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| Name | Class |
|---|---|
| Västerbotten County Council, Sweden | OTHER_GOV |
| Swedish Social Insurance Agency | OTHER_GOV |
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Many patients with exhaustion disorders continue to have significant difficulties with attention and memory function which reduce their work ability. This randomized study investigates whether the addition of a 12-week period of specific cognitive training or physical fitness training could further enhance cognitive function in patients with exhaustion disorder participating in a multimodal rehabilitation program.
This study was performed at The Stress Rehabilitation Clinic at the University hospital of Umeå. In total 161 patients with diagnosed exhaustion disorder were recruited consecutively to the study from March 2010 until June 2013. Participants were all in age span 18-60 years old, had an ongoing employment and were assessed as suitable for a 24-week multimodal rehabilitation, which consisted of cognitive behavioural therapy in group (maximum eight persons), prescription of physical activity/exercise (FaR©) and vocational measures with rehabilitation meetings. A randomization by group was performed after 12 weeks of multimodal rehabilitation to one of three conditions; A/ continued multimodal rehabilitation, B/ addition of a computer-based cognitive training, and C/ addition of physical fitness training. The added training was performed during the last 12 weeks of rehabilitation (week 12 to 24) and with three weekly training occasions. Primary endpoint was change in cognitive functioning, estimated as a global brain score. Secondary endpoints were changes in different specific neuropsychological tasks, estimated psychological wellbeing, physical capacity, work ability, health-related quality of life and cost-effectiveness. A long-term follow-up was performed one year after termination of the interventions (at week 76).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Continued multimodal rehabilitation | No Intervention | No addition of extra training in this group. Only ordinary continued multimodal rehabilitation. | |
| Computer-based cognitive training | Active Comparator | This arm also consisted of continued multimodal rehabilitation. |
|
| Physical fitness training | Active Comparator | This arm also consisted of continued multimodal rehabilitation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Computer-based cognitive training | Behavioral | A total of 36 training sessions, approximately 20 minutes long each. Five different tasks were used in training all tapping different aspects of cognitive control such as updating, shifting, visuo-spatial working memory and episodic memory binding. |
| Measure | Description | Time Frame |
|---|---|---|
| Short-term change in global brain score | The global brain score was calculated from ten neuropsychological tasks covering different domains in cognitive functioning | Week 12 and 24 |
| Long-term change in global brain score | The global brain score was calculated from ten neuropsychological tasks covering different domains in cognitive functioning | Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects |
| Measure | Description | Time Frame |
|---|---|---|
| Short-term change in "letter memory running span task" | A measure of the updating functioning | Week 12 and 24 |
| Long-term change in "letter memory running span task" | A measure of the updating functioning |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lisbeth Slunga Järvholm, MD, Ass Prof | Umeå University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Stress Rehabilitation Clinic, Umeå university hospital, Västerbotten county council | Umeå | 90333 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40229758 | Derived | Nelson A, Aronsson I, Tillfors M, Neely AS, Gavelin HM. The experienced route to cognitive health: Cognitive recovery in persons with prior stress-related Exhaustion disorder. BMC Psychiatry. 2025 Apr 14;25(1):375. doi: 10.1186/s12888-025-06713-7. | |
| 34006315 | Derived | Nelson A, Gavelin HM, Boraxbekk CJ, Eskilsson T, Josefsson M, Slunga Jarvholm L, Neely AS. Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study. BMC Psychol. 2021 May 18;9(1):84. doi: 10.1186/s40359-021-00576-9. |
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| ID | Term |
|---|---|
| D013577 | Syndrome |
| D000077062 | Burnout, Psychological |
| ID | Term |
|---|---|
| D004194 | Disease |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D013315 | Stress, Psychological |
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| Physical fitness training | Behavioral | A total of 36 training sessions, approximately 40 minutes long each, with physical fitness training performed as group indoor cycling. The participants were instructed to attain a load of approximately 65-80% of their maximum heart rate. |
|
| Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects |
| Short-term change in "3-back task" | A measure of the updating functioning | Week 12 and 24 |
| Long-term change in "3-back task" | A measure of the updating functioning | Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects |
| Short-term change in the "colour word interference test (the Stroop test)" | A measure of the inhibition functioning, from D-KEFS | Week 12 and 24 |
| Long-term change in the "colour word interference test (the Stroop test)" | A measure of the inhibition functioning, from D-KEFS | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "trail making test" | A measure of attentional shifting, from D-KEFS | Week 12 and 24 |
| Long-term change in the "trail making test" | A measure of attentional shifting, from D-KEFS | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "digit span forward test" | A measure of the working memory, from WAIS-R | Week 12 and 24 |
| Long-term change in the "digit span forward test" | A measure of the working memory, from WAIS-R | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "digit span backward test" | A measure of the working memory, from WAIS-R | Week 12 and 24 |
| Long-term change in the "digit span backward test" | A measure of the working memory, from WAIS-R | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "letter-number sequencing" test | A measure of the working memory, from WAIS-III | Week 12 and 24 |
| Long-term change in the "letter-number sequencing" test | A measure of the working memory, from WAIS-III | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "recall of concrete nouns" test (Buschke's selective reminding procedure) | A measure of the episodic memory | Week 12 and 24 |
| Long-term change in the "recall of concrete nouns" test (Buschke's selective reminding procedure) | A measure of the episodic memory | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in the "digit symbol" test | A measure of perceptual speed, from WAIS-R | Week 12 and 24 |
| Long-term change in the "digit symbol" test | A measure of perceptual speed, from WAIS-R | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in "Raven's advanced progressive matrices" | A measure of non-verbal reasoning ability | Week 12 and 24 |
| Long-term change in "Raven's advanced progressive matrices" | A measure of non-verbal reasoning ability | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in Shirom Melamed Burnout Questionnaire | A burnout measure | Week 12 and 24 |
| Long-term change in Shirom Melamed Burnout Questionnaire | A burnout measure | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in Short Form 36 item Health Questionnaire | Health-related quality of life estimate | Week 12 and 24 |
| Long-term change in Short Form 36 item Health Questionnaire | Health-related quality of life estimate | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in Checklist Individual Strength Questionnaire | Measure of fatigue | Week 12 and 24 |
| Long-term change in Checklist Individual Strength Questionnaire | Measure of fatigue | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in Hospital Anxiety and Depression Scale, HAD-S | A measure of anxiety and depression | Week 12 and 24 |
| Long-term change in Hospital Anxiety and Depression Scale, HAD-S | A measure of anxiety and depression | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in aerobic capacity | A submaximal cycle ergometer test performed to estimate maximal oxygen uptake | Week 12 and 24 |
| Long-term change in aerobic capacity | A submaximal cycle ergometer test performed to estimate maximal oxygen uptake | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Short-term change in work ability | Work Ability Index questionnaire, short version | Week 12 and 24 |
| Long-term change in work ability | Work Ability Index questionnaire, short version | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Long-term total sick leave change | Information about sick leave from registers at the Social Insurance Agency in Sweden | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| Long-term cost-effectiveness | Estimation of Changes in Quality Adjusted Life Years by using the Short Form-(36) Health Survey | Week 12, 24 and 76, mixed model with several time points to estimate long-term effects |
| 29693483 | Derived | Malmberg Gavelin H, Eskilsson T, Boraxbekk CJ, Josefsson M, Stigsdotter Neely A, Slunga Jarvholm L. Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO - a randomized clinical trial. Stress. 2018 Jul;21(4):279-291. doi: 10.1080/10253890.2018.1461833. Epub 2018 Apr 25. |
| 28865430 | Derived | Eskilsson T, Slunga Jarvholm L, Malmberg Gavelin H, Stigsdotter Neely A, Boraxbekk CJ. Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial. BMC Psychiatry. 2017 Sep 2;17(1):322. doi: 10.1186/s12888-017-1457-1. |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |