Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial. Wilshire C, Kindlon T, Matthees A, McGrath S. Fatigue. 2017 Jan 5:1-4. link to article This article critiques the findings of the 2013 paper from the PACE trial, which found that over a fifth of participants receiving CBT or GET 'recovered', and significantly more than the number that recovered in the other two groups (including the control group). The PACE authors obtained these results using a definition of recovery that was very different from the one they stated they would use in their published protocol. It was much more relaxed. The article examines the various justifications given by the researchers for loosening their criteria, showing that none stand up to scrutiny. It also reports recovery rates based on the PACE researchers' originally specified definition, showing that they are much much smaller, and not significantly different amongst the various treatment groups. The PACE authors had the opportunity to reply here: link to article. Wilshire et al wrote a rejoinder here: link to article 'PACE-Gate': When clinical trial evidence meets open data access. Geraghty KJ. Journal of Health Psychology. 2016. link to article Journal of Health Psychology. Special Issue on the PACE Trial. link to Table of Contents Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys. Geraghty K, Hann M, Kurtev S. J Health Psychol. 2017. link to article Do graded activity therapies cause harm in chronic fatigue syndrome? Kindlon T. Journal of Health Psychology. 2017 link to article Reporting of harms associated with graded exercise therapy and cognitive behavioural therapy in myalgic encephalomyelitis/chronic fatigue syndrome. Kindlon T. Bull IACFS ME. 2011;19(2):59-111. link to article Controversy over exercise therapy for chronic fatigue syndrome: key lessons for clinicians and academics. Mitchell AJ. BJPsych Advances. 2017 May 1;23(3):145-8. link to article The PACE authors' reply and Mitchell's rejoinder is available here A preliminary analysis of ‘recovery’ from chronic fatigue syndrome in the PACE trial using individual participant data. Matthees et al. Virology Blog. 2016. link to article Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent. Geraghty, K.J. and Blease, C. Journal of Health Psychology, 2016. p.1359105316667798. link to article Research Waste In ME/CFS (preprint, not yet published). Lee S. bioRxiv. 2017 Jan 1:133926. link to preprint Critiques of the PACE Trial by Journalist David Tuller. A list of articles plus links can be found here A full list of all Tuller's articles relating to MECFS can be found here PACE: The research that sparked a patient rebellion and challenged medicine Goldin R blog, 2016 link to blog Bad science misled millions with chronic fatigue syndrome. Here’s how we fought back Rehmeyer J blog, 2016 link to blog The PACE Trial Invalidates the Use of Cognitive Behavioral and Graded Exercise Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review. Vink M J Neurol Neurobiol. 2016;2(3). link to article Myth: ME is a mental illness Janssen R Observant (Dutch newspaper). 2017. link to news article The response of the PACE invesyigators can be found here (and at the bottom of that article, links to rejoinders from Vink, Tuller & Wilshire) A collection of letters and commentaries by Tom Kindlon on the PACE trial protocol Kindlon, T This document (to be found in a pdf file at the bottom of this post) gathers together a number of letters and commentaries that Tom has written about the PACE trial protocol.
