Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With CFS, 2021, Knoop et al

Effectiveness of Internet-Based Cognitive Behavior Therapy (Fatigue in Teenagers on the Internet) for Adolescents With Chronic Fatigue Syndrome in Routine Clinical Care: Observational Study


Abstract
Background: Internet-based cognitive behavior therapy (I-CBT) for adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been shown to be effective in a randomized controlled trial (RCT; Fatigue in Teenagers on the Internet [FITNET]). FITNET can cause a significant reduction in fatigue and disability.

Objective: We aimed to investigate whether FITNET treatment implemented in routine clinical care (IMP-FITNET) was as effective, using the outcomes of the FITNET RCT as the benchmark.

Methods: Outcomes of CFS/ME adolescents who started IMP-FITNET between October 2012 and March 2018 as part of routine clinical care were compared to the outcomes in the FITNET RCT. The primary outcome was fatigue severity assessed posttreatment. The secondary outcomes were self-reported physical functioning, school attendance, and recovery rates. Clinically relevant deterioration was assessed posttreatment, and for this outcome, a face-to-face CBT trial was used as the benchmark. The attitude of therapists toward the usability of IMP-FITNET was assessed through semistructured interviews. The number of face-to-face consultations during IMP-FITNET was registered.

Results: Of the 384 referred adolescents with CFS/ME, 244 (63.5%) started IMP-FITNET, 84 (21.9%) started face-to-face CBT, and 56 (14.6%) were not eligible for CBT. Posttreatment scores for fatigue severity (mean 26.0, SD 13.8), physical functioning (mean 88.2, SD 15.0), and full school attendance (mean 84.3, SD 26.5) fell within the 95% CIs of the FITNET RCT. Deterioration of fatigue and physical functioning after IMP-FITNET was observed at rates of 1.2% (n=3) and 4.1% (n=10), respectively, which is comparable to a waiting list condition (fatigue: 1.2% vs 5.7%, χ21=3.5, P=.06; physical functioning: 4.1% vs 11.4%, χ21=3.3, P=.07). Moreover, 41 (16.8%) IMP-FITNET patients made use of face-to-face consultations.

Conclusions: IMP-FITNET is an effective and safe treatment for adolescents with CFS/ME in routine clinical care.

https://www.jmir.org/2021/8/e24839

 

I have a feeling this is this another scam to get patients changing their questionnaire taking behaviour, I could be wrong though.

Is anyone here familiar with this criteria? It's available here (https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-3-25). I had a quick look at it and noticed some usual suspects in the list of authors. There seems to be an awful lot of focus on fatigue.

 

Mmm a paper published in 2021 using criteria from 2003.....

Nothing much changes then .( sarcasm)

Eta sarcasm

 

Such a definition is in effect asserting that all the symptoms of ME/CFS are ‘impairment of functioning’ resulting from ‘persistent fatigue’.

This is an unevidenced and implausible hypothesis, especially as many symptoms such as orthostatic intolerance occur independent of any level of fatigue and often precede any fatigue. Also such as PEM, the defining symptom used by most current informed researchers and clinicians, would suggest that ‘fatigue’ arises as a consequence of the illness process in conjunction with the other symptoms, rather than being a primary cause of other symptoms.

Such a definition displays its origins reflect a belief system rather than empirical observation.

 

Although my above comment is perhaps stating the obvious, my intention was to convey the idea that much/most BPS research into ME/CFS has never arisen out of an attempt to understand the clinical reality experienced by patients, something that has become even more obvious in the catch-all psychiatric pseudo diagnosis of MUS, rather it is an attempt to impose on an ill defined group of patients an ideologically motivated intervention approach.

For these clinicians/researchers the meaningfulness of their diagnostic categories are irrelevant, and indeed they seek ever broader definitions. They are not particularly interested in understanding what fatigue actually is or how it becomes manifested, which is why they never attempt to directly evaluate their ever mutating theoretical underpinnings, eg the deconditioning model advocated by PACE or the current favourite central sensitisation.

Any theoretical underpinnings are post hoc justification of their preferred psychological and behavioural interventions, rather than rational responses to serious observation of patients’ lived experience. Presumably this is why they focus on fatigue, which is the least specific symptom of ME/CFS, and ignore the more indicative symptoms of such as orthostatic intolerance or PEM. Unfortunately this has put back our understanding of ME/CFS as a clinical entity by decades, even though it is as rational as seeking to understand brain tumours by studying horrid headache syndrome or Alzheimer’s Disease through studying chronic forgetfulness.

 

Unfortunately, with the people involved whatever criteria they used are secondary to how they apply them. So it really doesn't make a difference, they do not have the skills to use them properly, everything is interpreted.