Table 3.
Summary of outcomes for anxiety symptoms and other relevant findings for included studies
| Authors (year) | Measure of anxiety | Pretreatment | Post-treatment (unless otherwise stated) | Statistical analysis of change in anxiety symptomatology | Summary of other relevant findings |
| Chalder et al 24 | HADS FQ |
HADS—median 7, (IQ range 6.7–9.7) FQ agoraphobia 12.9 (8, 17.8) FQ blood/injury—9.9 (5.7–14.2) FQ social—12.2 (8.8–15.6) FQ total—35.1 (26.2–43.9) FQ dysphoria—11.7 (7.0–16.4) |
6 min follow-up HADS—mean 0.5 IQ range 0.5–9 FQ agoraphobia—4.8 (2.2, 7.4) FQ blood/injury—6.9 (2.9–10.8) FQ social—8.5 (4.7–12.2) FQ total—20.2 (11.5–28.9) FQ dysphoria—6.3 (2.9–9.8) |
Wilcoxon signed ranks test (significance two tailed) HADS—2.02 (0.04) FQ agoraphobia—2.85 (0.00) FQ blood/injury—1.57 (0.12) FQ social—1.42 (0.16) FQ total—2.15 (0.03) FQ dysphoria—1.58 (0.11) |
The 20 participants who completed treatment had all returned to school at 6 months follow-up, with 19 of 20 attending full time. Depression significantly improved, as did social adjustment. |
| Diaz-Caneja et al 23 | MASC | Not stated. Raised levels of social anxiety and physical symptoms of anxiety. | Not stated although it is reported that anxiety improved | Not reported. | Report of a moderate response to treatment with the young person tolerating more activity. She had resumed contact with her friends, and although she still complained of tiredness and pain, she was attending classes daily. |
| Lloyd et al
25
Rimes et al 34 |
SCAS | Baseline mean 22.84 (SD 17.18) Baseline median 16.0 (IQR 10.8–35.0) Cases: Baseline mean 22 (SD 17). Median 16.0 (IQR 9.0–34.0) Controls: Median 16.5 (IQR 8.0–22.8) |
6 month follow-up mean 17.25 (SD 13.06) 6 month follow-up mean for CFS cases 17 (SD 14). |
Multilevel modelling and Wald tests Treatment effect estimate at 6 m 0.49 Significance (two-tailed) 0.003, effect size 0.16. T value (21)=2.1. Significant p value 0.005 |
Significant improvement in fatigue and school attendance, with reductions in depression and impairment and increased adjustment at 6 months. Adolescents with CFS had reduced cortisol excretion throughout the day compared with healthy controls. There was significant improvement in school attendance after treatment from 24% to 49%. There was reduction in fatigue after treatment; however, the results were not significant. |
| Nijhof et al 22 33 | STAIC | Intervention group: Mean 32.7 (SD 8.8) Control group: Mean 32.3 (SD 8.0) |
Not stated. | At 6 min, additional analyses of main findings with adjustments for anxiety, depression and primary outcomes, had no effects on the results. When looking at factors related to recovery at 2.5 years, anxiety OR 1.01 (95% CI 0.96 to 1.06), p=0.66 | Intervention (FITNET) was significantly more effective than the control (usual care) at 6 months—full school attendance (50 (75%) vs 10 (16%), relative risk 4.8, 95% CI 2.7 to 8.9; p<0.0001), absence of severe fatigue (57 (85%) vs 17 (27%), 3.2, 2.1 to 4.9; p<0.0001) and normal physical functioning (52 (78%) vs 13 (20%), 3.8, 2.3 to 6.3; p<0.0001). The short-term effectiveness of FITNET was maintained at 2.5 years follow-up. At 2.5 years follow-up, usual care led to similar recovery rates, although progress had taken longer to make. |
| Rimes et al 2 | DAWBA | Not stated. | Four participants developed CFS/ME at follow-up (4 to 6 months). | Not reported. | Of the four participants who developed CFS/ME over the follow-up period, three of four had at least one psychiatric diagnosis at baseline. |
| Rowe et al 23 | SSTAQ | Reported as one group Mean 46.2 (SD 24.4) SE 3.9 Range 0–98 |
6 months follow-up Mean 28.1 (SD 25.0) SE 5.9 Range 0–77 |
T value (df) 2.63 (56) Significant p value 0.01 |
Significant mean functional improvement in both groups. |
| Van de Putte, et al 26 | SSTAQ | Mean 36.9 (SD 7.8) | Not stated. | Not reported. | 47% of children ‘fully recovered’ (below score that is mean plus 2 SD of subjective fatigue distribution in healthy children). |
| Wright et al 20 | HADS anxiety | Intervention: Mean 10.17 (SD 3.71) Control: Mean 6.80 (SD 3.56) |
End of treatment Intervention: Mean 6.00 (3.63) Control: Mean 6.60 (SD 4.73) |
Analysis of covariance for anxiety, controlling for baseline score. Difference −1.60 (−8.31–5.10) F 0.3 (df 1.8) p=0.6 |
Activity (child and clinician rated) and school attendance improved markedly in the intervention (STAIRway) arm compared with little improvement in activity scores in the control (pacing) arm and a deterioration in school attendance. Global health (child and clinician rated) improved in both arms although more in the STAIRway arm than the pacing arm. |
CBT, cognitive behavioural therapy; CFS, Chronic Fatigue Syndrome; DAWBA, Development and Well-Being Assessment; FITNET, Fatigue In Teenagers on the interNET; FQ, Fear Questionnaire; HADS, Hospital Anxiety and Depression Scale; MASC, Multidimensional Anxiety Scale for Children; ME, myalgic encephalomyelitis; SCAS, Spence Children’s Anxiety Scale; SSTAQ, Spielberger State Trait Anxiety Questionnaire; STAIC, State-Trait Anxiety Inventory for Children; STAIRway, Structured Tailored Incremental Rehabilitation.