Cognitive Behavioural Therapy for chronic fatigue and CFS: outcomes from a specialist clinic in the UK (2020) Adamson, Wessely, Chalder

Actually dropouts were full term 2002-2016 but they only had data for reasons for dropout from 2007. See table 4 in paper for reasons

EDIT : I actually meant table 1 for reasons

 

I've only just realised the tables were at the end of the paper - I stopped reading once I'd got to the references and assumed the table were going to be inserted in the published text. What an idiot. I wondered where some of the info people were mentioning had come from!

And for self-rated CGI they had data from 365 patients?

 

Yep wow.
* 995 participants but only 365 had full data.
* Cohort wise the clinic received everyone whose GP thought they had fatigue but only 52% of those met the CDC criteria for CFS.
* No one questionnaire had more than 52% participants coverage from start to 3 month follow-up after treatment
* All subjective data. No objective data.

 

And this gets published ....

 

Who were the peer reviewers?

 

Playing to their own beguiled audience who lap up whatever crap (pardon the gory thought) these folk emit. Truth, science, integrity, etc. have nothing to do with it. Sophistry pure and simple. The prime objective seems to be winning/succeeding, other human values being relegated way below that.

 

Trying to understand the drop-outs in this paper because, as Trish has pointed out, that seems to be the main issue in how the results are represented.

They say they had data from 995 patients and a drop-out rate of 31% so you would think the main outcomes in this paper had around 687 patients who underwent CBT and filled in questionnaires. But if we look at the tables, the data for the main outcomes shows that there were far fewer patients who filled in the questionnaires.

For example, the self-imported improvement scores had data from only 365 patients. It would be good if the paper explained why the other 630 patients didn't fill in this questionnaire at follow-up. Was it for example because they only started handing out the questionnaire in a particular year and not before that?

A similar problem exists for the symptom questionnaires. For fatigue, for example, only 503 filled in the questionnaire at discharge while 977 filled it in at the start of the treatment. So why did 40% not fill in the questionnaire at discharge? At first, I thought it was because these patients might still be in treatment but the Method section says that patients were excluded "if they were still in active treatment".

So I think the most likely explanation is that the authors considered someone a drop-out only if they failed haven't filled in any of the questionnaires. So some of the 40% who didn't fill in the fatigue questionnaire at follow-up might have filled in another questionnaire and so they aren't counted as having dropped out.

That might be reasonable, it's just weird that so many people have filled in one of the questionnaires but not others. I would think the main difficulty in ensuring follow-up is getting in contact with the patient and make him/her fill in information. I suppose that if you manage to contact the patient and fill in one short questionnaire, it wouldn't be a big deal to let them fill in another short questionnaire - one like the Chalder Fatigue Scale that the patient filled in at the start of treatment. So it would be good if the paper could explain why this is is the case with their data.

It also makes the data hard to interpret. When they say that "90% were satisfied with their treatment" we don't really know how many patients that represents. 90% of what? How many patients rated treatment satisfaction? The abstract also says that "85% of patients self-reported that they felt an improvement in their fatigue at follow-up" without clarifying that only a third of the patients filled in this questionnaire at follow-up, about the same proportion of patients, dropped out and might have a different opinion.

It's rather misleading to state in the abstract that "data was available for 995 patients" and then highlight figures that only apply to a minority of those 995 patients.

 

I would imagine that the easiest way to get a 90% satisfaction result would be to start at 100% and deduct those who specifically, on the correct form, filled out perfectly, in black fountain pen, not blue biro, stated that they were dissatisfied/unhappy.

That way non of the pesky drop outs are represented and therefore they don't negatively affect the satisfaction score.

Otherwise it seems odd that a fair proportion of those who dropped out were also perfectly satisfied with the 'treatment'.

 

Wessely has made the argument that the Oxford criteria require severe and disabling fatigue that affects both physical and mental functioning. For example in this letter where he responds to a critique of the criteria by Baraniuk.

So perhaps that's the reason who some patients met 'NICE criteria' but not the Oxford criteria.

Source: https://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1364148

 

But when it comes to psychiatric conditions:

(ii) Patients with a current diagnosis of schizophrenia, manic depressive illness, substance abuse, eating disorder or proven organic brain disease. Other psychiatric disorders (including depressive illness, anxiety disorders, and hyperventilation syndrome) are not necessarily reasons for exclusion.

 

I've not read the paper so perhaps it defines the 'NICE criteria' differently but the current NICE guidelines say:

and

which, in my opinion, aren't massively different, if at all, from that description of the Oxford criteria - although one person's "substantial reduction in activity level" might, or might not, equate to "severe" and "disabling".

 

90% satisfaction! If you only count income in and ignore all expenses everyone is making a huge profit!!

 

Still is according to the googles.

 

You wouldn't know them, they live in Canada. Good chaps those two, Milton Weslin and Tramy Chauler.

 

I have no idea how many people may come to this thread that are new to the bPs way of doing research so I thought I'd just put a link to the chalder fatigue scale for perusal if anyone's interested:

http://www.goodmedicine.org.uk/files/assessment, chalder fatigue scale.pdf

This scale is discussed here:

https://www.s4me.info/threads/explo...ic-fatigue-syndrome-1998-morriss-et-al.11065/

And these links and further info on various scales can be found here:

https://www.s4me.info/threads/questionnaires-and-scales-used-in-me-or-cfs-research.879/

In our Science Library.

Also, just want to ask all and sundry if you think it would be feasible for us to attempt to create a viable scale. The question first would be what are we measuring since we all know that ME is not just fatigue.

I realise it may be too big a project. But just put it out there.

Moderator note
This post has been copied and following posts moved to a new thread:
Fatigue scales - finding or creating a valid questionnaire for fatigue in ME/CFS