***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To evaluate the effectiveness of home delivered pragmatic rehabilitation — a programme of gradually increasing activity design ed collaboratively by the patient and the therapist— and supportive listening — an approach based on non-directive counselling — for patients in primary care with chronic fatigue syndrome/myalgic encephalomyelitis or encephalitis ( CFS/ME ) . Design Single blind , r and omised , controlled trial . Setting 186 general practice s across the north west of Engl and between February 2005 and May 2007 . Participants 296 patients aged 18 or over with CFS/ME ( median illness duration seven years ) diagnosed using the Oxford criteria . Interventions Participants were r and omly allocated to pragmatic rehabilitation , supportive listening , or general practitioner treatment as usual . Both therapies were delivered at home in 10 sessions over 18 weeks by one of three adult specialty general nurses who had received four months ’ training , including supervised practice , in each of the interventions . GP treatment as usual was unconstrained except that patients were not to be referred for systematic psychological therapies during the treatment period . Main outcome measures The primary clinical outcomes were fatigue and physical functioning at the end of treatment ( 20 weeks ) and 70 weeks from recruitment compared with GP treatment as usual .  Lower fatigue scores and higher physical functioning scores denote better outcomes . Results A total of 257 ( 87 % ) of the 296 patients who entered the trial were assessed at 70 weeks , the primary outcome point . Analysis was on an intention to treat basis , with robust treatment effects estimated after adjustment for missing data using probability weights . Immediately after treatment ( at 20 weeks ) , patients allocated to pragmatic rehabilitation ( n=95 ) had significantly improved fatigue ( effect estimate -1.18 , 95 % confidence interval -2.18 to -0.18 ; P=0.021 ) but not physical functioning ( -0.18 , 95 % CI -5.88 to + 5.52 ; P=0.950 ) compared with patients allocated to treatment as usual ( n=100 ) . At one year after finishing treatment ( 70 weeks ) , there were no statistically significant differences in fatigue or physical functioning between patients allocated to pragmatic rehabilitation and those on treatment as usual ( -1.00 , 95 % CI -2.10 to + 0.11 ; P=0.076 and + 2.57 , 95 % CI 3.90 to + 9.03 ; P=0.435 ) . At 20 weeks , patients allocated to supportive listening ( n=101 ) had poorer physical functioning than those allocated to treatment as usual ( -7.54 , 95 % CI -12.76 to -2.33 ; P=0.005 ) and no difference in fatigue . At 70 weeks , patients allocated to supportive listening did not differ significantly from those allocated to treatment as usual on either primary outcome . Conclusions For patients with CFS/ME in primary care , pragmatic rehabilitation delivered by trained nurse therapists  improves fatigue in the short term compared with unconstrained GP treatment as usual , but the effect is small and not statistically significant at one year follow-up . Supportive listening delivered by trained nurse therapists is not an effective treatment for CFS/ME . Trial registration International St and ard R and omised Controlled Trial Number I RCT N74156610 BACKGROUND Reports of mild hypocortisolism in chronic fatigue syndrome led us to postulate that low-dose hydrocortisone therapy may be an effective treatment . METHODS In a r and omised crossover trial , we screened 218 patients with chronic fatigue . 32 patients met our strict criteria for chronic fatigue syndrome without co-morbid psychiatric disorder . The eligible patients received consecutive treatment with low-dose hydrocortisone ( 5 mg or 10 mg daily ) for 1 month and placebo for 1 month ; the order of treatment was r and omly assigned . Analysis was by intention to treat . FINDINGS None of the patients dropped out . Compared with the baseline self-reported fatigue scores ( mean 25.1 points ) , the score fell by 7.2 points for patients on hydrocortisone and by 3.3 points for those on placebo ( paired difference in mean scores 4.5 points [ 95 % CI 1.2 - 7.7 ] , p=0.009 ) . In nine ( 28 % ) of the 32 patients on hydrocortisone , fatigue scores reached a predefined cut-off value similar to the normal population score , compared with three ( 9 % ) of the 32 on placebo ( Fisher 's exact test p=0.05 ) . The degree of disability was reduced with hydrocortisone treatment , but not with placebo . Insulin stress tests showed that endogenous adrenal function was not suppressed by hydrocortisone .  Minor side-effects were reported by three patients after hydrocortisone treatment and by one patient after placebo . INTERPRETATION In some patients with chronic fatigue syndrome , low-dose hydrocortisone reduces fatigue levels in the short term . Treatment for a longer time and follow-up studies are needed to find out whether this effect could be clinical ly useful Background Chronic fatigue is common in the general population . Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms . Purpose This study aim ed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome . Methods Sixty-four participants were r and omly assigned to either an intervention group or a wait list control group . Outcome measures included fatigue symptoms , physical functioning , mental functioning , and telomerase activity . Results Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls . Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units ( p < 0.05 ) . The change was statistically significant when compared to the control group ( p < 0.05 ) . Conclusion Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome Abstract Objective : To assess the efficacy of an educational intervention explaining symptoms to encourage grade d exercise in patients with chronic fatigue syndrome . Design : R and omised controlled trial . Setting : Chronic fatigue clinic and infectious diseases outpatient clinic . Subjects : 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome . Interventions : Patients r and omised to the control group received st and ardised medical care .  Patients r and omised to intervention received two individual treatment sessions and two telephone follow up calls , supported by a comprehensive educational pack , describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based grade d exercise . The minimum intervention group had no further treatment , but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months . Main outcome measure : A score of 25 or an increase of 10 on the SF-36 physical functioning subscale ( range 10 to 30 ) 12 months after r and omisation . Results : 21 patients dropped out , mainly from the intervention groups . Intention to treat analysis showed 79 ( 69 % ) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two ( 6 % ) of controls , who received st and ardised medical care ( P<0.0001 ) . Similar improvements were observed in fatigue , sleep , disability , and mood . No significant differences were found between the three intervention groups . Conclusions : Treatment incorporating evidence based physiological explanations for symptoms  was effective in encouraging self managed grade d exercise . This result ed in substantial improvement compared with st and ardised medical care Background The causes of chronic fatigue syndrome ( CFS ) and idiopathic chronic fatigue ( ICF ) are not clearly known , and there are no definitive treatments for them . Therefore , patients with CFS and ICF are interested in Oriental medicine or complementary and alternative medicine . For this reason , the effectiveness of complementary and alternative treatments should be verified . We investigated the effectiveness of two forms of acupuncture added to usual care for CFS and ICF compared to usual care alone . Methods A three-arm parallel , non-blinded , r and omized controlled trial was performed in four hospitals . We divided 150 participants into treatment and control groups at the same ratio . The treatment groups ( Group A , body acupuncture ; Group B , Sa-am acupuncture ) received 10 sessions for 4 weeks . The control group ( Group C ) continued usual care alone . The primary outcome was the Fatigue Severity Scale ( FSS ) at 5 weeks after r and omization . Secondary outcomes were the FSS at 13 weeks and a short form of the Stress Response Inventory ( SRI ) , the Beck Depression Inventory ( BDI ) , the Numeric Rating Scale ( NRS ) , and the EuroQol-5 Dimension ( EQ-5D ) at 5 and 13 weeks . Results Group A showed significantly lower FSS scores than Group C at 5 weeks ( P = 0.023 ) . SRI scores were significantly lower in the treatment groups than in the control group at 5 ( Group A , P = 0.032 ; B , P < 0.001 ) and 13 weeks ( Group A , P = 0.037 ; B , P < 0.001 ) . Group B showed significantly lower BDI scores than Group C at 13 weeks ( P = 0.007 ) . NRS scores from the treatment groups were significantly reduced compared to control at 5 ( Group A and B , P < 0.001 ) and 13 weeks ( Group A , P = 0.011 ; B , P = 0.002 ) . Conclusions Body acupuncture for 4 weeks in addition to usual care may help improve fatigue in CFS and ICF patients .Trial registration Clinical Research Information Service ( CRIS ) KCT0000508 ; Registered on 12 August 2012 CONTEXT Given that the etiology of chronic fatigue syndrome ( CFS ) is believed to be multidimensional , interventions generally have been nonspecific and typically produce only mild to moderate effects . In medical practice , treatment for CFS remains largely symptomatic . Preliminary evidence of the efficacy of acupuncture for CFS is available , but the field has lacked high- quality trials . OBJECTIVE The research team conducted the study to determine the efficacy of acupuncture for CFS . DESIGN A two-arm , r and omized , controlled , singleblinded design was adopted . SETTING The study took place in a teaching laboratory at the School of Chinese Medicine at the University of Hong Kong , Hong Kong , China . PARTICIPANTS Recruited through press publicity in Hong Kong , 127 individuals--40 men and 87 women -- participated in the study . Intervention Through careful implementation of sham acupuncture in the control group ( CG ) , the study blinded all participants with regard to their experimental or control status . The treatment regime was 2 sessions/wk for 4 consecutive wk . OUTCOME MEASURES Measures of fatigue ( Chalder 's Fatigue Scale ) , health-related quality of life ( SF-12 ) , and general mental health ( GH Q-12 ) were taken at baseline and upon completion of treatment . RESULTS Ninety-nine participants completed the interventions , with 50 and 49 participants in the experimental group ( EG ) and CG respectively . Repeated measures ANOVA revealed a significant decrease in physical ( F(1,93 ) = 4.327 ; P = .040 ) and mental fatigue ( F(1,96 ) = 10.451 ; P = .002 ) and improvement in the physical component score of SF-12 ( F(1,93 ) = 4.774 ; P = .031 ) . Considerable effects with Cohen 's d were observed in the sham-control group : 0.92 , 0.78 , and 0.38 for the three scores , respectively . These positive effects could have included some therapeutic effects due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects . The EG showed moderate net effect sizes with Cohen 's d : 0.52 , 0.63 , and 0.54 for the three outcome measures , respectively . CONCLUSION Despite considerable positive effects for the CG , the EG demonstrated significant net-effect sizes at a moderate magnitude in physical and mental fatigue and in the physical component of health-related quality of life . The impacts on general mental health outcomes appeared to be smaller OBJECTIVE Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a r and omized controlled trial . METHODS Sixty patients with chronic fatigue syndrome were r and omly assigned to 13 sessions of either cognitive behavior therapy ( grade d activity and cognitive restructuring ) or relaxation . Outcome was evaluated by using measures of functional impairment , fatigue , mood , and global improvement . RESULTS Treatment was completed by 53 patients .  Functional impairment and fatigue improved more in the group that received cognitive behavior therapy . At final follow-up , 70 % of the completers in the cognitive behavior therapy group achieved good outcomes ( substantial improvement in physical functioning ) compared with 19 % of those in the relaxation group who completed treatment . CONCLUSIONS Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome . Improvements were sustained over 6 months of follow-up CONTEXT Chronic fatigue syndrome ( CFS ) is associated with a dysregulated hypothalamic-pituitary adrenal axis and hypocortisolemia . OBJECTIVE To evaluate the efficacy and safety of low-dose oral hydrocortisone as a treatment for CFS . DESIGN A r and omized , placebo-controlled , double-bl 
    Output:
    
However , there was no definitely effective intervention with coherence and reproducibility .