Crawley, Esther, Anderson, Emma, Cochrane, Madeleine et al. · Health technology assessment (Winchester, England) · 2024 · DOI
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.
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.
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.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Crawley, Esther, Anderson, Emma, Cochrane, Madeleine, Shirkey, Beverly A, Parslow, Roxanne, Hollingworth, William, et al. (2024). Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.. Health technology assessment (Winchester, England). https://doi.org/10.3310/VLRW6701
BibTeX
@article{mecfsatlas-crawley-2024-comparison-cognitive,
author = {Crawley, Esther and Anderson, Emma and Cochrane, Madeleine and Shirkey, Beverly A and Parslow, Roxanne and Hollingworth, William and Mills, Nicola and Gaunt, Daisy and Treneman-Evans, Georgia and Rai, Manmita and Macleod, John and Kessler, David and Pitts, Kieren and Cooper, Serena and Loades, Maria and Annaw, Ammar and Stallard, Paul and Knoop, Hans and Van de Putte, Elise and Nijhof, Sanne and Bleijenberg, Gijs and Metcalfe, Chris},
title = {Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.},
journal = {Health technology assessment (Winchester, England)},
year = {2024},
doi = {10.3310/VLRW6701},
note = {PubMed: 39485730},
url = {https://www.mecfsatlas.com/evidence/crawley-2024-comparison-cognitive},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/crawley-2024-comparison-cognitive
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