cognitive behavioural and personalised exercise interventions for fatigue in inflammatory rheumatic diseases (LIFT), 2022, Bachmair et al

Merged thread - article discussed first
Abstract here


Came across this article in the telegraph reporting CBT and exercise improves fatigue in RA:

https://www.telegraph.co.uk/news/2022/06/28/arthritis-getting-positive-thinking-could-ease-symptoms/

It seems to be in connection to this paper:

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00156-4/fulltext

It has a very familiar experimental set up i.e no blinding and subjective outcomes (chalder and fatigue severity scales)

 

I was looking yesterday at a meta review of meta reviews for CBT efficacy in all sorts of conditions, and it found positive evidence of CBT efficacy in just about everything they looked at:

"substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions"

I looked at some of the papers they were based on and unblinded trials with subjective outcomes are common and tolerated. Some have objective outcomes but i didn't look any deeper at their methodologies.

I'm wondering what everyone's opinion here is about how trustworthy CBT and pyschological research is in general if this is the tolerated standard. I could be generalising too much here but it's disconcerting.

 

Broken lifts are a well known problem.

 

Thanks, I was trying to find an audiobook version of this yesterday in fact but with no luck. I'll take a look at the text copy instead

 

Harking back to the recent ‘Psychology needs to get tired of winning’ thread (see https://www.s4me.info/threads/psychology-needs-to-get-tired-of-winning-2022-haeffel.28228/ ), it would be pertinent to ask are there any studies of CBT in which the authors do not claim to have demonstrated it helps their particular condition(s)?

Though it is perhaps worth noting that the PACE study could be claimed to have shown that CBT does not work for CFS, even with the over inclusive definition, despite the original authors contrary claims that it does.

 

I am sure that CBT to treat the frustrations of city drivers stopped at red traffic lights would subjectively reduce the length of time they seemed to have to wait at red lights.

Indeed when living in London, I practiced ‘traffic light mindfulness’ where I sought to develop complete equanimity over the issue of what colour the lights were, but rather to just enjoy the colours for their own sake and be grateful those moments of tranquility that red lights offered. It certainly felt like the time the lights were on red was much shorter. And thus we enter a realm of magical thinking where we believe that our thoughts change the world.

Also I am reminded of the more naïve practitioners of Nichiren Buddhism who genuinely believe that sufficient repetitions of their mantra will materialise what they desire, be it personal growth or a BMW.

[edited final sentence]

 

This is great - exactly what i was thinking about. It's quite damning

 

Merged thread

full title
Remotely delivered cognitive behavioural and personalised exercise interventions for fatigue severity and impact in inflammatory rheumatic diseases (LIFT): a multicentre, randomised, controlled, open-label, parallel-group trial

Summary
Background
Chronic fatigue is a poorly managed problem in people with inflammatory rheumatic diseases. Cognitive behavioural approaches (CBA) and personalised exercise programmes (PEP) can be effective, but they are not often implemented because their effectivenesses across the different inflammatory rheumatic diseases are unknown and regular face-to-face sessions are often undesirable, especially during a pandemic. We hypothesised that remotely delivered CBA and PEP would effectively alleviate fatigue severity and life impact across inflammatory rheumatic diseases.
Methods
LIFT is a multicentre, randomised, controlled, open-label, parallel-group trial to assess usual care alongside telephone-delivered CBA or PEP against usual care alone in UK hospitals. Patients with any stable inflammatory rheumatic disease were eligible if they reported clinically significant, persistent fatigue. Treatment allocation was assigned by a web-based randomisation system. CBA and PEP sessions were delivered over 6 months by trained health professionals in rheumatology. Coprimary outcomes were fatigue severity (Chalder Fatigue Scale) and impact (Fatigue Severity Scale) at 56 weeks. The primary analysis was by full analysis set. This study was registered at ClinicalTrials.gov (NCT03248518).
Findings
From Sept 4, 2017, to Sept 30, 2019, we randomly assigned and treated 367 participants to PEP (n=124; one participant withdrew after being randomly assinged), CBA (n=121), or usual care alone (n=122), of whom 274 (75%) were women and 92 (25%) were men with an overall mean age of 57·5 (SD 12·7) years. Analyses for Chalder Fatigue Scale included 101 participants in the PEP group, 107 in the CBA group, and 107 in the usual care group and for Fatigue Severity Scale included 101 in PEP, 106 in CBA, and 107 in usual care groups. PEP and CBA significantly improved fatigue severity (Chalder Fatigue Scale; PEP: adjusted mean difference −3·03 [97·5% CI −5·05 to −1·02], p=0·0007; CBA: −2·36 [–4·28 to −0·44], p=0·0058) and fatigue impact (Fatigue Severity Scale; PEP: −0·64 [–0·95 to −0·33], p<0·0001; CBA: −0·58 [–0·87 to −0·28], p<0·0001); compared with usual care alone at 56 weeks. No trial-related serious adverse events were reported.
Interpretation
Telephone-delivered CBA and PEP produced and maintained statistically and clinically significant reductions in the severity and impact of fatigue in a variety of inflammatory rheumatic diseases. These interventions should be considered as a key component of inflammatory rheumatic disease management in routine clinical practice.
Funding
Versus Arthritis

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00156-4/fulltext

 

the 'new' 'acceptable' name for GET?, PEP (personalised exercise programmes) one to watch for.

 

From the paper, my bolding

"Procedures
All participants were aware that the trial interventions were designed specifically to reduce fatigue. As a minimum, all participants received usual care in the form of a Versus Arthritis (formerly Arthritis Research UK) education booklet for fatigue. This booklet addresses the principal domains of fatigue, which can be amenable to self-management and represents usual care in almost all rheumatology services in the UK.

The CBA and PEP active treatments were therapist based, with accompanying manuals. They were adapted, with patient involvement, from previous fatigue-specific cognitive behavioural and exercise interventions
12, 13 to ensure that they were suitable for remote delivery via telephone, and were applicable to the broad spectrum of inflammatory rheumatic diseases. A detailed description of each intervention is available in the appendix (pp 3–8). Briefly, CBA was a psychological intervention that targeted unhelpful beliefs and behaviours and aimed to replace them with more adaptive ones. PEP was an exercise programme that was individually tailored and combined with a graded exposure behavioural therapy that was aimed to normalise misperceptions of effort and enhance exercise tolerance."

Spoiler: And guess what reference 12 is...

• White PD
• Goldsmith KA
• Johnson AL
• et al.

Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.

So full on PACE 2.0.

Alison Wearden is one of the named authors. And tucked away in the appendix PDF file is the fact that Peter White (Queen Mary University of London, UK) is listed as a study group member.

 

Here's one, REST (Restricted Exercise Safety Therapy). Most likely a better outcome.

 

At this point, it becomes legitimate to consider this level of obsession as a cognitive deficit. It's not normal to be so obsessed with something so mediocre.

But the publishing industry and academia are to blame for this. That such blatant speculation, out of fuzzy maths that can literally show anything with the right bias, can lead to such a strong assertion is not something you see when things have been failing for a bit. It's what you see when they have been failing for so long that everyone may as well have given up doing their job and it wouldn't even make any difference. This is phoning in phoning it in.

And of all the things, it's a minor squabble, but none of those programs are ever personalized, no more than a horoscope or 12 flavors of ice cream. It's outrageous that some small details like this are so routine that no one notices them anymore. They're as personalized as a car with a different paint color is from one another of the same make and model. Ridiculous.

But the Orwellian play on words here, explicitly using the poor evidence base for CBT and GET, citing it, and actually involving Peter White it seems, but renaming them both so that most people won't make the connection. This is truly the stuff of tobacco companies renaming themselves. It shows they understand the issues, but aren't bothered by it, in fact exploit the same dishonest methods with explicit intent.

If the future of medicine is to be the best liars around, the whole system needs reform. All of it, none of this is normal, it doesn't even exist in any other profession.

 

Since we're on the topic of renaming things, I would offer: Customized Rehabilitation Activation Protocol.