A general thread on the PACE trial!

https://twitter.com/user/status/1013036981985607681

 

https://twitter.com/user/status/1013701735301419008

 

https://twitter.com/user/status/1013859259782696960

 

https://twitter.com/user/status/1013701735301419008

https://twitter.com/user/status/1013827671128756224

https://twitter.com/user/status/1013830438035615751

https://twitter.com/user/status/1013859696254640128


https://twitter.com/user/status/1013880082992107524

 

Today's PACE-Trial-For-Beginners-Quiz

So, I skimmed the Cochrane thread, bookmarked some threads in Woolie's wonderful library, digged into this fabulous general thread on the PACE trial, and ended up with two surprise questions for today:

1) What does the acronym "PACE" stand for?

2) Why is the PACE trial called a "controlled" trial when in fact it had no control group but was a merely comparative trial?

 

Its very contrived:

Pacing, graded Activity, and Cognitive behaviour therapy: a randomised Evaluation (PACE)

I know, right?

PACE had a "control group", but the trial can't technically be called controlled, because that implies everything was identical in the control and active conditions except for the active ingredient. Since the "control" condition received less face time, that's incorrect. Arguably, other things, such as patients' expectations, were also not equivalent across trial arms.

 

It's also very misleading; as Pacing is APT (developed specifically for the trial), Graded activity is GET, and Cognitive behaviour therapy is also a 'special version' developed for CFS.

So right from the title the deceit/manipulation began....

 

I have said elsewhere that using technical definitions of things that are vastly different from the usual then rarely clarifying is their modus operandi.

 

It would be interesting to know who it was that came up with the name PACE. Was it a committee decision, or did someone present thee idea to them? It is so Orwellian that it would be useful to know.

 

PACE, SMILE, FINE, do you see a pattern? They always do this.

 

Yes, I get that, but it seems a little naïve and amateurish to be so blatant about it.

 

The original PACE paper does not call it a controlled trial I think. Cochrane included it in their analysis of controlled trials. It has been pointed out to them that this is no good. We will wait to see what happens next.

As I understand it the name PACE was used specifically to please patient charities who wanted pacing included, presumably to improve recruitment.

In fact there were pretty good controls for CBT and for GET : GET and CBT. And there was no difference. The authors seem to be too dumb to realise that they have a negative result there. If CBT or GET had come out significantly better than the other then we would have had something interesting. The authors claimed that of course pacing was a positive control but it wasn't because there was no brainwashing about getting better in that group.

 

Thanks, @Woolie . I noticed that the trial protocol (2007/BMC) called PACE a "randomised controlled trial" (RCT), but in the title of the Lancet paper ("The Paper" 2011) PACE was downgraded to a "randomised trial".

(Links to the papers: https://www.s4me.info/threads/publications-from-the-pace-trial.60/)

But why call a trial arm that does'nt fulfill the criteria of a control group a "control" group? Is there no clearer language?

Right and very contrived indeed.

Fun fake on Wikipedia's acronym list for PACE:

https://en.wikipedia.org/wiki/PACE

EDIT: sorry, @Jonathan Edwards -- crossposted

 

Good to know!

 

The fact that PACE is not controlled set me thinking about this and I thin it is quite subtle. In most scientific experiments you do a series of controls, each one designed to exclude your test result being due to a non-specific contextual factor. In PACE standard medical care and adaptive pacing are both controls in the sense that they exclude the result being due to just being in a trial over a period of time or just having some form of apparently novel procedure to follow. But they do not form an adequate set of controls.

So a controlled trial is, if it is to mean anything scientifically useful, a trial with an adequate set of controls. I see it as a bit like a locked house being a house with an adequate set of locks operated, not just a house with a lock.

 

Is this really true? Does PACE show that GET reduses PEM? Sounds strange....as some of the other cfs_research says

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">And yet PACE found that GET reduced PEM. The difference is between exercise that is benecifial to patients, and that which is harmful. The new CDC guidelines seem to have a fairly good idea.</p>&mdash; CFS Research (@cfs_research) <a href="https://twitter.com/user/status/1018875317438431234
">July 16, 2018</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

 

Self reported PEM decreased more in the CBT and GET arms, as assessed by questionnaire.

This doesn't show that CBT/GET reduce PEM because of the subjective unblinded trial design. I am also curious how they defined PEM.

 

PACE did not find that GET reduced PEM, because PEM was neither defined properly nor measured.

 

Do you know how they assessed severity of PEM? What questions were asked, how was PEM defined?