Open Access Highly Accessed Study protocol

Comparing specialist medical care with specialist medical care plus the Lightning Process® for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial)

Esther Crawley1*, Nicola Mills2, Will Hollingworth2, Zuzana Deans2, Jonathan A Sterne2, Jenny L Donovan2, Lucy Beasant3 and Alan Montgomery24

Author Affiliations

1 Centre for Child and Adolescent Health, School of Social and Community Medicine, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK

2 School of Social and Community Medicine, Canynge Hall, Whatley Road, Bristol BS8 2PS, UK

3 School of Social and Community Medicine, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK

4 University of Nottingham Clinical Trials Unit Queen’s Medical Centre, Nottingham NG7 2UH, UK

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Trials 2013, 14:444  doi:10.1186/1745-6215-14-444

Published: 26 December 2013



Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and potentially serious condition with a limited evidence base for treatment. Specialist treatment for paediatric CFS/ME uses interventions recommended by National Institute for Health and Clinical Excellence (NICE) including cognitive behavioural therapy, graded exercise therapy and activity management. The Lightning Process® (LP) is a trademarked intervention derived from osteopathy, life-coaching and neuro-linguistic programming, delivered over three consecutive days as group sessions. Although over 250 children with CFS/ME attend LP courses each year, there are no reported studies on the effectiveness or cost-effectiveness.


This pragmatic randomised controlled trial is set within a specialist paediatric CFS/ME service in the south west of England. Children and young people with CFS/ME (n = 80 to 112), aged 12 to 18 years old will be randomised to specialist medical care (SMC) or SMC plus the LP. The primary outcome will be physical function (SF-36 physical function short form) and fatigue (Chalder Fatigue Scale).


This study will tell us whether adding the LP to SMC is effective and cost-effective compared to SMC alone. This study will also provide detailed information on the implementation of the LP and SMC.

Trial registration

Current Controlled Trials ISRCTN81456207 (31 July 2012).

Fatigue; Paediatrics; Chronic fatigue syndrome; Myalgic encephalomyelitis