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Table 1 Summary of randomised clinical studies of complementary and alternative medicine for patients with chronic fatigue syndrome

From: Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review

First author (year)

Sample size

Diagnosis

Intervention group (Regime)

Control group (Regime)

Main outcomes

Intergroup differences

Adverse events

 

Gender (M/F)

      
 

Mean age (range)

      

Clollinge (1998) [10]

70

Fukuda

(A) Qigong (2 hr weekly for 9 weeks, n = 37) plus mindfulness meditation and group discussion

(B) No treatment (n = 33)

SF-36 Heath transition score

No between group analysis

n.r.

 

(10/50)

      
 

27-61

      

Dybwad (2007) [11]

31 (4/27)

CDC

(A) Qigong (2 hr weekly for 12 weeks), plus meditation, n = 15)

(B) No treatment (n = 16)

1) Work capacity (VO2max)

1) P = 0.01

n.r.

 

17-62

   

2) Fatigue severity

2) P < 0.05

 
     

3) SF36

3) NS

 

Surawy (2005) [12]

18

Oxford

(A) MBSR (once weekly for 8 weeks, n = 8)

(B) Wait-list (once weekly for 8 weeks, n = 9)

1) HADS Anxiety

1) P = 0.00

n.r.

 

10/8

   

2) HADS Depression

2) NS

 
 

18~65

   

3) Chalder Fatigue Scale

3) NS

 
 

(n.r)

   

4) SF36 Physical Functioning

4) NS

 

Walach (2008) [13]

409

Fukuda or Oxford

(A) Distant healing (blinded, n = 105)

(C) No distant healing (blinded, n = 95)

SF-36

NS for both the mental and physical component

n.r.

   

(B) Distant healing (not blinded, n = 102)

(D) No distant healing (not blinded, n = 109)

   

Field (1997) [14]

20

Not stated

(A) Massage therapy (twice weekly for 5 weeks, n = 10)

(B) Sham TENS (twice weekly for 5 weeks, n = 10)

1) CESD

1) P < 0.005

n.r.

 

4/16

   

2) Fatigue

2) P < 0.05

 
 

n.r.

   

3) Pain

3) P < 0.005

 
 

-47

   

4) Sleep

4) P < 0.05

 

Wang (2009) [15]

182

Fukuda

(A) Intelligent-turtle massage (5 times weekly, 10 times as a course, for 2 courses with a one-week interval in between, n = 91)

(B) Massage(45 min, 5 times a week, 10 times as a course, n = 91)

Physical Symptoms

P < 0.05

n.r.

 

141/40

      
 

21-62

      
 

(n.r)

      

Liu (2010) [16]

90 (44/46)

Fukuda

(A) Tuina (once 2 days for 15 times, n = 30)

(C) Fluoxetine (20 mg/d, 1 month, n = 30)

Total effective rate

A vs. B, NS; A vs. C, P < 0.05; B vs. C, NS

(C); 17 insomnia dizziness vexation nausea, hypodynamia

 

26.4~46.2

 

(B) Tai chi (n.r., 1 month, n = 30)

    
 

(n.r.)

      

Weatherley-Jones (2004) [17]

103/92

Oxford

(A) Homeopathy (6 months, n = 47)

(B) Placebo(6 months, n = 45)

1) MFI

1) NS except general fatigue, P = 0.04

n.r.

 

n.r.

   

2) FIS

2) NS

 
 

Over 18 years

   

3) FLP

3) P = 0.04

 
 

(n.r)

      

Awdry (1996) [18]

64/61

Oxford

(A) Homeopathy (1 year, n = 30)

(B) Placebo (n = 31)

1) Daily graphs

1-2) No between

n.r.

 

18/43

   

2) Symptoms score

group analysis

 
 

<65

      
 

(n.r.)

      

Hartz Hartz (2004) [19]

96/76

Fukuda

(A) Ginseng (Siberian, 2 months, n = 40

(B) Placebo (16 weeks, 2 month, n = 36)

RVI

NS

n.r.

 

n.r.

      
 

21~65

      
 

(n.r)

      

Forsyth (1999) [20]

26

CDC

(A) NADH (10 mg, once daily for 4 weeks, n = 26, cross over design)

(B) Placebo(n = 26)

Symptom score

P < 0.05

Overly stimulated, mild loss of appetite, heartburn, increased incidence of gas and an odd taste and dryness (1)

 

(9/17)

      
 

26-57

      
 

-39.6

      

Santaella (2004) [21]

31

Fukuda

(A) NADH or nutritional

(B) Psychological therapy (24 months, n = 11)

Symptom score (month 3)

P < 0.001

n.r.

 

n.r.

 

supplements (5-10 mg, 24 months, n = 20)

    
 

22~54

      
 

(n.r)

      

Brouwers (2002) [22]

53

CDC

(A) General nutritional supplement (twice a day for 10 weeks, n = 27)

(B) Placebo(n = 26)

1) Fatigue severity

1)-3) NS

n.r.

 

(16/37)

   

2) Functional impairment

  
 

n.r.

   

3) Physical activity levels

  
 

-39.3

      

De Becker (2001) [23]

90

Fukuda or Holmes

(A) Acclydine (250 mg, 4 times daily for 1st 4 weeks and 250 mg, twice daily for 2nd 4 weeks, n = 45)

(B) Placebo (n = 45)

CGI

No between group analysis

n.r.

 

n.r.

      
 

n.r.

      
 

(n.r.)

      

The (2007) [24]

57

CDC

(A) Food supplement (Acclydine 1000 mg to 250 mg for 14 weeks, n = 30)

(B) Placebo (n = 27)

1) Fatigue severity

1)-4) NS

Mild nausea (1), exacerbation of CFS symptoms (1) and irritable bowel symptoms (1)

 

(20/37)

   

2) Function impairment

  
 

n.r.

   

3) Activity level

  
 

(n.r.)

   

4) Daily fatigue level

  

McDertmott (2006) [25]

71

CDC

(A) Food supplement (Biobran 2 mg three times per day for 8 weeks, n = 37)

(B) Placebo(n = 34)

1) Fatigue scale

1) NS

 
 

(20/51)

   

2) QOL

2) NS

 
 

n.r.

   

(WHOQOL_BREF)

  
 

(n.r.)

      

Stewart (1987) [26]

12

Not stated

(A) Supplements (subjects given supplements for 3 weeks, after first 3 weeks cross-over treatment arms for further 3 weeks, 2 multi-digestive enzymes, crossover design n = 12)

(B) Placebo(n = 12)

1) Fatigue

1)-2) No between group analysis

n.r.

 

n.r.

   

2) Bowel movements

  
 

n.r.

      
 

(n.r.)

      

Rothschild (2002) [27]

70/68

CDC

(A) Supplement (mushrooms plus aloe vera and cat's claw, processed and fermented, 3 caplets taken 3 times daily before meals, n = 33)

(B) Placebo (n = 35)

Symptoms

No between

n.r.

 

20/50

    

group analysis

 
 

n.r.

      
 

(n.r.)

      

Vermeulen (2004) [28]

90

CDC

(A) Acetyl-L-carnitine (2 g daily for 24 weeks, n = 30)

(B) Propionyl-L-carnitine (n = 30)

1) Fatigue scale

No between group analysis

n.r.

 

(21/69)

  

(C) A plus B (n = 30)

2) Pain

  
 

n.r.

   

3) Attention/concentration

  
 

(n.r.)

      

Behan (1990) [29]

63

Not stated

(A) Fatty acids((Efamol Marine, 8 capsules per day, n = 39)

(B) Placebo (n = 24)

1) Symptom measure

1) P < 0.001

n.r.

 

27/36

   

2) General health

2) P < 0.0001

 
 

21-63

    

3) n.r.

 
 

-40

      

Warren (1999) [30]

50

Oxford

(A) Essential fatty acids (Efamol Marine 1000 mg 4 times a day for 3 months, n = 25)

(B) Placebo (n = 25)

1) Physical symptom

1) NS

n.r.

 

(21/29)

   

2) Depression (Beck Depression Inventory)

2) NS

 
 

18-59

      
 

-35.7

      

Kaslow (1989) [31]

14

CDC

(A) Liver extract-folic acid-cyanocobalamin (intramuscular injection 2 ml for 1-week, n = 14, crossover design)

(B)Placebo (n = 14)

Functional status questionnaire

NS

None

 

(3/11)

      
 

30-48

      
 

(n.r.)

      

Ockerman (2000) [32]

22

CDC

(A)Antioxidant treatment (pollen and pistil 7 tablets per day for 3 months, n = 22, cross-over design)

(B) Placebo (3 month, n = 22)

1) Total well-being

1) No between group analysis

n.r.

 

(3/19)

   

2) Clinical symptoms

2) No between group analysis

 
 

27-70

      
 

-50

      

Cox (1991) [33]

34/31

other

(A) Vitamin and minerals (Magnesium, 6 weeks, n = 14)

(B) Placebo (6 weeks, n = 17)

Mean Nottingham

P = 0.001

n.r.

 

11/23

   

health profile score

  
 

18~56

      
 

(n.r.)

      

Tiev (1999)

326

Not stated

(A) Sulbutiamine (400 mg

(C) Placebo (n = 109)

1) MFI

1) Sleep disturbance

(A):9,(B):6,(C):12 diarrhoea, cystitis, bronchitis, arthritic pain, back pain, asthma, abdominal pain, insomnia, constipation, gastroenteritis, diffuse pain, sinusitis, headache, renal coli, vertigo, pharyngitis, tracheitis.

   

daily, n = 106)

 

2) Clinical global impression

(p = 0.03)

 
   

(B) Sulbutiamine (600 mg

 

3) Baecke's measure of activity

Pain (p = 0.044)

 
   

daily, n = 111)

 

4) Illness severity

2) NS

 
      

3) NS

 

Willams (2002) [35]

30

Oxford

(A) Melatonin (5 mg in the

(B) phototherapy (2500 Lux for 1

1) VAS for symptom severity; SF-36

1) Sleep disturbance(p = 0.03);Pain (p = 0.044)

n.r.

 

13/17

 

evening, 12 week, n = 30)

hour in the morning, 12 weeks, n = 30)

2) Mental fatigue

2) NS

 
 

n.r.

   

3) HADS

3) NS

 
 

-44.5

      
  1. CDC: Centers for Disease Control and Prevention; CESD: Center for Epidemiological Studies Depression Scale; CFS: Chronic Fatigue Syndrome; CGI: Clinician's Global Impression Scale; FIS: Fatigue Impact Scale; FLP: Functional Limitations Profile; HADS: Hospital Anxiety and Depression Scale; MBSR: Mindfulness-Based Stress Reduction; MFI: Multidimensional Fatigue Inventory; n.r.: not reported; NS: Not significant; RVI: Rand Vitality Index; NADH: Nicotinamide adenine dinucleotide; QoL: Quality of life; SF-36: Short Form 36; VAS: Visual Analogue Scale; WHOQOL-BREF: WHO Quality of Life-BREF.