Review article
Interventions in Pediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review

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Abstract

Purpose

A range of interventions have been used for the management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in children and adolescents. Currently, debate exists as to the effectiveness of these different management strategies. The objective of this review was to synthesize and critically appraise the literature on interventions for pediatric CFS/ME.

Method

CINAHL, PsycINFO and Medline databases were searched to retrieve relevant studies of intervention outcomes in children and/or adolescents diagnosed with CFS/ME. Two reviewers independently selected articles and appraised the quality on the basis of predefined criteria.

Results

A total of 24 articles based on 21 studies met the inclusion criteria. Methodological design and quality were variable. The majority assessed behavioral interventions (10 multidisciplinary rehabilitation; 9 psychological interventions; 1 exercise intervention; 1 immunological intervention). There was marked heterogeneity in participant and intervention characteristics, and outcome measures used across studies. The strongest evidence was for Cognitive Behavioral Therapy (CBT)-based interventions, with weaker evidence for multidisciplinary rehabilitation. Limited information exists on the maintenance of intervention effects.

Conclusions

Evidence for the effectiveness of interventions for children and adolescents with CFS/ME is still emerging. Methodological inadequacies and inconsistent approaches limit interpretation of findings. There is some evidence that children and adolescents with CFS/ME benefit from particular interventions; however, there remain gaps in the current evidence base.

Section snippets

Search strategy

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (The PRISMA Statement) [28]. The following electronic databases were searched: Medline (1987 to 2012), CINAHL (1987–2012), and PsycINFO (1987–2012). The searches were restricted to English-language publications published in peer-reviewed journals from 1987 (because the first universal diagnostic criteria for CFS were published at this time [29]) to May 2012. The Medical

Descriptions of studies

Figure 1 shows the search strategy results. The final sample included 24 papers on 21 studies. A list of excluded articles is available from the corresponding author on request.

Participant characteristics

Participant characteristics for each study are displayed in Table 2. Some variability existed among studies as far as the diagnostic criteria used to define CFS/ME. Most studies [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46] used the Centers of Disease Control and Prevention (CDC) 1994

Discussion

To our knowledge, this is the first systematic review undertaken to examine interventions aimed at improving outcomes exclusively in pediatric CFS/ME. Findings from 24 papers evaluating multidisciplinary, psychological, physical, and immunological interventions were reviewed. All of the studies yielded positive findings, but methodological weaknesses were common. Based on systematic quality assessment, the strongest evidence was for CBT-based interventions with weaker evidence for the

Acknowledgments

We would like to acknowledge the members of the Melbourne Pediatric CFS/ME Research Team for their support and guidance. All phases of this study were supported by The Mason Foundation Grant through the Australian and New Zealand Banking Group Limited Trustees. The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

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