Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled 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 Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome Randomised Controlled Trial of Cognitive Behaviour Therapy Delivered in Groups of Patients with Chronic Fatigue Syndrome Therapist effects in routine psychotherapy practice: An account from chronic fatigue syndrome A Randomized Controlled Graded Exercise Trial for Chronic Fatigue Syndrome: Outcomes and Mechanisms of Change Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome A Description of the Trials, Reviews, and Practice Guidelines Indexed in the PEDro Database The efficacy of the Rességuier method in the treatment of fibromyalgia syndrome: a randomized controlled trial. INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions
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 examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis ( RA ) . DESIGN R and omized controlled trial . SETTING Hospital outpatient rheumatology clinic . PARTICIPANTS Persons with RA aged 20 to 65 years ( N=70 ) :  intervention group ( n=36 ) and reference group ( n=34 ) . INTERVENTIONS The 12-week intervention , with 6-month follow-up , focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities . The reference group continued with regular activities ; both groups received usual health care . MAIN OUTCOME MEASURES Primary outcome was general fatigue ( visual analog scale ) . Secondary outcomes included multidimensional fatigue ( Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Question naire ) and fatigue-related variables ( ie , disease , health , function ) . RESULTS At posttest , general fatigue improved more in the intervention group than the reference group ( P=.042 ) . Improvement in median general fatigue reached minimal clinical ly important differences between and within groups at posttest and follow-up . Improvement was also observed for anxiety ( P=.0099 ) , and trends toward improvements were observed for most multidimensional aspects of fatigue ( P=.023-.048 ) , leg strength/endurance ( P=.024 ) , and physical activity ( P=.023 ) . Compared with the reference group at follow-up , the intervention group improvement was observed for leg strength/endurance ( P=.001 ) , and the trends toward improvements persisted for physical ( P=.041 ) and living-related ( P=.031 ) aspects of fatigue , physical activity ( P=.019 ) , anxiety ( P=.015 ) , self-rated health ( P=.010 ) , and self-efficacy ( P=.046 ) . CONCLUSIONS Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA 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 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 Background : Meta-analyses have been inconclusive about the efficacy of cognitive behaviour therapies ( CBTs ) delivered in groups of patients with chronic fatigue syndrome ( CFS ) due to a lack of adequate studies . Methods : We conducted a pragmatic r and omised controlled trial with 204 adult CFS patients from our routine clinical practice who were willing to receive group therapy .  Patients were equally allocated to therapy groups of 8 patients and 2 therapists , 4 patients and 1 therapist or a waiting list control condition . Primary analysis was based on the intention-to-treat principle and compared the intervention group ( n = 136 ) with the waiting list condition ( n = 68 ) . The study was open label . Results : Thirty-four ( 17 % ) patients were lost to follow-up during the course of the trial . Missing data were imputed using mean proportions of improvement based on the outcome scores of similar patients with a second assessment . Large and significant improvement in favour of the intervention group was found on fatigue severity ( effect size = 1.1 ) and overall impairment ( effect size = 0.9 ) at the second assessment . Physical functioning and psychological distress improved moderately ( effect size = 0.5 ) . Treatment effects remained significant in sensitivity and per- protocol analyses . Subgroup analysis revealed that the effects of the intervention also remained significant when both group sizes ( i.e. 4 and 8 patients ) were compared separately with the waiting list condition . Conclusions : CBT can be effectively delivered in groups of CFS patients . Group size does not seem to affect the general efficacy of the intervention which is of importance for setting s in which large treatment groups are not feasible due to limited referral Abstract The effect of therapists in psychotherapy is a much debated topic , with a number of studies showing therapist variance being large while other studies show little or no variability in outcomes due to therapists . The aim of this study was to investigate therapist effects in a well-defined sample of patients and therapists from an outpatient service which specializes in providing cognitive behaviour therapy ( CBT ) for patients with chronic fatigue syndrome ( CFS ) . Therapy was provided in a highly specialized clinical setting for CFS and was delivered by qualified CBT therapists with at least 2 years experience with this client group . Three hundred and seventy-four patients with CFS and 12 cognitive behavioural psychotherapists took part .  Therapist effects on the primary outcomes of fatigue and disability were investigated with multilevel r and om effects models and variance component analysis . Different models were computed and compared . Results showed a reduction in fatigue and disability scores after therapy . Variance explained by therapists , when demographic covariates were accounted for , was 0 % for fatigue and under 2 % for disability . A number of important factors may have played a significant role in minimizing therapist effects in our study . These are : specialist setting , single centre , patients with the same primary diagnosis , therapists of the same orientation and training , shared environment and supervision . Future studies may stress the importance of these factors in the investigation of the therapist effect in psychotherapy The aim of this study was to investigate the potential mechanisms underlying the efficacy of grade d exercise therapy for  chronic fatigue syndrome ( CFS ) . Forty-nine CFS patients were r and omized to a 12-week  grade d exercise programme  or to st and ard medical care . At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group . A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect . Grade d exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms Few studies have examined therapist effects and therapeutic alliance ( TA ) in treatments for chronic fatigue syndrome ( CFS ) . Therapist effects are the differences in outcomes achieved by different therapists . TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy . Prior research suffers the method ological problem that the allocation of therapist was not r and omized , meaning therapist effects may be confounded with selection effects . We used data from a r and omized controlled treatment trial of 296 people with CFS . The trial compared pragmatic rehabilitation ( PR ) , a nurse led , home based self-help treatment , a counselling-based treatment called supportive listening ( SL ) , with general practitioner treatment as usual . Therapist allocation was r and omized . Primary outcome measures , fatigue and physical functioning were assessed blind to treatment allocation . TA was measured in the PR and SL arms . Regression models allowing for interactions were used to examine relationships between ( i ) therapist and therapeutic alliance , and ( ii ) therapist and average treatment effect ( the difference in mean outcomes between different treatment conditions ) . We found no therapist effects . We found no relationship between TA and the average treatment effect of a therapist . One therapist formed stronger alliances when delivering PR compared to when delivering SL ( effect size 0.76 , SE 0.33 , 95 % CI 0.11 to 1.41 ) . In these therapies for CFS , TA does not influence symptomatic outcome . The lack of significant therapist effects on outcome may result from the trial ’s rigorous quality control , or r and om therapist allocation , eliminating selection effects . Further research is needed . Trial Registration : IS RCT Background Cancer-related fatigue ( CRF ) is one of the most common and distressing side effects of cancer and its treatment . During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life ( QoL ) . Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being , effective treatment methods are scarce . Physical activity for breast cancer patients has been reported to decrease fatigue , to improve emotional well-being and to increase physical strength . The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise , however , are poorly understood . In the BEST trial we aim to assess the effects of resistance training on fatigue , QoL and physical fitness as well as on molecular , immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy . Methods / design The BEST study is a prospect i ve r and omized , controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy .  To determine the effect of exercise itself beyond potential psychosocial group effects , patients in the control group perform a group-based progressive muscle relaxation training . Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy . Main exclusion criteria are acute infectious diseases , severe neurological , musculosceletal or cardiorespiratory disorders . The primary endpoint is cancer-related fatigue ; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood , saliva and urine . In addition , QoL , depression , physical performance and cognitive capacity will be assessed . Discussion The BEST study is the first r and omized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy . Based on the analysis of physiological , immunological and inflammatory parameters it will contribute to a better underst and ing of the physiological and psychosocial effects and the biological mechanisms of resistance training . The ultimate goal is the implementation of optimized intervention programs to reduce fatigue , improve quality of life and potentially the prognosis after breast cancer . Trial registration Clinical Trials.gov PURPOSE We determined the feasibility of conducting a r and omized clinical trial design ed to compare 2 methods of manual therapy ( myofascial physical therapy and global therapeutic massage ) in patients with urological chronic pelvic pain syndromes . MATERIAL S AND METHODS We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers . Eligible patients were r and omized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each . Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment , adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment . Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods . RESULTS There were 23 ( 49 % ) men and 24 ( 51 % ) women r and omized during a 6-month period . Of the patients 24 ( 51 % ) were r and omized to global therapeutic massage , 23 ( 49 % ) to myofascial physical therapy and 44 ( 94 % ) completed the study . Therapist adherence to the treatment protocol s was excellent . The global response assessment response rate of 57 % in the myofascial physical therapy group was significantly higher than the rate of 21 % in the global therapeutic massage treatment group ( p = 0.03 ) . CONCLUSIONS We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS Background : Exercise training is beneficial , but most persons with multiple sclerosis ( MS ) are sedentary and physically inactive . This has prompted a new focus on the promotion of lifestyle physical activity in MS . We previously design ed , tested , and refined a behavioral intervention delivered through the Internet that successfully increased lifestyle physical activity in MS , but have not evaluated the effects on secondary symptomatic and health-related quality of life ( HRQOL ) outcomes . Objective : We conducted a 6-month r and omized controlled trial ( RCT ) that examined the efficacy of an Internet-delivered , behavioral intervention for improving outcomes of fatigue , depression , anxiety , pain , sleep quality , and HRQOL in 82 ambulatory persons with MS . The secondary aim was to replicate previous results regarding change in free-living physical activity . Results : There was a significant and positive effect of the intervention on fatigue severity ( p=.001 , ηρ2=.15 ) and its physical impact ( p=.008 , ηρ2=.09 ) , depression ( p=.006 , ηρ2=.10 ) , and anxiety ( p=.006 , ηρ2=.10 ) . There were non-significant improvements in pain ( p=.08 , ηρ2=.04 ) , sleep quality ( p=.06 , ηρ2=.05 ) , and physical HRQOL ( p=.06 , ηρ2=.05 ) . We replicated our previous results by demonstrating an increase in self-reported physical activity ( p=.001 , ηρ2=.13 ) . Conclusions : Our results support behavioral interventions targeting lifestyle physical activity as an alternative approach for managing symptoms in MS Summary Background Grade d exercise therapy is an effective and safe treatment for chronic fatigue syndrome , but it is therapist intensive and availability is limited . We aim ed to test the efficacy and safety of grade d exercise delivered as guided self-help . Methods In this pragmatic r and omised controlled trial , we recruited adult patients ( 18 years and older ) who met the UK National Institute for Health and Care Excellence criteria for chronic fatigue syndrome from two secondary -care clinics in the UK . Patients were r and omly assigned to receive specialist medical care ( SMC ) alone ( control group ) or SMC with additional guided grade d exercise self-help ( GES ) . Block r and omisation ( r and omly varying block sizes ) was done at the level of the individual with a computer-generated sequence and was stratified by centre , depression score , and severity of physical disability . Patients and physiotherapists were necessarily unmasked from intervention assignment ; the statistician was masked from intervention assignment . SMC was delivered by specialist doctors but was not st and ardised ; GES consisted of a self-help booklet describing a six-step grade d exercise programme that would take roughly 12 weeks to complete , and up to four guidance sessions with a physiotherapist over 8 weeks ( maximum 90 min in total ) . Primary outcomes were fatigue ( measured by the Chalder Fatigue Question naire ) and physical function ( assessed by the Short Form-36 physical function subscale ) ; both were self-rated by patients at 12 weeks after r and omisation and analysed in all r and omised patients with outcome data at follow-up ( ie , by modified intention to treat ) . We recorded adverse events , including serious adverse reactions to trial interventions . We used multiple linear regression analysis to compare SMC with GES , adjusting for baseline and stratification factors . This trial is registered at IS RCT N , number IS RCT N22975026 . Findings Between May 15 , 2012 , and Dec 24 , 2014 , we recruited 211 eligible patients , of whom 107 were assigned to the GES group and 104 to the control group . At 12 weeks , compared with the control group , mean fatigue score was 19·1 ( SD 7·6 ) in the GES group and 22·9 ( 6·9 ) in the control group ( adjusted difference −4·2 points , 95 % CI −6·1 to −2·3 , p<0·0001 ; effect size 0·53 ) and mean physical function score was 55·7 ( 23·3 ) in the GES group and 50·8 ( 25·3 ) in the control group ( adjusted difference 6·3 points , 1·8 to 10·8 , p=0·006 ; 0·20 ) . No serious adverse reactions were recorded and other safety measures did not differ between the groups , after allowing for missing data . Interpretation GES is a safe intervention that might reduce fatigue and , to a lesser extent , physical disability for patients with chronic fatigue syndrome . These findings need confirmation and extension to other health-care setting s. Funding UK National Institute for Health Research Research for Patient Benefit Programme and the Sue Estermann Fund Background Chronic fatigue is common in the general population . Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms . Purpose This study aim ed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome . Methods Sixty-four participants were r and omly assigned to either an intervention group or a wait list control group . Outcome measures included fatigue symptoms , physical functioning , mental functioning , and telomerase activity . Results Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls . Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units ( p < 0.05 ) . The change was statistically significant when compared to the control group ( p < 0.05 ) . Conclusion Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome This perspective provides an overview of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy . Data from the Physiotherapy Evidence Data base ( PEDro ) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy . The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929 . Most of the r and omized controlled trials , systematic review s , and evidence -based clinical practice guidelines in physical therapy have been published since the year 2000 . This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice OBJECTIVES In fibromyalgia syndrome ( FMS ) defined rehabilitation guidelines are yet to be vali date d. Our aim is to evaluate the efficacy of the Rességuier method ( RM ) in FMS . METHODS Forty-one patients were r and omly assigned to Interventional ( 22 pts ) and Observational ( 19 pts ) Group ( IG and OG ) . The study lasted 8 months . Patients were assessed at baseline ( T0 ) after a 2-month rehabilitation ( T1 ) and at a 6-month follow-up ( T2 ) ( only IG ) with SF-36 Physical ( PSI ) and Mental Synthetic Index ( MSI ) , Regional Pain Scale ( RPS ) , Fibromyalgia Impact Question naire ( FIQ ) , Number Rating Scales 0 - 10 to measure pain , movement quality , sleep , relax ability , analgesics number/per week . OG patients maintained their lifestyle for the duration of the study . RM aims to obtain patient awareness and control of bodily perceptions , thus reaching a modulation of responses to pain . Therapist controls patient attention and perception by verbal and manual contacts and leads them to perform bodily and respiratory active and conscious movements . RESULTS In IG , at T1 all items were improved : PSI and MSI ( p<0.001 and = 0.001 ) , FIQ ( p<0.0001 ) , RPS ( p<0.001 ) , pain ( p<0.0001 ) , movement quality ( p=0.001 ) , relax ability ( p<0.0001 ) , sleep ( p<0.001 ) ; analgesics number/per week was reduced ( p<0.001 ) . All results obtained at T1 , except FIQ , were maintained at T2 . In OG at T1 versus T0 , no difference in any of the assessed parameters was observed . CONCLUSION In FMS patients , the rehabilitation with RM  improves HRQoL , FMS-related disability and perceived pain , thus reducing the assumption of analgesics & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy
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 .