Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions Quality of life and symptom severity for individuals with chronic fatigue syndrome: findings from a randomized clinical trial. Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale. Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population Sexual Abuse, Physical Abuse, Chronic Fatigue, and Chronic Fatigue Syndrome: A Community-Based Study Dietary intervention in chronic fatigue syndrome. Diabetes in Older Adults Acetyl-L-Carnitine Supplementation During HCV Therapy With Pegylated Interferon-α 2b Plus Ribavirin: Effect on Work Performance; A Randomized Clinical Trial A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome. Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: randomised controlled trial. Randomised controlled trial of graded exercise in chronic fatigue syndrome. Chronic myofascial pain: management by low-output helium-neon laser therapy. The evidence‐based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome CONTROVERSIES IN ENDODONTICS. Burnout and Risk of Type 2 Diabetes: A Prospective Study of Apparently Healthy Employed Persons Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome
OBJECTIVE This study evaluated the long-term outcome of cognitive behavior therapy versus relaxation therapy for patients with chronic fatigue syndrome . METHOD Sixty patients who participated in a r and omized controlled trial of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome were invited to complete self-rated measures and participate in a 5-year follow-up interview with an assessor who was blind to treatment type . RESULTS Fifty-three patients ( 88 % ) participated in the follow-up study : 25 received cognitive behavior therapy and 28 received relaxation therapy . A total of 68 % of the patients who received cognitive behavior therapy and 36 % who received relaxation therapy rated themselves as " much improved " or " very much improved " at the 5-year follow-up . Significantly more patients receiving cognitive behavior therapy , in relation to those in relaxation therapy , met criteria for complete recovery , were free of relapse , and experienced symptoms that had steadily improved or were consistently mild or absent since treatment ended . Similar proportions were employed , but patients in the cognitive behavior therapy group worked significantly more mean hours per week . Few patients crossed the threshold for " normal " fatigue , despite achieving a good outcome on other measures . Cognitive behavior therapy was positively evaluated and was still used by over 80 % of the patients . CONCLUSIONS Cognitive behavior therapy for chronic fatigue syndrome can produce some lasting benefits but is not a cure . Once therapy ends , some patients have difficulty making further improvements . In the future , attention should be directed toward ensuring that gains are maintained and extended after regular treatment ends OBJECTIVE Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a r and omized controlled trial . METHODS Sixty patients with chronic fatigue syndrome were r and omly assigned to 13 sessions of either cognitive behavior therapy ( grade d activity and cognitive restructuring ) or relaxation . Outcome was evaluated by using measures of functional impairment , fatigue , mood , and global improvement . RESULTS Treatment was completed by 53 patients .  Functional impairment and fatigue improved more in the group that received cognitive behavior therapy . At final follow-up , 70 % of the completers in the cognitive behavior therapy group achieved good outcomes ( substantial improvement in physical functioning ) compared with 19 % of those in the relaxation group who completed treatment . CONCLUSIONS Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome . Improvements were sustained over 6 months of follow-up OBJECTIVE To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors . METHODS In ten German centres , 261 patients with cancer-related fatigue were r and omly assigned to a patient education program consisting of 6 sessions à 90 min or st and ard care . The primary outcome measure was cancer-related fatigue . Data were analysed using analysis of variance ( ANOVA ) with repeated measures . RESULTS Patients in the intervention group showed statistically significant reduction in cancer-related fatigue ( F = 76.510 , p < 0.001 , η(2 ) = 0.248 ) . Secondary outcomes also showed significant improvements in all measures , including quality of life ( F = 29.607 , p < 0.001 , η(2 ) = 0.113 ) , general self-efficacy ( F = 27.680 , p < 0.001 , η(2 ) = 0.107 ) , exercise self-efficacy ( F = 49.230 , p < 0.001 , η(2 ) = 0.175 ) , physical activity ( F = 8.036 , p < 0.001 , η(2 ) = 0.033 ) , anxiety ( F = 33.194 , p < 0.001 , η(2 ) = 0.125 ) , depression ( F = 24.604 , p < 0.001 , η(2 ) = 0.096 ) , and fatigue knowledge ( F = 55.157 , p < 0.001 , η(2 ) = 0.192 ) . CONCLUSION The program was effective in reducing perceived fatigue as well as further outcomes . PRACTICE IMPLICATION S This newly developed education program has the potential to fill a gap in the care of cancer survivors . The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group Background The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries , but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions . While most workers are eligible for job accommodation and disability compensation benefits , other workplace strategies might improve individual-level coping and problem solving to prevent work disability . In this study , we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders . Methods In a r and omized controlled trial ( RCT ) , workers participating in an employer-sponsored self-management group intervention  will be compared with a no-treatment ( wait list ) control condition .  Volunteer employees ( n = 300 ) will be recruited from five participating employers and r and omly assigned to intervention or control . Participants in the intervention arm will attend facilitated group workshop sessions at work ( 10 hours total ) to explore methods for improving comfort , adjusting work habits , communicating needs effectively , applying systematic problem solving , and dealing with negative thoughts and emotions about work . Work engagement and work limitation are the principal outcomes . Secondary outcomes include fatigue , job satisfaction , self-efficacy , turnover intention , sickness absence , and health care utilization . Measurements will be taken at baseline , 6- , and 12-month follow-up . A process evaluation will be performed alongside the r and omized trial . Discussion This study will be most relevant for organizations and occupational setting s where some degree of job flexibility , leeway , and decision-making autonomy can be afforded to affected workers . The study design will provide initial assessment of a novel workplace approach and to underst and factors affecting its feasibility and effectiveness . Trial registration Clinical trials.gov : NCT01978392 ( Issued November 6 , 2013 OBJECTIVE Chronic fatigue syndrome is a profoundly disabling condition characterized by severe , unrelenting fatigue and a number of other physical and cognitive symptoms . Currently , there is no cure or widely accepted treatment for chronic fatigue syndrome , and few rehabilitation programs exist to address quality of life issues in chronic fatigue syndrome . In the present r and omized clinical trial , the effects of an integrative , consumer-driven rehabilitation program on quality of life and symptom severity for individuals with chronic fatigue syndrome were examined . METHOD Forty-seven participants were r and omly assigned to either an immediate program group ( n = 23 ) or a delayed program control group ( n = 24 ) and assessed with the Chronic Fatigue Syndrome Symptom Rating Scale and the Quality of Life Index before the program , after program participants completed the group phase , and after program participants completed the one-on-one phase . It was hypothesized that the program would lead to improvements in quality of life and an overall reduction in symptom severity . RESULTS Linear growth models were estimated comparing program and control conditions over time using r and om-effects regression analyses . Significant condition by time interactions were observed for the main outcomes of symptom severity and overall quality of life . Effect sizes for these interactions involving symptom severity ( Cohen 's d = 0.71 ) and overall quality of life ( Cohen 's d = .66 ) were moderate . CONCLUSIONS Findings indicate that consumer driven programs such as this one can have a positive impact on symptom severity and quality of life over time for individuals with chronic fatigue syndrome Chronic fatigue syndrome ( CFS ) produces physical and neurocognitive disability that significantly affects health-related quality of life ( HRQL ) .  Multidisciplinary treatment combining grade d exercise therapy ( GET ) cognitive behavioural therapy ( CBT ) and pharmacological treatment has shown only short-term improvements . To compare the effects on HRQL of ( 1 ) multidisciplinary treatment combining CBT , GET , and pharmacological treatment , and ( 2 ) usual treatment ( exercise counselling and pharmacological treatment ) at 12 months of follow-up . Prospect i ve , r and omized controlled trial with a follow-up of 12 months after the end of treatment . Patients consecutively diagnosed with CFS ( Fukuda criteria ) were r and omly assigned to intervention ( n = 60 ) or usual treatment ( n = 60 ) groups . HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form question naire ( SF-36 ) . Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Question naire ( HAQ ) and comorbidities . At baseline , the two groups were similar , except for lower SF-36 emotional role scores in the intervention group . At 12 months , the intervention did not improve HRQL scores , with worse SF-36 physical function and bodily pain scores in the intervention group . Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL . The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis BACKGROUND Disability is a defining feature of chronic conditions , and it is an increasingly used measure of therapy effectiveness . The  Work and Social Adjustment Scale ( WSAS )  is a simple and clear measure of disability . Although the scale is widely used , no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome ( CFS ) . METHODS Data from two sample s of patients were used , one from a multicenter r and omized controlled clinical trial of treatments for CFS ( n = 639 ) and the other from a clinic that specializes in CFS ( n=384 ) . All patients completed the WSAS as well as other measures . RESULTS Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable . CFS patients who had comorbid diagnoses of depression , anxiety or fibromyalgia had higher WSAS scores . High levels of disability were associated with high number of physical symptoms , severe fatigue , depression , anxiety , poor sleep quality and poor physical fitness , with correlation coefficients ranging between 0.41 and 0.11 . Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test . Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy .  Disability significantly decreased after therapy and remained stable at follow-ups . CONCLUSION The WSAS is a reliable and valid assessment tool for disability in patients with CFS Abstract Objective : To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome . Design : R and omised controlled trial with final assessment at 12 months . Setting : An infectious diseases outpatient clinic . Subjects : 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome . Interventions : Medical care comprised assessment , advice , and follow up in general practice . Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care . Main outcome measures : The proportions of patients ( a ) who achieved normal daily functioning ( Karnofsky score 80 or more ) and ( b ) who achieved a clinical ly significant improvement in functioning ( change in Karnofsky score 10 points or more ) by 12 months after r and omisation . Results : Only two eligible patients refused to participate . All r and omised patients completed treatment . An intention to treat analysis showed that 73 % ( 22/30 ) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27 % ( 8/30 ) of patients who were given only medical care ( difference 47 percentage points ; 95 % confidence interval 24 to 69 ) . Similar differences were observed in subsidiary outcome measures . The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy . Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone . Conclusion : Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment . Key messages Key messages There is no generally accepted form of treatment New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue Background Scant research has adequately addressed the impact of chronic fatigue syndrome on patients ' daily activities and quality of life . Enumerating specific problems related to quality of life in chronic fatigue syndrome patients can help us to better underst and and manage this illness . This study addresses issues of functional status in persons with chronic fatigue syndrome and other fatiguing illnesses in a population based sample , which can be generalized to all persons with chronic fatigue . Methods We conducted a r  and om telephone survey in Wichita , Kansas to identify persons with chronic fatigue syndrome and other fatiguing illnesses . Respondents reporting severe fatigue of at least 1 month 's duration and r and omly selected non-fatigued respondents were asked to participate in a detailed telephone interview . Participants were asked about symptoms , medical and psychiatric illnesses , and about physical , social , and recreational functioning . Those meeting the 1994 chronic fatigue syndrome case definition , as determined on the basis of their telephone responses , were invited for clinical evaluation to confirm a diagnosis of chronic fatigue syndrome . For this analysis , we evaluated  unemployment due to fatigue , number of hours per week spent on work , chores , and other activities ( currently and prior to the onset of fatigue ) , and energy level .  Results There was no difference between persons with chronic fatigue syndrome and persons with a chronic fatigue syndrome-like illness that could be explained by a medical or psychiatric condition for any of the outcomes we measured except for unemployment due to fatigue ( 15 % vs. 40 % , P < .01 ) . Persons with chronic fatigue syndrome and other fatiguing illnesses had substantially less energy and spent less time on hobbies , schooling , or volunteer work than did non-fatigued controls ( P < .01 ) . Conclusions Persons with chronic fatigue syndrome are as impaired as persons whose fatigue could be explained by a medical or psychiatric condition , and they have less energy than non-fatigued controls Using a r and omly selected community-based sample , this investigation examined whether histories of childhood sexual , physical , and death threat abuse predicted adulthood outcomes of specific medical and psychiatric conditions involving chronic fatigue . This study also tested prior suggestions that most individuals with chronic fatigue syndrome report a past history of interpersonal abuse . Multinomial logistic regression was used to examine the relationship between abuse history and chronic fatigue group outcomes while controlling for the effects of sociodemographics . Compared with healthy controls , childhood sexual abuse was significantly more likely to be associated with outcomes of idiopathic chronic fatigue , chronic fatigue explained by a psychiatric condition , and chronic fatigue explained by a medical condition . None of the abuse history types were significant predictors of chronic fatigue syndrome . A closer examination of individuals in the chronic fatigue syndrome group revealed that significantly fewer individuals with CFS reported abuse as compared with those who did not . The implication s of these findings are discussed BACKGROUND Anecdotal reports and books have been published linking an over growth of C and ida Albicans with chronic fatigue syndrome ( CFS ) , suggesting dietary change as a treatment option . Little scientific data has been published to vali date this controversial theory . This study aims to determine the efficacy of dietary intervention on level of fatigue and quality of life ( QoL ) in individuals with CFS . METHODS A 24-week r and omized intervention study was conducted with 52 individuals diagnosed with CFS . Patients were r and omized to either a low sugar low yeast ( LSLY ) or healthy eating ( HE ) dietary interventions .  Primary outcome measures were fatigue as measured by the Chalder Fatigue Score and QoL measured by Medical Outcomes Survey Short Form-36 . RESULTS A high drop out rate occurred with 13 participants not completing the final evaluation ( 7HE/6LSLY ) . Intention to treat analysis showed no statistically significant differences on primary outcome measurements . CONCLUSION In this r and omized control trial , a LSLY diet appeared to be no more efficacious on levels of fatigue or QoL compared to HE . Given the difficulty with dietary compliance experienced by participants , especially in the LSLY group , it would appear HE guidance is a more pragmatic approach than advocating a complicated dietary regime More than 25 % of the U.S. population aged ≥65 years has diabetes ( 1 ) , and the aging of the overall population is a significant driver of the diabetes epidemic . Although the burden of diabetes is often described in terms of its impact on working-age adults , diabetes in older adults is linked to higher mortality , reduced functional status , and increased risk of institutionalization ( 2 ) . Older adults with diabetes are at substantial risk for both acute and chronic microvascular and cardiovascular complications of the disease . Despite having the highest prevalence of diabetes of any age-group , older persons and /or those with multiple comorbidities have often been excluded from r and omized controlled trials of treatments— and treatment targets — for diabetes and its associated conditions . Heterogeneity of health status of older adults ( even within an age range ) and the dearth of evidence from clinical trials present challenges to determining st and ard intervention strategies that fit all older adults . To address these issues , the American Diabetes Association ( ADA ) convened a Consensus Development Conference on Diabetes and Older Adults ( defined as those aged ≥65 years ) in February 2012 . Following a series of scientific presentations by experts in the field , the writing group independently developed this consensus report to address the following questions : 1 . What is the epidemiology and pathogenesis of diabetes in older adults ? 2 . What is the evidence for preventing and treating diabetes and its common comorbidities in older adults ? 3 . What current guidelines exist for treating diabetes in older adults ? 4 . What issues need to be considered in individualizing treatment recommendations for older adults ? 5 . What are consensus recommendations for treating older adults with or at risk for diabetes ? 6 . How can gaps in the evidence best be filled ? According to the most recent surveillance data , the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33 % , depending on the diagnostic criteria Background : The health status of employees with chronic hepatitis C has major implication s for organizations and labour market . Objectives : To assess the effects of Acetyl-L-Carnitine administration on work productivity , daily activity , and fatigue in subjects with chronic hepatitis C treated with Pegylated-Interferon-α2b and Ribavirin .  Patients and Methods : In this prospect i ve , r and omized , placebo controlled , double blind clinical trial , 30 subjects ( Group A ) with chronic hepatitis , received Pegylated-Interferon-α2b ( 1.5 mg/kg per week ) plus Ribavirin and placebo , while 32 subjects ( Group B ) received the same dosage of Pegylated-Interferon-α2b plus Ribavirin plus 2 g Acetyl-L-Carnitine twice per day , for 12 months . Work productivity loss , impairment in daily activities , presenteeism , absenteeism , have been assessed using the Work Productivity and Activity Impairment question naire . We also evaluated severity of fatigue , mental fatigue and physical fatigue . Results : Significant difference were observed in physical fatigue , mental fatigue and severity of fatigue , aspartate aminotransferase , alanine aminotransferase , and viremia after 12 months treatment . In Group B we observed a significant decrease of presenteeism and daily activity impairment after 6 months , 12 months and at follow up . A significant increase of work productivity was observed after 12 months and at follow up . Conclusions : Office workers with chronic hepatitis C , treated with Pegylated-Interferon-α2b plus Ribavirin , had work performance loss . In subjects treated with Acetyl-L-Carnitine supplementation we observed increased daily activity and reduced presenteeism and fatigue . Acetyl-L-Carnitinegroup had a smaller reduction of productivity comparing to placebo group PURPOSE The chronic fatigue syndrome ( CFS ) is characterized by profound fatigue , neuropsychiatric dysfunction , and frequent abnormalities in cell-mediated immunity . No effective therapy is known . PATIENTS AND METHODS Forty-nine patients ( 40 with abnormal cell-mediated immunity ) participated in a r and omized , double-blind , placebo-controlled trial to determine the effectiveness of high-dose intravenously administered immunoglobulin G. The patients received three intravenous infusions of a placebo solution or immunoglobulin at a dose of 2 g/kg/month . Assessment of the severity of symptoms and associated disability , both before and after treatment , was completed at detailed interviews by a physician and psychiatrist , who were unaware of the treatment status . In addition , any change in physical symptoms and functional capacity was recorded using visual analogue scales , while changes in psychologic morbidity were assessed using patient-rated indices of depression . Cell-mediated immunity was evaluated by T-cell subset analysis , delayed-type hypersensitivity skin testing , and lymphocyte transformation with phytohemagglutinin . RESULTS At the interview conducted by the physician 3 months after the final infusion , 10 of 23 ( 43 % ) immunoglobulin recipients and three of the 26 ( 12 % ) placebo recipients were assessed as having responded with a substantial reduction in their symptoms and recommencement of work , leisure , and social activities . The patients design ated as having responded had improvement in physical , psychologic , and immunologic measures ( p less than 0.01 for each ) . CONCLUSION Immunomodulatory treatment with immunoglobulin is effective in a significant number of patients with CFS , a finding that supports the concept that an immunologic disturbance may be important in the pathogenesis of this disorder BACKGROUND Face-to-face cognitive-behavioural therapy ( CBT ) leads to a reduction of fatigue in chronic fatigue syndrome ( CFS ) . Aims To test the efficacy of internet-based CBT ( iCBT ) for adults with CFS . METHOD A total of 240 patients with CFS were r and omised to either iCBT with protocol -driven therapist feedback or with therapist feedback on dem and , or a waiting list . Primary outcome was fatigue severity assessed with the Checklist Individual Strength ( Netherl and s Trial Register : NTR4013 ) . RESULTS Compared with a waiting list , intention-to-treat ( ITT ) analysis showed a significant reduction of fatigue for both iCBT conditions ( protocol -driven feedback : B = -8.3 , 97.5 % CI -12.7 to -3.9 , P < 0.0001 ; feedback on dem and : B = -7.2 , 97.5 % CI -11.3 to -3.1 , P < 0.0001 ) . No significant differences were found between both iCBT conditions on all outcome measures ( P = 0.3 - 0.9 ) . An exploratory analysis revealed that feedback-on-dem and iCBT required less therapist time ( mean 4 h 37 min ) than iCBT with protocol -driven feedback ( mean 6 h 9 min , P < 0.001 ) and also less than face-to-face CBT as reported in the literature . CONCLUSIONS Both iCBT conditions are efficacious and time efficient . Declaration of interest None OBJECTIVE To investigate whether 12 weeks of grade d exercise with pacing would improve specific physiological , psychological and cognitive functions in people with chronic fatigue syndrome ( CFS ) . DESIGN R and omised controlled trial . SETTING Human performance laboratory at the University of Western Australia . PARTICIPANTS 61 patients aged between 16 and 74 years diagnosed with CFS . INTERVENTIONS Either grade d exercise with pacing ( 32 patients ) or relaxation/flexibility therapy ( 29 patients ) performed twice a day over 12 weeks . MAIN OUTCOME MEASURES Changes in any of the physiological , psychological or cognitive variables assessed . RESULTS Following the grade d exercise intervention , scores were improved for resting systolic blood pressure ( P = 0.018 ) , work capacity ( W.kg(-1 ) ) ( P = 0.019 ) , net blood lactate production ( P = 0.036 ) , depression ( P = 0.027 ) and performance on a modified Stroop Colour Word test ( P = 0.029 ) . Rating of perceived exertion scores , associated with an exercise test , was lower after grade d exercise ( P = 0.013 ) . No such changes were observed in the relaxation/flexibility condition , which served as an attention-placebo control . CONCLUSIONS Grade d exercise was associated with improvements in physical work capacity , as well as in specific psychological and cognitive variables . Improvements may be associated with the ab and onment of avoidance behaviours Therapeutic benefits of low-output helium-neon laser therapy have not been established , but laser therapy has been suggested as an effective means of treating many acute and chronic musculoskeletal pain syndromes . Although not released for general clinical use by the FA , the helium-neon laser has been promoted to physical therapists and athletic trainers as potentially useful for the treatment of pain syndromes . In particular , it has been proposed that it may be more effective than conventional measures such as medication and conventional physical therapy in the treatment of myofascial pain syndromes ( fibrositis , fibromyalgia ) . The citations in the literature include only case reports . Sixty-two patients were treated by using acupuncture points .  Two sessions of five treatments were given six weeks apart . A crossover double-blind technique was used in the treatments . The clinical responses were assessed using portions of the McGill Pain Question naire . No statistical difference between the treatment and the placebo groups could be determined New insights into the phenotype of Joint Hypermobility Syndrome ( JHS ) and Ehlers‐Danlos Syndrome‐hypermobile type ( hEDS ) have raised many issues in relation to classification , diagnosis , assessment , and treatment . Within the multidisciplinary team , physical therapy plays a central role in management of individuals with hypermobility related disorders . However , many physical therapists are not familiar with the diagnostic criteria , prevalence , common clinical presentation , and management . This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children , adolescents , and adults with JHS/hEDS . Due to the complexity of the symptoms in the profile of JHS/hEDS , the International Classification of Functioning , Disability and Health ( ICF ) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions , activities and participation , as well as environmental and personal factors . The current evidence ‐based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions . Multicenter r and omized controlled trials are warranted to assess the clinical and cost‐effectiveness of interventions for children and adults . Until further multicenter trials are conducted , clinical decision‐making should be based on theoretical and the current limited research evidence . For all individuals diagnosed with JHS/hEDS , international consensus and combined efforts to identify risk profiles would create a better underst and ing of the pathological mechanisms and the potential for optimizing health care for affected individuals . © 2017 Wiley Periodicals , Diseases of the dental pulp often have an infectious origin , and treatments are aim ed to control infections of the root canal system . Endodontic treatment principles originally evolved on the basis of trial and error , and only in recent decades have scientific methods been adopted to support clinical strategies . Yet , relevant research on the disease processes , their diagnoses , and efficient treatment are rare in the endodontic literature . Hence , the advancement of biologically based knowledge significant to clinical endodontics has been slow . Therefore , many differences of opinion still prevail in this field of dentistry . This review highlights and analyzes the background of some of the more heavily debated issues in recent years . Specifically , it deals with disagreements regarding the clinical management of pulpal exposures by caries in the adult dentition , definitions of success and failure of endodontic therapy  , and causes of and measures to control infections of the root canal system . Clearly , a most apparent gap in the published endodontic literature is the lack of r and omized clinical trials that address the more significant controversial matters relating to the management of pulpal wounds , medication , and the number of appointments required for the treatment of infected root canals . However , trials in endodontics require extremely long follow-up periods if valid conclusions are to be generated . Therefore , it is not to be expected that there will be rapid solutions to these issues in the foreseeable future Objective : This prospect i ve study was design ed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout , a unique affective response to combined exposure to chronic stressors . Methods : The study participants were 677 employed men and women who were followed up for 3 to 5 years ( mean = 3.6 years ) for the onset of diagnosed type 2 diabetes .  Burnout was assessed by the  Shirom-Melamed Burnout Measure  with its three subscales : emotional exhaustion , physical fatigue , and cognitive weariness . Results : The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status . During the follow-up period , 17 workers developed type 2 diabetes . Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes ( 95 % confidence interval [ CI ] = 1.19–2.85 ) even after adjusting for age , sex , body mass index , smoking , alcohol use , leisure time physical activity , initial job category , and follow-up duration . In a sub sample of 507 workers , the relative risk of diabetes was found to be much higher after additional control for blood pressure levels ( odds ratio = 4.32 , 95 % CI = 1.75–10.67 ) , available only for this sub sample . Conclusions : These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals . CI = confidence interval ; CVD = cardiovascular disease ; SMBM = Shirom-Melamed Burnout Measure ; HbA1c = glycosylated hemoglobin A1c ; VE = vital exhaustion ; MI = myocardial infa rct ion ; MBI = Maslach Burnout Inventory ; BMI = body mass index ; SBP = systolic blood pressure ; DBP = diastolic blood pressure ; OR = odds ratio ; APR = acute phase response ; CRP = C-reactive protein ; HDL = high-density lipoprotein ; HPA = hypothalamic – pituitary – adrenal Objective : It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with chronic fatigue syndrome . Design : An uncontrolled clinical trial ( semi-experimental design ) . Setting : Outpatient clinic of a university department . Subjects : Twenty-four patients with chronic fatigue syndrome . Interventions : Subjects undertook a walking test with the two concurrent exercise limits . Each subject walked at an intensity where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio = 1.0 derived from a previous submaximal exercise test and for a duration calculated from how long each patient felt they were able to walk . Main outcome measures : The Short Form 36 Health Survey or SF-36 , the Chronic Fatigue Syndrome Symptom List , and the Chronic Fatigue Syndrome — Activities and Participation Question naire were filled in prior to , immediately after and 24 hours after exercise . Results : The fatigue increase observed immediately post-exercise ( P= 0.006 ) returned to pre-exercise levels 24 hours post-exercise . The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise ( P=0.03 ) . Fourteen of the 24 subjects experienced a clinical ly meaningful change in bodily pain ( change of SF-36 bodily pain score ≥10 ) ; 6 indicated that the exercise bout had slightly worsened their health status , and 2 had a clinical ly meaningful decrease in vitality ( change of SF-36 vitality score ≥20 ) . There was no change in activity limitations /participation restrictions . Conclusion : It was shown that the use of exercise limits ( limiting both the intensity and duration of exercise ) prevents important health status changes following a walking exercise in people with chronic fatigue syndrome , but was unable to prevent short-term symptom increases BACKGROUND The Joint Working Group of the Royal Colleges of Physicians , Psychiatrists and General Practitioners ( 1996 ) recommended grade d exercise and antidepressants for patients with chronic fatigue syndrome . We assessed efficacy and acceptability of these treatments . METHOD Six-month prospect i ve r and omised placebo and therapist contact time controlled trial with allocation to one of four treatment cells : exercise and 20 mg fluoxetine , exercise and placebo drug , appointments only and 20 mg fluoxetine , appointments and placebo drug . Drug treatment was double blind and patients were blind to assignment to exercise or appointments . RESULTS Ninety-six ( 71 % ) of 136 patients completed the trial . Patients were more likely to drop out of exercise than non-exercise treatment ( P = 0.05 ) . In an intention to treat analysis , exercise result ed in fewer patients with case level fatigue than appointments only at 26 weeks ( 12 ( 18 % ) v. 4 ( 6 % ) respectively P = 0.025 ) and improvement in functional work capacity at 12 ( P = 0.005 ) and 26 weeks ( P = 0.03 ) . Fluoxetine had a significant effect on depression at week 12 only ( P = 0.04 ) . Exercise significantly improved health perception ( P = 0.012 ) and fatigue ( P = 0.028 ) at 28 weeks . CONCLUSIONS Grade d exercise produced improvements in functional work capacity and fatigue , while fluoxetine improved depression only Abstract Objective : To assess the efficacy of an educational intervention explaining symptoms to encourage grade d exercise in patients with chronic fatigue syndrome . Design : R and omised controlled trial . Setting : Chronic fatigue clinic and infectious diseases outpatient clinic . Subjects : 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome . Interventions : Patients r and omised to the control group received st and ardised medical care .  Patients r and omised to intervention received two individual treatment sessions and two telephone follow up calls , supported by a comprehensive educational pack , describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based grade d exercise . The minimum intervention group had no further treatment , but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months . Main outcome measure : A score of 25 or an increase of 10 on the SF-36 physical functioning subscale ( range 10 to 30 ) 12 months after r and omisation . Results : 21 patients dropped out , mainly from the intervention groups . Intention to treat analysis showed 79 ( 69 % ) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two ( 6 % ) of controls , who received st and ardised medical care ( P<0.0001 ) . Similar improvements were observed in fatigue , sleep , disability , and mood . No significant differences were found between the three intervention groups . Conclusions : Treatment incorporating evidence based physiological explanations for symptoms  was effective in encouraging self managed grade d exercise . This result ed in substantial improvement compared with st and ardised medical care
Rehabilitation programs that promote physiotherapy techniques such as exercise , mobilization , and body awareness ( e.g. , MRT and GET ) are the most effective in reducing medium and long-term fatigue severity in CFS patients
OBJECTIVE The objectives of this work were to fill the gap in the scientific literature and to evaluate the results of physical therapy treatments  in individuals affected by chronic fatigue syndrome , considering only studies that employed a r and omized controlled trial .