments for this condition reviewed in the Cochrane Library and recommended by the National Institute for Health and Clinical Excellence are cognitive behavioural therapy and graded exercise therapy, with cognitive behavioural therapy in specialist care having the larger evidence base.3 4 5 A primary care trial of brief cognitive behavioural therapy for CFS/ME offered by general practitioners who had received simplified training in the subject was unsuccessful.6 Few patients with CFS/ME receive specialist services, partly as a result of limited access, but also because many feel that psychological treatments delegitimise their condition.2 Thus, a treatment that includes aspects of the successful treatments, but in a more pragmatic fashion with less emphasis on psychology, is an attractive proposition. But does it work?

    The linked randomised controlled trial by Wearden and colleagues (doi:10.1136/bmj.c1777), assesses pragmatic rehabilitation for CFS/ME offered in primary care.7 The rehabilitation consists of …

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