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Table 2 Instruments to assess which CBT modules are indicated

From: Study protocol of the TIRED study: a randomised controlled trial comparing either graded exercise therapy for severe fatigue or cognitive behaviour therapy with usual care in patients with incurable cancer

CBT Module Instrument Rating (RANGE) Cut-off value
Sleep problems and deregulated sleep-wake cycle Sleep-wake diary Bedtimes and wake up times of 12 consecutive days and nights Visual inspection of bedtimes and wake up times
Sickness Impact Profile [41]:
subscale Sleep and Rest
Number and type of items endorsed, weighted according to a standardised weighting scheme Score ≥ 60
Symptom Checklist-90 [52]:
subscale Sleeping Problems
5-point Likert scale (3–15) Score ≥ 6
Dysfunctional cognitions regarding cancer (prognosis) and cancer treatment Impact of Event Scale [53]:
subscale Intrusion
subscale Avoidance
4-point Likert scale (7–28)
4-point Likert scale (8–32)
Score ≥ 10
Score ≥ 10
Pictorial Representation of Illness and Self Measure [54] Self-illness separation (SIS) in cm
Self-fatigue separation (SFS) in cm
Fatigue-related suffering: SIS > SFS
Illness-related suffering: SFS > SIS
Illness Cognition Questionnaire [55, 56]:
subscale Acceptance
subscale Helplessness
4-point Likert scale (6–24)
4-point Likert scale (6–24)
Score ≤ 12
Score > 14
Beck Depression Inventory-II Primary Care [57] 4-point Likert scale (0–21) Score ≥ 4
Hospital Anxiety and Depression Scale [58]:
subscale Anxiety
subscale Depression
4-point Likert scale (0–21)
4-point Likert scale (0–21)
Score ≥ 9
Score ≥ 9
Dysfunctional fatigue-related cognitions Fatigue Catastrophising Scale [45] 5-point Likert scale (10–50) Score ≥ 16
Self-Efficacy Scale [26, 59] 4-point Likert scale (7–28) Score ≤ 19
Illness Management Questionnaire-factor III [60] 6-point Likert scale (9–54) Score ≥ 30
Anxiety for Fatigue 4-point Likert scale (8–32) Score ≥ 14
Deregulated activity pattern Actigraphy during 12 consecutive days Number of days with a mean physical activity level > 66 Low-active: 0-1
Relatively-active: ≥ 2
Sickness Impact Profile [41]:
subscale Social Interactions
Number and type of items endorsed, weighted according to a standardised weighting scheme Score ≥ 100
Checklist Individual Strength [33]: subscale Concentration 7-point Likert scale (5–35) Score ≥ 18
Negative social interactions and low perceived social support Van Sonderen Social Support Inventory [61] (shortened version):
subscale Negative Interactions
subscale Discrepancies
4-point Likert scale (7–28)
4-point Likert scale (8–32)
Score ≥ 10
Score ≥ 14