Table 1. Overview of studies selected for review.
| Lead author (Year) | Title | Intervention groups (n) | Participants | Setting | Study design | Intervention duration | MMAT Quality Score |
|---|---|---|---|---|---|---|---|
| Age: Mean (SD) | |||||||
| (A-Z) | |||||||
| Sex: Female / Male (%) | |||||||
| Clark (2017) | Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial | SMC (102) | 38.4 (11.9) years | Secondary care / Specialist clinic | Open-label, pragmatic RCT | 8 weeks | 5 |
| GET & SMC (97) | |||||||
| 79% / 21% | |||||||
| Dailey (2013) | Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia | No TENS (41) | 49.2 (12) years | Not stated | Randomised, placebo-controlled cross-over | 3 weeks | 5 |
| Active TENS (41) | 98% / 2% | ||||||
| Placebo TENS (41) | |||||||
| Demirbag (2012) | The effects of sleep and touch therapy on symptoms of fibromyalgia and depression | Control (54) | 42.5 (11.8) years | Community / Clinic | Randomised comparison study with control | 6 weeks | 3 |
| TMA (54) | |||||||
| SMA (54) | 110% / 0% | ||||||
| El Mokadem (2020) | Three principles/innate health: The efficacy of psycho-spiritual mental health education for people with chronic fatigue syndrome | Waiting list (11) | 42.9 (10.5) (range: 19–66) years | Not stated | Randomised trial with waitlist control | 8 weeks | 4 |
| Three Principles/Innate Health (11) | |||||||
| 86% / 14% | |||||||
| Ericsson (2016) | Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial | Relaxation (63) | 51.4 (9.4) years | Community / Clinic | Multicentre RCT | 15 weeks | 3 |
| Group-based GET (67) | 100% / 0% | ||||||
| Fernie (2016) | Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome | CBT (116) | 40.8 (12.5) (range: 18–75) years | Secondary care / outpatient | Comparison of CBT & GET in practice | 4 months | 3 |
| GET (55) | |||||||
| Fitzgibbon (2018) | Evidence for the improvement of fatigue in fibromyalgia: a 4-week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized-controlled trial | Sham rTMS (12) | 45.6 (12.8) years | Secondary care / Lab-based | Randomised, double-blind placebo controlled | 4 weeks | 5 |
| rTMS (14) | |||||||
| 92% / 8% | |||||||
| Friedberg (2016) | Efficacy of two delivery modes of behavioural self-management in severe chronic fatigue syndrome | SMC (46) | 48.4 (11.5) years | Primary care / home-based | Randomised comparison | 3 months | 4 |
| Self-management & web diaries (39) | |||||||
| 88% / 12% | |||||||
| Self-management & paper diaries (39) | |||||||
| Hansen (2013) | Heart rate variability and fatigue in patients with chronic fatigue syndrome after a comprehensive cognitive behaviour group therapy program | Healthy controls (21) | 41.6 (range: 29–67) years | Not stated | Comparison (healthy controls vs. CFS patients) | 4 days | 4 |
| CBT / GET / Group therapy (19) | 100% / 0% | ||||||
| Heald (2019) | Service based comparison of group cognitive behaviour therapy to waiting list control for chronic fatigue syndrome with regard to symptom reduction and positive psychological dimensions | Waiting list (28) | 43.1 (13.2) years | Primary care / specialist clinic | Repeated measures–individuals act as own control | 8 weeks | 4 |
| Group CBT (28) | |||||||
| 61% / 39% | |||||||
| Jason (2010) | Provision of social support to individuals with chronic fatigue syndrome | Waiting list (15) | 57.6 (13) years | Primary care / home-based | Randomised trial with waitlist control | 4 months | 4 |
| Social support (15) | 83% / 17% | ||||||
| Keijmel (2017) | Effectiveness of Long-term Doxycycline Treatment and Cognitive-Behavioral Therapy on Fatigue Severity in Patients with Q Fever Fatigue Syndrome (Qure Study): a Randomized Controlled Trial | Placebo (52) | 43.8 (12.1) years | Secondary care / Lab-based | RCT | 24 weeks | 4 |
| Doxycycline (52) | |||||||
| CBT (50) | 48% / 52% | ||||||
| Kim (2013) | Indirect moxibustion (CV4 and CV8) ameliorates chronic fatigue: a randomized, double-blind, controlled study | Sham Moxibustion (20) | Median: 44 (range: 32–63) years | Lab-based | Double-blinded RCT | 4 weeks | 4 |
| Moxibustion (25) | 78% / 22% | ||||||
| Kim (2015) | Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial | SMC (50) | 42.2 (11.7) years | Secondary care | RCT | 4 weeks | 4 |
| Acupuncture & SMC (49) | |||||||
| 65% / 35% | |||||||
| Sa-am Acupuncture & SMC (51) | |||||||
| Lee (2015) | The effect of oriental medicine music therapy on idiopathic chronic fatigue | Waiting list (15) | 44.9 (12.4) years | Secondary care / outpatient | Randomised trial with waitlist control | 2 weeks | 4 |
| Oriental medicine music therapy (15) | |||||||
| 90% / 10% | |||||||
| Maddali (2016) | Efficacy of rehabilitation with Tai Ji Quan in an Italian cohort of patients with Fibromyalgia Syndrome | Educational course (22) | 52.2 (12.2) years | Primary care / home-based | Randomised comparison | 16 weeks | 4 |
| Tai Ji Quan (22) | |||||||
| Marques (2015) | Effects of a Self-regulation Based Physical Activity Program (The ’4-STEPS’) for Unexplained Chronic Fatigue: a Randomized Controlled Trial | SMC (46) | 48.1 (11) years | Community / home-based | Multicentre RCT | 12 weeks | 3 |
| Self-regulation Based Physical Activity (45) | 98% / 2% | ||||||
| Marques (2017) | Efficacy of a randomized controlled self-regulation based physical activity intervention for chronic fatigue: mediation effects of physical activity progress and self-regulation skills | SMC (46) | 48.1 (11) years | Primary care / home-based | Multicentre RCT | 12 weeks | 3 |
| Self-regulation Based Physical Activity (45) | 98% / 2% | ||||||
| Mist (2018) | Randomized Controlled Trial of Acupuncture for Women with Fibromyalgia: group Acupuncture with Traditional Chinese Medicine Diagnosis-Based Point Selection | Group Education (14) | 54 (12.4) years | Community / Specialist clinic | Random allocation / repeated measures | 10 weeks | 4 |
| 100% / 0% | |||||||
| Group Acupuncture (16) | |||||||
| Ng (2013) | Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design | Sham Acupuncture (49) | 40.9 (6.6) years | Lab-based | Single-blinded RCT | 4 weeks | 3 |
| 69% / 31% | |||||||
| Acupuncture (50) | |||||||
| O’Dowd (2006) | Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme | SMC (51) | 41.1 (11.9) years | Secondary care / outpatient | Double-blind RCT | 16 weeks | 4 |
| CBT (52) | |||||||
| GET (50) | 66% / 33% | ||||||
| Oka (2014) | Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial | Pharma (15) | 38.6 (12.6) years | Community / Clinic | RCT | 2 months | 4 |
| Yoga & Pharma (15) | |||||||
| 80% / 20% | |||||||
| Perrin (2011) | Muscle fatigue in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and its response to a manual therapeutic approach: A pilot study | Healthy controls (9) | 35.8 (range: 20–55) years | Lab-based | Comparison–osteopathy vs self-selected treatment vs healthy control | 12 months | 3 |
| Osteopathic treatment (9) | |||||||
| Any treatment (9) | 44% / 56% | ||||||
| Powell (2004) | Patient education to encourage graded exercise in chronic fatigue syndrome: 2-year follow-up of randomised controlled trial | SMC (34) | 33.2 (10.3) years | Outpatient / home-based | RCT | 12 months | 3 |
| GET: | |||||||
| Min. intervention (37) | 75% / 25% | ||||||
| Telephone intervention (39) | |||||||
| Max. intervention (33) | |||||||
| Racine (2019) | Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: a Pilot Randomized Controlled Trial | Control (43) | No details | Community / Clinic | RCT | 10 weeks | 3 |
| Operant learning (17) | |||||||
| Energy conservation activity pacing (24) | |||||||
| Raijmakers (2019) | Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study | Placebo (52) | 43.8 (12.1) years | Secondary care / outpatient | RCT | 24 weeks | 4 |
| Doxycycline (52) | |||||||
| CBT (50) | 48% / 52% | ||||||
| Ridsdale (2012) | The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial | SMC & CBT booklet (75) | 39.8 (range: 34–46) years | Primary care / home-based | RCT | 12 months | 5 |
| GET (71) | 78% / 22% | ||||||
| Counselling (76) | |||||||
| Sharpe (2015) | Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial | SMC (115) | 38 (12) years | Primary care / Community | Multicentre randomised trial | 6 months | 3 |
| APT & SMC (120) | 77% / 23% | ||||||
| CBT & SMC (119) | |||||||
| GET & SMC (127) | |||||||
| Shu (2016) | Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: a Pilot Controlled Clinical Trial | Healthy controls (15) | 37.1 (14.3) years | Lab-based | RCT | 3 weeks | 3 |
| Acupuncture (15) | 73% / 27% | ||||||
| Moxibustion (15) | |||||||
| Stubhaug (2008) | Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial | Placebo (24) | 46.32 (8.75) years | Not stated | RCT | 24 weeks | 4 |
| Mirtazapine (25) | |||||||
| CBT (23) | 82% / 18% | ||||||
| Tummers (2010) | Effectiveness of stepped care for chronic fatigue syndrome: a randomized noninferiority trial | SMC (85) | 38.1 (10.3) years | Outpatient / home-based | Randomised non-inferiority study | 6 months | 2 |
| Self-instruction & CBT (84) | |||||||
| 79% / 21% | |||||||
| UÄŸurlu (2017) | The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial | Sham Acupuncture (25) | 45.4 (8.2) years | Community / Specialist clinic | RCT | 5 weeks | 4 |
| 100% / 0% | |||||||
| Acupuncture (25) | |||||||
| Van Hoof (2003) | Hyperbaric Therapy in Chronic Fatigue Syndrome | HBOT: | 42 (13) years | Lab-based | Randomised sampling | 1 week | 5 |
| Healthy controls (13) | 66% / 34% | ||||||
| Infection (13) | |||||||
| Vos-Vromans (2016) | Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: a randomized controlled trial | CBT (60) | 40.3 (11.1) years | Community | Multicentre RCT | 10 weeks | 3 |
| Multidisciplinary rehabilitation treatment (62) | |||||||
| 80% / 20% | |||||||
| Wearden (2010) | Nurse led, home-based self-help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial | SMC (100) | 44.6 (11.4) years | Primary care / home-based | Single-blind RCT | 18 weeks | 4 |
| Pragmatic rehab (95) | 78% / 22% | ||||||
| Supportive listening (101) | |||||||
| Weatherley-Jones (2004) | A randomized, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome | Placebo (50) | 38.9 (10.8) years | Community / Clinic | Triple-blind RCT | 6 months | 4 |
| Homeopathic medication (53) | |||||||
| 59% / 41% | |||||||
| White (2011) | Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial | SMC (160) | 38 (12) years | Secondary care | Multicentre randomised trial | 24 weeks | 4 |
| APT & SMC (159) | 77% / 23% | ||||||
| CBT & SMC (161) | |||||||
| GET & SMC (160) | |||||||
| Wiborg (2015) | Randomised controlled trial of cognitive behaviour therapy delivered in groups of patients with chronic fatigue syndrome | Waiting list (68) | 37.9 (11.3) years | Secondary care / outpatient | RCT | 6 months | 5 |
| CBT: | |||||||
| Large group (68) | |||||||
| Small group (68) | 77% / 23% | ||||||
| Windhorst (2017) | Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: an exploratory pilot study | Biofeedback (13) | 50.7 (9.3) years | Secondary care / outpatient | Randomised study | 8 weeks | 5 |
| GET (11) | 100% / 0% | ||||||
| Wu (2020) | Observation on therapeutic efficacy of tuina plus cupping for chronic fatigue syndrome | Ginseng lozenges (50) | 40.1 (5.1) years | Community / Specialist clinic | RCT | 16 weeks | 4 |
| 63% / 37% | |||||||
| Tuina & Cupping (50) |
Cognitive behavioural therapy (CBT); Chronic Fatigue Syndrome (CFS); Graded Exercise Therapy (GET); Randomised controlled trial (RCT); Adaptive Pacing Therapy (APT); Standard Medical Care (SMC); Transcutaneous electrical nerve stimulation (TENS); Hyperbaric oxygen therapy (HBOT); Touch, Music & Aroma (TMA); Sleep, Music & Aroma (SMA); Repetitive transcranial magnetic stimulation (rTMS); Standard deviation (SD).