A feasibility study comparing two treatment approaches for chronic fatigue syndrome in adolescents

There is lack of consensus about the effectiveness of the main treatment approaches. These range from approaches that involve high levels of rest, through ''pacing'' to more active rehabilitation. More active rehabilitation has devel- oped as a treatment focusing on graded rehabilitation, and more recently cognitive behavioural techniques. They are now more likely to integrate a range of approaches to address physiological, psychological, social, and systemic aspects of the syndrome. Strong feelings about treatment can be expressed by proponents at either end of the spectrum, sometimes with criticism of alternative approaches. Some advocating active rehabilitation quote research saying that prolonged excessive inactivity has adverse consequences. 10 Conversely advocates of prolonged rest who find support from internet sites, 11 some specialist clinics, 4 and some general practitioners 12 believe active rehabilitation can be damaging. Criticism of over- zealous rehabilitation can tend to undermine all rehabilita- tion, and criticism of rest can tend to undermine all energy management programmes. This polarisation of views con- spires against healthy discussion on middle ground treat- ments. This makes open minded randomised controlled trials essential to provide evidence to guide treatment and restore confidence in treatment centres, particularly as new initia- tives to establish centres of excellence unfold. This study assesses the feasibility of a larger treatment trial comparing the effectiveness of the two current most common treatment approaches. We sought to explore the acceptability of treatments and the numbers needed to show a meaningful difference between treatments.