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Results for “Physical Functional Performance”

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At least 487 records · Page 27Linked to original sources

PubMed2006

Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis.

OBJECTIVE: Physical function and body composition in older obese adults with knee osteoarthritis (OA) were examined after intensive weight loss. RESEARCH METHODS AND PROCEDURES: Older obese adults (n = 87; > or = 60 years; BMI > or = 30.0 kg/m2) with symptomatic knee OA and difficulty with daily activities were recruited for a 6-month trial. Participants were randomized into either a weight stable (WS) or weight loss (WL) program. Participants in WL (10% weight loss goal) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk. WS participants attended health information sessions. Body composition and physical function (Western Ontario and McMaster University Osteoarthritis Index, 6-minute walking distance, and stair climb time) were assessed at baseline and 6 months. Statistical analysis included univariate analysis of covariance on 6-month measurements using baseline values as covariates. Associations between physical function and body composition were performed. RESULTS: Body weight decreased 8.7 +/- 0.8% in WL and 0.0 +/- 0.7% in WS. Body fat and fat-free mass were lower for WL than WS at 6 months (estimated means: fat = 38.1 +/- 0.4% vs. 40.9 +/- 0.4%, respectively; fat-free mass = 56.7 +/- 0.4 vs. 58.8 +/- 0.4 kg, respectively). WL had better function than WS, with lower Western Ontario and McMaster University Osteoarthritis Index scores, greater 6-minute walk distance, and faster stair climb time (p < 0.05). Changes in function were associated with weight loss in the entire cohort. DISCUSSION: An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA. Greater improvements in function were observed in those with the most weight loss.

Activities of Daily Living↗

PubMedDate not supplied

Respiratory muscle function in physically active elderly women.

This study was performed in 52 women, aged 60 to 76 years: 27 were engaged in a gymnastics program, 3 h a week, for at least 2 years; 25 were age-matched controls. All were lifelong nonsmokers, free of disease symptoms and lived independently at home; none had previously engaged in exercise programs. Spirometry included volumes, flows and maximal voluntary ventilation (MVV); maximal mouth pressures both inspiratory (MIP) and expiratory (MEP) were also measured. The two groups differed only in the mean value of MEP (cm of water) which was 107.7 +/- 37.3 S.D. in the active group and 87.4 +/- 22.8 S.D. in the controls (P = 0.028). MIP and MVV were also higher in the active group but the differences were not significant. However, a significant correlation between MVV and both MIP and MEP was only found in the active group, suggesting a relation between muscular endurance and strength. This exercise program, although not oriented towards the respiratory system, improved the performance of the respiratory muscles probably by an effect on the abdominal musculature.

Journal Article↗

PubMed1994

The development of a battery of measures for assessing physical functioning of chronic pain patients.

The physical performance of chronic pain patients is of major concern both for their assessment and for treatment evaluation. However, there are few widely used physical tests, a shortage of reliability and validity data on published tests, and an over-reliance on self-report or on clinical measures of dubious generalisability. A set of tests was designed to cover speed and endurance in walking, stair climbing, standing up from a chair, sit-ups, arm endurance, grip strength, and peak flow. Standard instructions and testing conditions were used by a trained tester on a population of chronic pain patients before and after a cognitive-behavioural chronic pain management programme. Reliability, validity, and acceptability of each test was examined, and recommendations made for their relative utility.

Adult↗

PubMed2003

Physical activity and its relationship to physical performance in patients with end stage knee osteoarthritis.

STUDY DESIGN: Cross-sectional observational design. OBJECTIVES: To compare physical activity levels in men and women with end-stage knee osteoarthritis to those of a comparison group and to examine the relationship between physical activity level and physical performance. BACKGROUND: Osteoarthritis of the knee is associated with significant losses in functional performance and high social costs. Although reductions in physical activity are reported, they have not been quantified or explored. METHODS AND MEASURES: Fifty-nine candidates awaiting total knee arthroplasty (TKAC group) and 79 individuals without osteoarthritis (comparison group) participated. Physical activity was assessed using the Voorrips Questionnaire. Performance measures included fast self-paced walk test, timed up-and-go test, and a timed stair performance measure. A subset of subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and underwent muscular strength and endurance testing. The effects of gender and group were tested using GLM ANOVA. Pearson product moment correlations were used to examine relationships between the variables. RESULTS: All aspects of physical activity were lower (P<.001) in the TKAC group, with a moderate difference in household score (18%) and a large difference in leisure activities (63%). Unlike the comparison group, modest but significant correlations (r = 0.31-0.33, P<.03) were observed between overall physical activity and performance test scores for the TKAC group. Physical activity was not significantly related to pain reported on the WOMAC or during the performance tasks. CONCLUSIONS: The belief that pain limits the physical activity of patients with severe osteoarthritis requires further investigation. The profound differences between a comparison group and patients with end-stage osteoarthritis in physical activity have critical implications for the well-being and effective treatment of this population.

Activities of Daily Living↗

PubMed1999

Does laxity alter the relationship between strength and physical function in knee osteoarthritis?

OBJECTIVE: Since strengthening interventions have had a lower-than-expected impact on patient function in studies of knee osteoarthritis (OA) and it is known that laxity influences muscle activity, this study examined whether the relationship between strength and function is weaker in the presence of laxity. METHODS: One hundred sixty-four patients with knee OA were studied. Knee OA was defined by the presence of definite osteophytes, and patients had to have at least a little difficulty with knee-requiring activities. Tests were performed to determine quadriceps and hamstring strength, varus-valgus laxity, functional status (Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning subscale [WOMAC-PF] and chair-stand performance), body mass index, and pain. High and low laxity groups were defined as above and below the sample median, respectively. RESULTS: Strength and chair-stand rates correlated (r = 0.44 to 0.52), as did strength and the WOMAC-PF score (r = -0.21 to -0.36). In multivariate analyses, greater laxity was consistently associated with a weaker relationship between strength (quadriceps or hamstring) and physical functioning (chair-stand rate or WOMAC-PF score). CONCLUSION: Varus-valgus laxity is associated with a decrease in the magnitude of the relationship between strength and physical function in knee OA. In studies examining the functional and structural consequences of resistance exercise in knee OA, stratification of analyses by varus-valgus laxity should be considered. The effect of strengthening interventions in knee OA may be enhanced by consideration of the status of the passive restraint system.

Adult↗

PubMed1995

Objectively measuring physical ability in elderly persons: the Physical Capacity Evaluation.

The Physical Capacity Evaluation, a performance measure of functional capabilities comprised of 13 tasks simulating those used in activities of daily living, was tested on 289 community-dwelling elderly people and compared against a widely used self-report measure of function, the Health Assessment Questionnaire. Factor analysis identified one dominant component in each instrument. Internal consistency reliability (Cronbach's alpha) was .90 for both instruments. Global disability (Health Assessment Questionnaire) and function (Physical Capacity Evaluation) scores were correlated -.74. One-week retest reliabilities on 58 subjects were .94 for the Physical Capacity Evaluation and .95 for the Health Assessment Questionnaire. The Physical Capacity Evaluation is a valid and reliable measure of physical performance for use with elderly people.

Activities of Daily Living↗

PubMed1997

Does family support buffer the impact of specific chronic diseases on mobility in community-dwelling elderly?

The present study explores whether different structural (presence of partner and children) and functional (amounts of instrumental and emotional support provided by partner and children) family characteristics buffer the influence of chronic diseases on physical functioning. Logistic regression analyses were performed in a population-based sample of 2830 community-dwelling elderly people with chronic diseases as independent variable, and mobility difficulties as dependent variable, for separate strata of family characteristics. The presence of buffer effects was ascertained by comparing the associations between disease variables and mobility difficulties across the strata of family characteristics, using the odds ratios and 95% confidence intervals. Living together with a partner appears to buffer the association between the presence of one chronic disease and mobility difficulties, but no such effect is present among subjects with more than one disease. Regarding specific chronic diseases, partner presence has a beneficial influence only on the association between stroke and mobility difficulties, regardless of whether the partner provides little or much support. For patients with chronic non-specific lung disease (asthma, chronic bronchitis or pulmonary emphysema), a small amount of instrumental support (help with daily chores in and around the house) received from the partner is associated with a higher risk for mobility difficulties, compared to patients who receive a large amount of instrumental support and to patients who are not living with a partner. Neither the presence of children, nor the amounts of support received from them, influences associations between specific chronic diseases and mobility difficulties. The present study provides limited evidence supporting a buffer effect of family characteristics on the association between chronic diseases and mobility. Only in elderly people with a relatively low burden of disease does family support mitigate the adverse effects of disease on physical functioning.

Activities of Daily Living↗

PubMed1992

[Age-induced changes in the cardiovascular system in normal subjects].

To assess the effect of age on cardiac structure and function, we performed echocardiograms on 104 physically active, normal, community-dwelling volunteers (68 men and 36 women), ranging in age from 18 to 84 years and having no evidence of hypertension or cardiovascular disease. With advancing adult aging, the following were observed: a decrease in aortic compliance (r = 0.42); an increase in systolic (r = 0.61), diastolic (r = 0.24), pulse (r = 0.60) and mean (r = 0.48) arterial pressure; and a modest enlargement of aortic root (r = 0.47) and left atrial dimension (r = 0.30) were observed. Left ventricular end-diastolic volume (r = 0.25), wall thickness (r = 0.30) and mass (r = 0.37) also increased with aging, while left ventricular end-systolic volume was not age-related. Furthermore, a stepwise multivariate linear model identified the decrease in arterial compliance (R2 = 0.06; p < 0.02) and the increase in left ventricular stroke work (R2 = 0.38; p < 0.0001) as the only variables independently related to the increase in left ventricular mass that occurs with advancing age. Regarding left ventricular systolic function, aging was also related to an increase in left ventricular stroke work (r = 0.40) and ejection time (r = 0.44), while pump function, (measured as ejection fraction and cardiac index at rest), and contractility (measured by load independent end-systolic indexes) were unaffected by aging. Conversely, pulsed Doppler analysis of mitral inflow showed a significant age-related decline in the peak early filling velocity (r = -0.45) and in the ratio of early and late diastolic filling velocity (r = -0.66), while peak late diastolic flow velocity (r = 0.50), diastolic pressure half time (r = 0.34) and duration of isovolumic relaxation (r = 0.56) increased significantly with age.

Adolescent↗

PubMed1997

Verbally administered Barthel Index as functional assessment in brain tumour patients.

OBJECTIVE: To investigate verbally administered Barthel Index as a measure of functional status in patients with high grade gliomas. BACKGROUND: Barthel Index (BI) is a performance score of activities of daily living which has been validated in patients with neurological disability. While any assessment of quality of life in brain tumour patients should include all the aspects of CNS function we concentrated on measurement of physical performance status and evaluated the role of BI as a measure of palliative effect of treatment in patients with high grade glioma undergoing radiotherapy. METHODS: BI was verbally administered on 504 occasions in 107 patients with high grade glioma. The BI scores were correlated with Karnofsky performance score (KPS), and neurological performance score (NPS) as a measure of inter-index reliability. The BI's prognostic value was assessed using actuarial survival data. RESULTS: BI was sensitive to change and reflected the degree of functional impairment. In patients with high grade glioma BI correlated with KPS, and NPS (R2 = 0.872 and 0.658 respectively). BI score was also of prognostic value in terms of survival. The median survival of patients with functional independence was 9 months with moderate disability 5 months and with severe disability 4 months. CONCLUSION: Verbally administered Barthel Index is easy to use, reliable and sensitive to change and is of prognostic value. It is a useful tool in the management of patients with gliomas, as an objective evaluation of palliative effectiveness of treatment in patients with functional disability.

Activities of Daily Living↗

PubMed2000

[The preventive effects of physical activity in the elderly].

PHYSICAL ACTIVITY AND AGING: Physical activity prevents some age-related impairment. Physical activity reduces the decline of physical capacity which remains limited by maximal heart rate, and reduces the incidence of cardiovascular diseases by decreasing and preventing associated risk factors. Physical activity reduces age-related bone loss, its effect being potentialized by hormonal replacement therapy, and improves balance function, leading to a lower incidence of falls and fractures in older subjects. Physical activity helps to preserve nutritional balance and lean mass/fat mass ratio and reduces age-related insulin resistance. Moreover, physical activity has a beneficial influence on psychological function by improving cognitive performances and decreasing incidence of depression. Lastly, physical activity seems to reduce the incidence of several cancers, colic and mammary cancers particularly. PHYSICAL ACTIVITY, QUANTITY AND QUALITY OF LIFE: These multiple actions explain that physical activity, if it's adapted to subject's specificities increases longevity, delay entry in dependence and improves quality of life in older subjects. WHAT ARE THE RECOMMENDED ACTIVITIES: There is a superiority of individualized programs giving greater place to warm-up and associated endurance and resistive exercises intended to improve simultaneously cardiovascular and muscular functions. SPECIAL INTERESTS OF PHYSICAL ACTIVITY IN FRAIL AND VERY OLD SUBJECTS: Throughout its beneficial effects on aerobic capacity, muscular function, social integration, cognitive function and autonomy, physical activity may have a particular interest in frail subjects, when programs are adapted to physical capacities of these subjects and associated with nutritional supplements.

Accidental Falls↗

PubMed1993

Using multidimensional health measures in older persons to identify risk of hospitalization and skilled nursing placement.

We examine the relationship between multidimensional measures of function and outcomes in a cohort of older persons admitted to the residential care level of a multi-level long-term care facility. We collected self-reported measures of various aspects of health using the Medical Outcome Study Short-form Health Survey (SF-20) and the Dartmouth COOP charts, as well as performance-based measures of physical and cognitive function. Subjects (mean age 84.3 years) were followed for a median of 557 days. In multivariate analyses, emotional function (measured by either the SF-20 or COOP method) was a predictor of placement in skilled care. Self-reported overall health (measured by either the SF-20 or COOP method) and timed manual performance were predictive of hospitalization. Change on the functional status measures between 2 points in time was not associated with later placement in skilled care except in the case of timed manual performance. In an older population at risk for frequent and numerous health events, this study shows that two popularized self-report methods for assessing function yield results that predict future outcomes of great importance to older persons. However, measures that predict use of long-term care may not predict use of the hospital and vice versa.

Activities of Daily Living↗

PubMed2002

Clinical assessment of function among women with a recent cerebrovascular event: a self-reported versus performance-based measure.

BACKGROUND: Self-reported functional status is a commonly used health measure in clinical settings, yet the optimal approach for assessing function is often debated. OBJECTIVE: To examine the agreement between a self-reported and a performance-based measure of function and the relative ability of each measure to predict long-term health outcomes. DESIGN: Prospective cohort study. SETTING: 20 hospitals in Connecticut and Massachusetts. PARTICIPANTS: 620 postmenopausal women (46 to 91 years of age) who had experienced a stroke or transient ischemic attack. MEASUREMENTS: A self-reported and a performance-based measure of function were assessed at baseline (before intervention) by using the Barthel index and the Physical Performance Test. RESULTS: Disagreement between the self-reported and performance-based measure of function was common (slight disagreement, 55.0%; substantial disagreement, 19.3%). Most women (95.4%) overreported their level of function. Women who were more clinically impaired (risk ratio [RR] for more comorbid conditions, 1.52 [95% CI, 1.17 to 1.97]; RR for recent stroke, 2.33 [CI, 1.45 to 3.73]; and RR for cognitive impairment, 1.76 [CI, 1.34 to 2.32]); who were less educated (RR = 1.30 [CI, 1.02 to 1.67]); and who were of nonwhite ethnicity (RR 1.43 [CI, 1.07 to 1.91]) were more likely to overreport their level of function. An impaired performance-based measure of function predicted subsequent stroke or death (hazard ratio, 1.50, [CI, 1.06 to 2.11]); however, an impaired self-reported measure of function was not likely to predict these outcomes. CONCLUSIONS: Clinicians should be aware that results of self-reported and performance-based measures of function can differ in women who have experienced a recent cerebrovascular event. Although more difficult to collect, results of a performance-based measure may provide information about long-term health outcomes that is not available from a self-reported measure.

Activities of Daily Living↗

PubMed2005

Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985.

OBJECTIVE: A comprehensive quantitative analysis of measures of disease activity and joint damage has not been available to compare patients in different eras in the same clinical setting. This study was undertaken to determine whether the clinical status of patients with rheumatoid arthritis (RA) has improved on average in recent years. METHODS: A quantitative cross-sectional evaluation, which included joint count, radiographic, laboratory, patient questionnaire, and physical function measures, and therapies, was performed in 125 consecutive RA patients seen from 1984 through 1986 ("1985 cohort"). A virtually identical assessment was performed in 150 patients seen from 1999 through 2001 ("2000 cohort"), in the same weekly academic clinic. Measures were compared using descriptive statistics and a median regression model, adjusted for age, duration of disease, level of formal education, and rheumatoid factor. RESULTS: Patients in 1985 had significantly poorer status compared with those in 2000: median 12 versus 5 swollen joints, Larsen radiographic score 20 versus 3, erythrocyte sedimentation rate 33 mm/hour versus 20, and modified Health Assessment Questionnaire 1.0 versus 0.4 (P < 0.019). Severe Disease Activity Scores >5.1 were seen in 69% of 1985 patients, compared with 30% in 2000. Methotrexate was taken by 10% of patients in 1985, versus 76% in 2000. The proportion of patients not taking any disease-modifying antirheumatic drugs was 66% in 1985 versus 13% in 2000. CONCLUSION: Patients receiving standard care for RA in this setting had significantly better status, including radiographic scores, in 2000 than in 1985, associated with aggressive treatment strategies, prior to the introduction of biologic agents.

Arthritis, Rheumatoid↗

PubMed1999

[Diagnosis of zinc deficiency].

Though far more common, particularly in elderly people, than was previously assumed, marginal zinc deficiency does not lead to the classical manifestations of zinc deficiency and is therefore difficult to diagnose. There is therefore a need for sensitive parameters that can reliably demonstrate even marginal zinc deficiency, as suboptimal zinc status can seriously impair human health, performance, reproductive functions, and mental and physical development. The most important criteria for the diagnosis of zinc deficiency are critically discussed. The laboratory parameters currently considered to be the most useful indicators of marginal zinc deficiency are zinc-binding capacity and serum/plasma alkaline phosphatase activity before and after zinc supplementation (zinc tolerance test!). In order to obtain a reliable assessment of a patients zinc status, a number of different diagnostic parameters should always be measured.

Aged↗

PubMed1994

Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn's Relapse Prevention Trial Study Group.

BACKGROUND/AIMS: Quality of life (QOL), a subjective index of health perception and function, embraces physical, social, and emotional performance but has not had a prominent role in clinical trials of inflammatory bowel disease (IBD). To test the robustness of the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific QOL index, this study assessed its validity, reliability, and responsiveness during a multicenter trial. METHODS: Three hundred five patients with stable Crohn's disease received cyclosporin or placebo for 18 months. IBDQ and dimensional scores (bowel, social, systemic, and emotional) were correlated with disease activity (Crohn's disease activity index [CDAI] and Harvey-Bradshaw index). Concordance of IBDQ scores was tested in 280 stable subjects. Linear regression evaluated change in IBDQ scores over time. RESULTS: IBDQ scores correlated highly with CDAI (r = -0.67; P < 0.0001). The reliability coefficient for IBDQ score was 0.70 vs. 0.66 for CDAI and 0.55 for Harvey-Bradshaw index. Regression line slopes of IBDQ scores were significantly different in patients who deteriorated from those who remained stable ([b] < 0.15; P < 0.0001). QOL scores were lower in patients who required surgery. CONCLUSIONS: The IBDQ is a valid reliable assessment tool that reflects important changes in the health status of patients with IBD. The IBDQ is a robust measure of therapeutic efficacy and should be used in future clinical trials in IBD.

Adult↗

PubMed2006

Relations between body composition, functional and hormonal parameters and quality of life in healthy postmenopausal women.

OBJECTIVE: To investigate whether body composition, functional status and serum hormone levels are associated with quality of life in healthy postmenopausal women. DESIGN: A cross-sectional study among 402 women aged 56-73 years, 8-30 years postmenopausal. Quality of life (QoL) was assessed using the questionnaire on life satisfaction (QLS), with two modules directed at general factors (QLS-general) and health factors (QLS-health). Muscle strength was measured using dynamometry. Functional ability was estimated by physical performance (PPS), physical activity during the preceding year, and impairment in activities of daily living (ADL). Bone mineral density, lean mass and fat mass were assessed by dual-energy X-ray absorptiometry. Fasting levels of serum oestradiol, oestrone, and sex hormone-binding globulin (SHBG), testosterone, cortisol, androstenedione, DHEA and DHEAS, insulin-like growth factor (IGF-1), its binding proteins (IGFBP-1 and -3) and insulin, were determined. RESULTS: Both QLS modules did not decrease with age. The major positive predictor of QLS-general module was the presence of a partner. Higher physical performance and higher educational level of participants' partners were significantly related to higher QLS-general, while smoking and presence of co-morbidities were significantly associated with a lower QLS-general. The determinants studied were mostly related to the QLS-health module, the major negative predictor of QLS-health being the presence of co-morbidities, followed by physical activity, physical performance and grip strength. Higher educational level of participants was related with higher QLS-health module, while higher BMI, fat mass and presence of disability were associated with significantly lower QLS-health. No consistent relation was found between serum levels of hormones measured and both QLS modules. CONCLUSIONS: The most important and specific determinant for psychological well-being was having a partner. Physical and psychological well-being are further strongly associated in this population of healthy postmenopausal women below 75 years of age, while increasing fat mass was related to decreased well-being. Our results suggest that in elderly and late postmenopausal women hormonal factors do not predict quality of life.

Absorptiometry, Photon↗

PubMedDate not supplied

Urinary incontinence in the elderly: relation to cognitive and motor function.

Urinary incontinence is a common problem in older subjects, very often wrongfully accepted as a normal part of the aging process. A total of 520 subjects (208 males and 312 females; mean age 74.8 +/- 11.8 years), from both private- and nursing-home dwelling populations, were included in this study aimed to estimate the incidence of urinary incontinence and identify factors associated with condition, in aged subjects. The incidence and type of urinary incontinence (stress, urge or mixed incontinence) were assessed by structured questionnaires and diagnosis was confirmed by a seven-day consecutive voiding diary. Assessment of physical, cognitive and emotional functions was performed on each subject using the Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living Scale (IADL), Tinetti Scale (gait), Tinetti Scale (balance) and Geriatric Depression Scale (GDS) instruments. In the total population sample the incidence of urinary incontinence was 47.9%. The incontinence cases were classified, according to the different types, as: stress incontinence (males: 3.4%; females: 8.7%; males+females: 6.5%); urge incontinence (males: 27.4%; females: 31.4%; males+females: 29.8%); mixed incontinence (males: 20.2%; females: 5.8%; males+females: 11.5%). In the total population sample, no significant relationship was found between age and prevalence of urinary incontinence. In the elderly female group, age significantly correlated in a direct manner with urge incontinence (P<0.01) and inversely with stress incontinence (P<0.001). Only in the male sex group age significantly correlated with mixed incontinence (P<0.005). Multiple linear regression analysis showed that the dependent variable 'incontinence' could be predicted by MMSE (P<0.001) in the male sex group and by the Tinetti Scale (gait) (P<0.001) in the female sex group.

Journal Article↗

PubMed2004

Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care.

BACKGROUND: Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet. METHOD: This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated. RESULTS: In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI) = -25 to -15), with no significant difference between groups (mean difference = -1.3; CI = -3.9 to 1.3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS. CONCLUSIONS: Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier 'to sell'. Low recovery in the CFS subgroup suggests that brief treatment is too short.

Adolescent↗