Cochrane Review: 'Exercise therapy for chronic fatigue syndrome', Larun et al. - New version October 2019 and new date December 2024

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Cochrane Review: 'Exercise therapy for chronic fatigue syndrome' 2017, Larun et al. - Recent developments, 2018-19
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[2019] Latest version published

Very low quality of evidence.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003200.pub8/full

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Discussion of the relabelling of the review with a new 2024 date starts here:
Cochrane Review: 'Exercise therapy for chronic fatigue syndrome', Larun et al. - New version October 2019 and new date December 2024

 

Article from Cochrane

https://www.cochrane.org/news/publication-cochrane-review-exercise-therapy-chronic-fatigue-syndrome

 

https://twitter.com/user/status/1179432303631708160

 

Not for the contested one, where it seems like Larun got her way: "There is moderate‐certainty evidence that exercise therapy was probably more effective than control in reducing fatigue at end of treatment".

And also "1.8 Self‐perceived changes in overall health
There is moderate‐certainty evidence that exercise therapy probably increases the number of people who report at least some degree of improvement in self‐perception of overall health at end of treatment"

They can emphasise that in any PR spin.

 

They continue to classify the PACE Trial as having a low risk of bias in terms of selective reporting which is hard to accept.

This is the comment I made previously:

https://twitter.com/user/status/1179437917472772096

 

"Most studies had a low risk of selection bias?"

How does that fit with AHRQ's conclusion that "Oxford case definition results in a high risk of including patients who may have an alternate fatiguing illness or whose illness resolves spontaneously with time."

 

I'm confused has there been an outcome/updated version to the Larun paper or not?

 

Is 'probably' considered a scientific term now then?

 

from the correspondence between Atle Fretheim (for the review authors) and David Tovey (Cochrane):

https://www.s4me.info/threads/cochr...developments-2018-19.10030/page-4#post-179984

 

Probably.

Thus far, I've only seen the abstract but it looks that there are still a lot of issues that will need to be analyzed and discussed.

 

Disappointing but I think we could all see this coming. Had they been serious, they would have withdrawn it without delay.

 

The revised Cochrane Review on ME/CFS was released today, October 2, 2019. We will share a more in-depth analysis shortly. However, we must immediately emphasize that #MEAction does not support graded exercise therapy due to serious risk of harms to people with ME, and that we are deeply concerned about the conclusions of this review.

The report’s conclusion is highly problematic:

“Exercise therapy probably has a positive effect on fatigue in adults with CFS compared to usual care or passive therapies. The evidence regarding adverse effects is uncertain. Due to limited evidence it is difficult to draw conclusions about the comparative effectiveness of CBT, adaptive pacing or other interventions. All studies were conducted with outpatients diagnosed with 1994 criteria of the Centers for Disease Control and Prevention or the Oxford criteria, or both. Patients diagnosed using other criteria may experience different effects.”

The review states:

1 "We are uncertain about the risk of serious adverse reactions [in graded exercise therapy] because the certainty of the evidence is very low.”

2. “All [studies] had a high risk of performance and detection bias."

3. "It is important to note that the evidence in this review is from people diagnosed with 1994 criteria of the Centers for Disease Control and Prevention or the Oxford criteria. People diagnosed using other criteria may experience different effects."

4. Almost all outcomes included in the review are given a ‘Certainty of the Evidence’ grade of low or very low.

How this poor evidence led Cochrane to conclude that “exercise therapy probably has a positive effect on fatigue in adults with CFS” is unknown.

Our added points:
1. The review only looks at Randomised Control Trials (RCTs) and doesn't account for patient surveys that show the high rates of deterioration following exercise therapy for ME.

2. While, there are several studies showing that exercise does harm people with ME, we do acknowledge there is not systematic evidence regarding the harms of exercise therapies. Therefore, we consider patient surveys indicating GET harms people with ME, and the growing literature around abnormal responses to exercise, the best available evidence.

You can learn more about the effects of graded exercise therapy and the effects on people with ME here:
1. #MEAction’s white paper: People with Myalgic Encephalomyelitis Show Deleterious Effects following GET and CBT
https://www.meaction.net/…/Effects-of-GET-CBT-in-people-wit…

2. A recent survey of over 2.200 people confirmed that graded exercise therapy (GET) is harming a large majority of people with ME receiving this treatment in the UK
https://www.meaction.net/…/get-and-cbt-are-not-safe-for-me…/

3. Reanalysis of the PACE trial shows GET and CBT are ineffective https://www.meaction.net/…/reanalysis-of-pace-trial-shows-…/
Recap from David Tuller of the Cochrane review saga http://www.virology.ws/…/whats-up-with-cochranes-exercise-…/

The Cochrane review can be found here: https://www.cochranelibrary.com/…/14651858.CD003200.p…/full…

 

@Wonko,

It seems the term "probably" is "scientific".... (sort of scientific)

"New research that claims red and processed meat is probably not harmful to our health has caused controversy among experts who maintain people should cut down." (my bolding)

https://www.theguardian.com/food/2019/sep/30/research-red-meat-poses-no-health-risk

 

It's really impressive how Cochrane manage to dance around the actual problems of their review to avoid damaging their entire brand. The problem with the studies isn't that there exists some sort of special ME/CFS group of patients that the studies in question might not apply to. The problem is that despite using the widest possible inclusion criteria, the studies weren't even able to show actual improvement for the patients in the studies receiving CBT / GET compared with the control groups. Of course if Cochrane were to make this admission, it would render countless other reviews from Cochrane, which also rely entirely on unblinded studies with subjective outcome measures obsolete. Which would ruin their entire smug brand. So we end up with this useless concession instead.

Is what people should be thinking whenever they hear about this bogus organisation from now on. Can't say I'm surprised, but also won't pretend like I'm not disgusted.

 

Where did you see that? When I ctrl+f it doesn't come up.

 

Maybe Larun and co. wouldn't let them. Why shouldn't another tail have a good wag of this particular dog?