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Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention

机译:癌症相关的疲劳和康复:体育锻炼与认知行为疗法相结合,仅进行体育锻炼且无干预的随机对照多中心试验

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摘要

Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial. This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention. In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included. The study was conducted at 4 rehabilitation centers in the Netherlands. All patients were survivors of cancer. Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours. Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points. Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups. Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.
机译:研究表明,癌症康复可以减轻癌症幸存者的疲劳。迄今为止,尚不清楚哪种类型的康复治疗最有益。这项随机对照试验比较了体育锻炼与认知行为疗法联合单纯体育锻炼对癌症相关疲劳的影响,而没有进行干预。在这项多中心随机对照试验中,将147名癌症幸存者随机分配到接受体育锻炼结合认知行为疗法的组(PT + CBT组,n = 76)或仅接受体育锻炼的组(PT组, n = 71)。此外,还包括一个由62名癌症幸存者组成的非干预对照组(WLC组),他们在其他地方的康复中心等待中。该研究在荷兰的4个康复中心进行。所有患者均为癌症幸存者。每周两次进行2个小时的个人训练和小组运动的体育锻炼,而认知行为疗法每周两次进行一次,持续2个小时。在干预之前和之后(入组后12周)用多维疲劳清单评估疲劳。 WLC组在同一时间完成了调查表。 3组之间的基线疲劳无显着差异。随着时间的流逝,除了WLC组的精神疲劳外,所有组的所有领域的疲劳水平均显着下降。干预后疲劳的方差分析显示,小组疲劳对总体疲劳,身体和精神疲劳以及减少的激活有积极的作用,但对减少的动机没有统计学意义。与WLC组相比,PT组报告了4个疲劳域的下降幅度更大,而PT + CBT组报告了仅物理疲劳的下降幅度更大。 PT + CBT组和PT组之间在疲劳下降方面没有发现显着差异。与没有干预相比,体育锻炼加上认知行为疗法和体育锻炼单独对疲劳有明显的有益影响。在减少癌症相关的疲劳方面,体育锻炼与体育锻炼结合认知行为疗法同等有效,甚至比体育锻炼更有效,这表明认知行为疗法没有超出体育锻炼益处的其他有益作用。

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  • 来源
    《Physical Therapy》 |2010年第10期|p.1413-1425|共13页
  • 作者单位

    E. van Weert, PhD, is Principal Investigator, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands, SHARE, Graduate School for Healthcare Research, University Medical Center Groningen, University of Groningen, and Comprehensive Cancer Centre North- East, Groningen, the Netherlands. Address all correspondence to Dr van Weert at: e.van.weert@rev.umcg.nl.A.M. May, PhD, is Assistant Professor, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands, and Department of Medical Psychology and Psychotherapy, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.I. Korstjens, PhD, is Senior Lecturer- Researcher, Department Midwifery Science, University of Midwifery Education and Studies Maastricht, Maastricht, the Netherlands, and Department of Health Promotion, Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, the Netherlands.W.J. Post, PhD, is Statistician, Department of Epidemiology, University Medical Center Groningen, University of Groningen.C.P. van der Schans, PhD, is Professor in Health Care and Nursing, Hanze University, Applied Sciences, Groningen, the Netherlands, and Comprehensive Cancer Centre North- East, Groningen, the Netherlands.B. van den Borne, PhD, is Professor in Patient Education, Department of Health Promotion, Care and Public Health Research Institute (Caphri), Maastricht University.I. Mesters, PhD, is Associate Professor, Department of Epidemiology, Care and Public Health Research Institute (Caphri), Maastricht University.W.J.G. Ros, PhD, is Assistant Professor, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht.J.E.H.M. Hoekstra-Weebers, PhD, is Head of Supportive Care, Comprehensive Cancer Centre North-East, Groningen, the Netherlands, and Principal Investigator, Wenckebach Institute, University Medical Center Groningen, University of Groningen. Dr Hoekstra-Weebers also is affiliated with SHARE, Graduate School for Healthcare Research, University Medical Center Groningen, University of Groningen.[van Weert E, May AM, Korstjens I, et al. Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention. Phys Ther. 2010,90:1413-1425.]© 2010 American Physical Therapy AssociationDr van Weert, Dr May, Dr Korstjens, Dr van der Schans, Dr van den Borne, Dr Mesters, Dr Ros, and Dr Hoekstra-Weebers provided concept/idea/research design. Dr van Weert, Dr May, Dr Korstjens, Dr van den Borne, Dr Mesters, and Dr Hoekstra-Weebers provided writing. Dr van Weert, Dr May, and Dr Korstjens provided data collection. Dr van Weert, Dr May, Dr Korstjens, Dr Post, Dr Ros, and Dr Hoekstra-Weebers provided data analysis. Dr van Weert, Dr May, Dr Korstjens, Dr van den Borne, Dr Ros, and Dr Hoekstra- Weebers provided project management. Dr van der Schans, Dr van den Borne, and Dr Ros provided fund procurement. Dr Ros provided participants. Dr Ros and Dr Hoekstra- Weebers provided facilities/equipment and institutional liaisons. Dr Post, Dr van der Schans, Dr van den Borne, and Dr Hoekstra- Weebers provided consultation (including review of manuscript before submission).The authors acknowledge the contribution to the study of Professor R.W. Trijsburg (Erasmus Medical Center Rotterdam) who sadly passed away on April 8, 2007. They also thank the professional staff and participants at all rehabilitation centers whose participation made this study possible.The medical ethics committee of the University Medical Center Utrecht and the local research ethics committees approved the study.This study was supported by grants from the Dutch Cancer Society (UU-2003-2782), Comprehensive Cancer Center North-East, and Maastricht University.This article was received June 25, 2009, and was accepted May 23, 2010.DOI: 10.2522/ptj.20090212,;

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