Six studies (n=245), one of which was a randomised controlled trial (n=47), were included in the review. The remaining studies compared cohorts of patients before and after an intervention or compared patients with CFS versus no-fatigue controls (three within-participant designs, one controlled study of post/non-infectious patients versus no-fatigue controls, and one study comparing intervention versus no intervention control).
Where reported, the drop-out rates at follow-up were 0% in two studies, 33 to 34% in two studies and 4% in one study, with follow-up periods ranging from 9 months to 5 years; one study did not carry out any follow-up assessments.
Three studies of in-patient programmes reported increases in the Karnofsky scale (15 to 25 points from baseline in one study), the number of individuals returning to normal physical activity (19% reporting return to normal after follow-up in one study), and the improvement of physical and mental symptoms (as measured by the Cornell Medical Index in one study). One of the studies conducted in adolescent school children reported that, at follow-up, 78% of children had returned to school;in another study 89% of adults had returned to work.
One out-patient study (n=28) reported a 61% improvement in self-reported baseline symptoms and quality of life (8 out of 8 participants); two participants returned to normal work/school/physical exercise and five returned to previously normal function. One community-based study reported 61% of participants returned to work at follow-up and 27% were functioning at a level equivalent to employment. A community-based randomised controlled trial reported that participants receiving the rehabilitation programme (compared with control) had an improved Quality of Life Index, lower symptom severity (Symptom Severity Checklist), and increases in resource gain, energy, well-being and mastery resource (Conservation of Resources Evaluation Scale). The improvement in quality of life continued at the 12-month follow-up.