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American Academy of Pediatrics
Article

Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up

Sanne L. Nijhof, Loudy P. Priesterbach, Cuno S. P. M. Uiterwaal, Gijs Bleijenberg, Jan L. L. Kimpen and Elise M. van de Putte
Pediatrics June 2013, 131 (6) e1788-e1795; DOI: https://doi.org/10.1542/peds.2012-2007
Sanne L. Nijhof
aDepartment of Pediatrics, Wilhelmina Children’s Hospital, and
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Loudy P. Priesterbach
aDepartment of Pediatrics, Wilhelmina Children’s Hospital, and
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Cuno S. P. M. Uiterwaal
bJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; and
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Gijs Bleijenberg
cExpert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Jan L. L. Kimpen
aDepartment of Pediatrics, Wilhelmina Children’s Hospital, and
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Elise M. van de Putte
aDepartment of Pediatrics, Wilhelmina Children’s Hospital, and
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Abstract

OBJECTIVE: Cognitive behavioral therapy (CBT) is known to be an effective treatment of adolescents with chronic fatigue syndrome (CFS), but its availability is limited. Fatigue in Teenagers on the Internet (FITNET), an Internet-based CBT program for adolescents with CFS, has been developed as an alternative to face-to-face CBT. Recently, its short-term effectiveness has been proven in a randomized clinical trial. Here we aimed to assess the long-term outcome of CFS in adolescents after FITNET treatment and after usual care. In addition, factors related to recovery at long-term follow-up (LTFU) for adolescents treated with the FITNET program were investigated.

METHODS: The study was an LTFU of participants of the FITNET trial. Data were completed for 112 (88.2%) of 127 approached FITNET study participants. Primary outcomes were fatigue severity (Checklist Individual Strength–20), physical functioning (87-item Child Health Questionnaire), and school/work attendance.

RESULTS: After a mean follow-up of 2.7 years, 66 (58.9%) adolescents had recovered from CFS. Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU. At LTFU there was no difference between the recovery rates for the different treatment strategies (original randomization: FITNET [64%] versus any form of usual care [52.8%]). Per additional month of “pretreatment disease duration,” the odds for recovery were 4% lower (odds ratio: 0.96; 95% confidence interval: 0.93–0.99; P = .016), and per added point on “focus on bodily symptoms” (Body Consciousness Scale) of the mother (0–20 points) the odds for recovery were 11% lower (odds ratio: 0.89; 95% confidence interval: 0.80–0.99; P = .029).

CONCLUSIONS: The short-term effectiveness of Internet-based CBT on adolescent CFS is maintained at LTFU. At LTFU, usual care led to similar recovery rates, although these rates were achieved at a slower pace.

  • chronic fatigue
  • adolescents
  • FITNET
  • Fatigue in Teenagers on the Internet
  • follow-up
  • cognitive behavioral therapy
  • Internet
  • functioning
  • recovery
  • Abbreviations:
    CBT —
    cognitive behavioral therapy
    CDC —
    Centers for Disease Control and Prevention
    CFS —
    chronic fatigue syndrome
    CHQ-CF87 —
    87-item Child Health Questionnaire
    CI —
    confidence interval
    CIS-20 —
    Checklist Individual Strength–20
    FITNET —
    Fatigue in Teenagers on the Internet
    FN —
    Direct Start FITNET
    LTFU —
    long-term follow-up
    OR —
    odds ratio
    RCT —
    randomized clinical trial
    SRI —
    self-rated improvement
    UC —
    Usual Care Only
    XO —
    FITNET Cross-over After Usual Care
    • Accepted February 26, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Vol. 131, Issue 6
    1 Jun 2013
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    Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up
    Sanne L. Nijhof, Loudy P. Priesterbach, Cuno S. P. M. Uiterwaal, Gijs Bleijenberg, Jan L. L. Kimpen, Elise M. van de Putte
    Pediatrics Jun 2013, 131 (6) e1788-e1795; DOI: 10.1542/peds.2012-2007

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    Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up
    Sanne L. Nijhof, Loudy P. Priesterbach, Cuno S. P. M. Uiterwaal, Gijs Bleijenberg, Jan L. L. Kimpen, Elise M. van de Putte
    Pediatrics Jun 2013, 131 (6) e1788-e1795; DOI: 10.1542/peds.2012-2007
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    • Fatigue in Teenagers on the Internet
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