Background
Methods
Data sources
Selection Criteria
Data Extraction, Quality, and Risk of Bias Assessment
Results
Study description
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 |
Study | Random sequence generation | Allocation concealment | Patient blinding | Assessor blinding | Reporting drop-out or withdrawal†
| Intention-to-treat analysis†
| Selective outcome reporting | Other potential bias |
---|---|---|---|---|---|---|---|---|
Clollinge (1998) [10] | Low | Low | High | Low | Low | High | High | Unclear |
Dybwad (2007) [11] | Low | Low | High | Low | Low | Unclear | Low | Low |
Surawy (2005) [12] | Unclear | Unclear | High | Unclear | High | Unclear | Unclear | Unclear |
Walach (2008) [13] | Low | Low | Low | Low | Low | High | Low | Low |
Field (1997) [14] | Low | Unclear | High | High | Unclear | Unclear | Unclear | High |
Wang (2009) [15] | Unclear | Unclear | Low | Low | High | Unclear | Low | Unclear |
Liu (2010) [16] | Unclear | Unclear | High | Unclear | Unclear | Unclear | Unclear | Unclear |
Weatherley-Jones (2004) [17] | Low | Low | Low | Low | Low | Low | Low | Low |
Awdry (1996) [18] | Unclear | Unclear | Low | Low | High | High | Low | Unclear |
Hartz (2004) [19] | Low | Low | Low | Low | Low | Low | Low | Low |
Forsyth (1999) [20] | Unclear | Unclear | Low | Unclear | Unclear | High | Unclear | Unclear |
Santaella (2004) [21] | Unclear | Unclear | High | High | High | High | Low | Unclear |
Brouwers (2002) [22] | Unclear | High | Low | Low | Low | Low | Unclear | Low |
De Becker (2001) [23] | Unclear | Low | Low | Unclear | Unclear | Unclear | Unclear | Low |
The (2007) [24] | Low | Low | Low | Low | Low | Low | Unclear | Low |
McDertmott (2006) [25] | Low | Low | Low | Low | Low | High | Low | Low |
Stewart (1987) [26] | Unclear | Unclear | High | High | Low | High | High | Unclear |
Rothschild (2002) [27] | Unclear | Unclear | Low | Low | High | High | Unclear | Unclear |
Vermeulen (2004) [28] | Low | Low | Low | Low | Low | Low | Low | Low |
Behan (1990) [29] | Low | Low | High | High | Low | Unclear | High | Unclear |
Warren (1999) [30] | Low | Low | Low | Low | Low | Low | Low | Unclear |
Kaslow (1989) [31] | Unclear | Low | Low | Low | Low | Unclear | Unclear | Low |
Ockerman (2000) [32] | Unclear | Low | Low | Low | Low | Unclear | Unclear | Low |
Cox (1991) [33] | Unclear | Unclear | Low | Low | Unclear | High | Low | Unclear |
Tiev (1999) [34] | Unclear | Unclear | Unclear | Unclear | Low | Unclear | Unclear | Unclear |
Willams (2002) [35] | Unclear | Unclear | Unclear | Unclear | Low | Unclear | Unclear | Unclear |