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Acupoint Application as a Traditional Chinese Medicine Treatment for Fatigue Associated with Chronic Obstructive Pulmonary Disease
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Implementing evidence-based practice for patients with chronic fatigue syndrome.
Jan F Wiborg1, Michel Wensing, Marcia Tummers
1Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
Clinical Psychology & Psychotherapy
|December 12, 2012
Summary
Community mental health centers can implement cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS). An implementation manual aided support, but external help was still needed for initial rollout of CBT for CFS.
Area of Science:
- Mental Health Services Research
- Clinical Psychology
- Rehabilitation Medicine
Background:
- Chronic Fatigue Syndrome (CFS) presents significant challenges for community-based mental health care.
- Cognitive Behaviour Therapy (CBT) is a recognized treatment for CFS, but its implementation in community settings requires investigation.
- The effectiveness of an implementation manual in supporting CBT delivery for CFS in routine care is not well-established.
Purpose of the Study:
- To evaluate the implementability and sustainability of CBT for CFS in community mental health centers (MHCs) using an implementation manual.
- To assess treatment outcomes for patients receiving CBT for CFS within these community settings.
- To compare the implementation process and outcomes with existing literature on CBT for CFS.
Main Methods:
- A prospective study monitoring three Dutch MHCs implementing or sustaining CBT for CFS.
- Inclusion of one MHC utilizing a stepped care model for CFS treatment.
- Collection of implementation process data and patient treatment outcome data, including fatigue severity and physical functioning.
Main Results:
- All three MHCs successfully implemented and delivered CBT for CFS, with patient numbers exceeding 40 and manageable dropout rates (15-35%).
- Effect sizes for changes in fatigue severity ranged from 0.88 to 1.76, and for physical functioning from 0.43 to 1.23, generally aligning with benchmarks.
- Additional external support was necessary for MHCs new to CBT for CFS, indicating the manual's role in enhancing, rather than replacing, support.
Conclusions:
- Community-based MHCs demonstrate capacity for implementing and sustaining CBT for CFS.
- An implementation manual can support, but not fully substitute, external assistance for team leaders during initial CBT for CFS implementation.
- Consideration should be given to the challenges of implementing stepped care models for CFS, and low-intensity interventions may benefit from being introduced after therapists gain experience with conventional CBT for CFS.
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