Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background: Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective: While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods: This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results: The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions: This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.

Understanding how sporting characteristics and behaviours influence destination selection: a grounded theory study of golf tourism

Sports tourism has received growing attention in academic research over the past two decades (Weed and Bull, 2009, Gibson, 2005) but greater understanding of the consumer is needed, particularly the factors influencing decisions to include sport as part of a leisure trip. This paper provides, through a focus on the sport of golf, insight into the characteristics of the sports tourist and how sports tourist behaviours influence the selection of locations deemed suitable for sports participation. This qualitative research employs a grounded theory methodology, underpinned by a constructivist epistemology, to evaluate twenty-six in-depth interviews with golf tourists. The findings propose a model which explains the relationship between golf tourist behaviours and destination selection. This identifies six strands which determine the relationship between the golf tourist, golf behaviours and destination selection (constructing the golf holiday, emotional rewards of taking a trip, total trip spend, amenities and support facilities, course characteristics and reputation of the destination). Furthermore it illuminates the complexity of these relationships through recognition of four spheres of influence (group dynamics, competition and ability, golfing capital and intermediaries). Discussion elucidates how this increased understanding of the golf tourist behaviours and destination selection might be applied to other sports, with conclusions exploring implications for the sports tourism industry and destinations.