E1 ReplicatedModerate confidencePEM ✗RCTPeer-reviewedMachine draft
Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.
Crawley, Esther, Anderson, Emma, Cochrane, Madeleine et al. · Health technology assessment (Winchester, England) · 2024 · DOI
Quick Summary
This study compared two online treatments for teenagers with ME/CFS: a cognitive behavioural therapy programme called FITNET-NHS and activity management delivered by video calls. After 6 months, teenagers using FITNET-NHS showed better improvements in physical function and attended about half a day more school per week than those receiving activity management. However, FITNET-NHS was more expensive, and by 12 months both groups had improved similarly, making it unclear whether the extra cost was worth the temporary benefit.
Why It Matters
Most UK adolescents with ME/CFS lack access to specialist face-to-face CBT treatment. This trial demonstrates that online CBT can be delivered effectively and is feasible at scale, though it highlights the tension between clinical efficacy and healthcare resource allocation. The findings provide evidence directly relevant to treatment commissioning decisions for paediatric ME/CFS services.
Observed Findings
- At 6 months, FITNET-NHS participants achieved greater physical function improvements than activity management controls (mean difference 8.2 points on SF-36 Physical Function, p=0.003).
- FITNET-NHS participants attended approximately half a day more school per week at 6 months, with this difference maintained at 12 months.
- Both groups continued to improve from 6 to 12 months, with no significant between-group difference remaining at 12-month follow-up (mean difference 4.4, 95% CI -1.7 to 10.5).
- FITNET-NHS incurred £1047.51 additional cost per participant compared to activity management.
- Approximately 25–26% of participants in both groups met pre-defined criteria for worsening condition during treatment.
Inferred Conclusions
- Online cognitive behavioural therapy can be delivered feasibly to adolescents with ME/CFS and produces faster short-term improvements in physical function and school attendance than activity management.
- The additional cost of FITNET-NHS and lack of sustained advantage at 12 months make it unlikely to be cost-effective from an NHS perspective at conventional willingness-to-pay thresholds (£20,000 per QALY).
- Activity management delivered via videocall represents a more cost-effective treatment option despite slower initial gains.
- Comorbid mood disorders do not appear to substantially modify the relative effectiveness of the two interventions.
What This Study Does Not Prove
This study does not prove that FITNET-NHS is ineffective overall—it showed real improvements in physical function and school attendance at 6 months—but rather that its cost-effectiveness compared to activity management is questionable given limited sustained advantage at 12 months. The study also does not establish superiority for patients with significant mood comorbidities, as no clear differential effect was observed. Additionally, the findings cannot be generalised to in-person CBT delivery or to adult ME/CFS populations.
Tags
Symptom:Cognitive DysfunctionPainFatigue
Phenotype:Pediatric
Method Flag:PEM Not DefinedMixed Cohort
Metadata
- DOI
- 10.3310/VLRW6701
- PMID
- 39485730
- Review status
- Machine draft
- Evidence level
- Replicated human evidence from multiple independent studies
- Last updated
- 8 April 2026