Multiple Sclerosis Journal - October 2017 - 1551

LE van den Akker, H Beckerman et al.

Figure 2. Observed results on the primary outcome CIS20r fatigue (mean, SD, at each measurement moment).

theoretical model proposed by Van Kessel and MossMorris8 and support the supposition that cognitive,
emotional, and behavioral factors can perpetuate or
worsen fatigue.
Based on the current results, some recommendations
can be given. Future research into the factors related
to the process of change during CBT may improve
CBT for MS-related fatigue. Furthermore, insight into
factors related to the diminishing post-treatment
effects might aid the improvement of the current CBT
program or the development of interventions that are
able to sustain a positive short-term effect over the
long term (e.g. CBT booster sessions). The evidence
provided by this randomized clinical trial supports a
clinical practice recommendation to start CBT in
patients with severe MS-related fatigue.
Conclusion
The TREFAMS-CBT trial showed a significant and
beneficial short-term effect of individually tailored
CBT provided by certified psychologists compared to
the control intervention on MS-related fatigue. Future
research should focus on identifying the mechanisms
of change to provide a basis for maintaining positive
effects over the long term.
Acknowledgements
We gratefully acknowledge the participants, CBT
therapists, and the specialized MS nurses who contributed to this trial. We would also like to thank
the rehabilitation physicians for their help during the
recruitment phase and would like to acknowledge the
support provided by the national and regional patient
organizations MSVN and everybody involved with
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the TREFAMS-CBT trial in the participating centers.
Trial registration: TREFAMS-CBT ISRCTN58583714.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.

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Table of Contents for the Digital Edition of Multiple Sclerosis Journal - October 2017