Open Effectiveness of Acceptance Commitment Therapy or Micro Breaks in Patients With Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis

Thanks for your efforts on this FMMM1. Just to note though, this trial does seem to have actimetry outputs. Of course that doesn't compensate for the many problems of the trial including its underlying premise, or guarantee that the actimetry results will actually be reported in the resulting paper.

 

I think any identified secondary outcomes should also be reported. But yes, the summary that we have neatly steps around specifying secondary outcomes while implying that there will be objective outcomes.

Also, the microbreak intervention is extraordinarily vague. The microbreaks might be filled with moderate to high intensity exercise, eating, breathing, relaxing or resting. It's not clear from the information we have just how the content of the microbreaks will be selected. Patients 'are encouraged to keep micro break diaries', but it doesn't sound as if those will be generating data for the study, and as others have said, recording every time an activity is broken up by doing another activity is unrealistic. Taking time out to record a microbreak is a microbreak itself. So, we are left with patients potentially performing a sort of pacing but the researchers potentially being able to claim that regular breaks for e.g. exercise is what helps. Worse, if later therapists apply the microbreak technique, they can choose to focus on the bits they like - the exercise, the breathing exercises.

I think it would be very worthwhile getting detail about the study from the researchers:
- what are the secondary outcomes and how will they be measured? If actimetry will be used, how long will measurements be made, and when? What molecules in saliva and blood will be tested for, and when?
- how will the detail of the micro break intervention, as applied by the patient, be recorded? Will actimetry be used to characterise patterns of movement in each of the interventions?

Pinning down the intentions of the researchers now would help a lot to ensure that actimetry data and any other secondary objectives are recorded properly and reported, or at least made available to other researchers.