1. Sign our petition calling on Cochrane to withdraw their review of Exercise Therapy for CFS here.
    Dismiss Notice
  2. Guest, the 'News in Brief' for the week beginning 18th March 2024 is here.
    Dismiss Notice
  3. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice

Efficacy of therapist-delivered transdiagnostic CBT for patients with persistent physical symptoms in secondary care: an RCT, 2021, Chalder et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Joan Crawford, Jun 7, 2021.

  1. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

    Messages:
    3,488
    Location:
    Belgium
    The results are actually very clear that the intervention didn't work. the confidence interval for the primary outcome, WSAS measured at 52 weeks had a 95% confidence interval of −3.44 to 0.48. It excludes what the authors themselves have defined as the minimum clinically important difference. None of the secondary outcomes showed a significant difference, even though patients in the control group received no intervention. Yet the authors claim: "We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS."
     
    Atle, FMMM1, EzzieD and 16 others like this.
  2. chrisb

    chrisb Senior Member (Voting Rights)

    Messages:
    4,602
    The linguistic problems seem odd. "May" indicates conditionality. Surely it is incumbent upon researchers to indicate in what conditions it "is".
     
  3. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    The point is also this was a major trial funded after other trials provided "preliminary evidence." It wasn't I assume supposed to produce preliminary evidence but actual actionable definitive evidence. Which of course it didn't produce.

    Has anyone seen a mininal clinically important difference figure for the PHQ-15 measure?
     
  4. Barry

    Barry Senior Member (Voting Rights)

    Messages:
    8,385
    Yes, the protocol says ...
    Makes no suggestion of WSAS being a secondary outcome at any point.
     
    Invisible Woman, MEMarge and Mithriel like this.
  5. Barry

    Barry Senior Member (Voting Rights)

    Messages:
    8,385
    [my bold]

    This seems to be their standard get-out-of-jail card - we didn't prove anything useful but we'll spin it so it sounds like we only ever intended to lay the ground for another (worthless?) study anyway.
     
  6. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    They were always going to measure WSAS at the other time-points but designated the 52-week as the primary outcome. I'm not sure if the other time points would automatically be inferred to be secondary outcomes? Or just to have no defined category? And I'm not sure oft he same about the other time-points for the designated secondary outcomes. Were they all secondary outcomes? Or just the 52-week time point? Researchers sometimes seem loosey-goosey about whether something is a primary outcome measure (WSAS) or the primary outcome at a specific time point (WSAS at 52 weeks).
     
  7. Barry

    Barry Senior Member (Voting Rights)

    Messages:
    8,385
    I thought a major objective of a protocol was to pin down such detail and so avoid ambiguity. Especially something so crucial as whether something is a primary or secondary outcome at whatever point in the process. If anything so important can be reinterpreted or misinterpreted (possibly deliberately) after a trial has started, then the protocol has failed in its objective surely.
     
  8. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    that is, in fact, the intent. but it seems the format can still leave it hard to pin people down on some of these things.
     
  9. Andy

    Andy Committee Member

    Messages:
    21,808
    Location:
    Hampshire, UK
    Atle, rainy, Missense and 9 others like this.
  10. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    Missense, EzzieD, Hutan and 6 others like this.
  11. Andy

    Andy Committee Member

    Messages:
    21,808
    Location:
    Hampshire, UK
    Like you've never had a stalker before... ;)
     
    Missense, FMMM1, EzzieD and 12 others like this.
  12. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    12,290
    Location:
    Canada
    Honestly whoever gave approval for WSAS (or whatever acronym I won't even bother getting it right) being a primary outcome deserves to be fired, from a cannon, into the Sun, and also mostly out of a job, Sun cannon or not.

    Seriously who are these clowns? Have they no pride in their work at all? They are just there day-in-day-out going through the motions as if none of this mattered? As if none of this had any real-life impacts? Who are these clowns and what is wrong with not only them but the people who decided they should be making any decisions of more importance than which condiment goes first in the sandwich someone ordered?
     
    Atle, FMMM1, EzzieD and 4 others like this.
  13. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    that's kind of important, don't you think? does the training require you to learn how to change things if something doesn't work out over and over? that might be difficult for some people.
     
    FMMM1, EzzieD, Hutan and 3 others like this.
  14. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

    Messages:
    903
    Location:
    United States
    I think this is their post-PACE grifting strategy. Everything is now 'preliminary' and 'needs more research'. Being 'definitive' is a huge problem.

    PACE backfired because it was hyped and sold as definitive. As such, too many important people and institutions took note of it being obliterated and it has turned into a grinding, comprehensive, and public loss for them. Wouldn't want to repeat that with any other conditions.

    Better to fly under the radar and collect funding for studies you never intend to mean anything. Clearly there is no shortage of gullible funders. You don't even need to manufacture a positive result, apparently.

    It's less than they had hoped for, but it will pay the bills.
     
    FMMM1, EzzieD, Sean and 8 others like this.
  15. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    Messages:
    9,573
    Location:
    UK
  16. JemPD

    JemPD Senior Member (Voting Rights)

    Messages:
    3,903
    from @dave30th 's blog
    Why does the scientific establishment allow researchers to behave like estate agents? (thats real estate agents in the US i believe) The abstract's conclusion is like reading an estate agent's spun description of a dump that is literally falling down, as 'needs new wallpaper'. What the hell are they playing at? i feel furious with them for letting all this crap slide past, for YEARS, without most of them doing more than raising an eyebrow, even AFTER the problems are pointed out to them.

    Thank God for the Dave Tullers & Jonathan Edwards', without whom we would be royally, comprehensively screwed, but sometimes it feels like they are King Canute :( I just despair at the ever flowing tide of crap that keeps flowing and drowning us all.
     
    rainy, Missense, Simbindi and 12 others like this.
  17. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    Interesting theory. They later claimed at some point that they didn't mean to claim that PACE was "definitive," and that they'd only said "definitive" one time--that it wasn't their overall opinion. Or something like that. No one funds major trials after small trials to get "preliminary results." It is very disturbing that the journals allow them to make these claims when the trial obviously did not produce the results they expected.
     
    Simbindi, EzzieD, inox and 10 others like this.
  18. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

    Messages:
    10,280

    Riiight. £5m on a trial that wasn't meant to be"definitive", funded in part by the DWP.

    If that's the case ,someone needs to be asking why the heck they were shelling out that kind of dosh.
     
  19. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

    Messages:
    903
    Location:
    United States
    Yeah I think after PACE their best strategy is to avoid any showdowns. As long as funders are gullible enough, they may well be able to get funding even for 'major' trials; then they just tell the funder what they want to hear, but otherwise keep pretty quiet - just publish the paper rather than the whole media campaign that came after PACE.
     
  20. Campanula

    Campanula Established Member (Voting Rights)

    Messages:
    54
    Location:
    Norway
    Atle, rainy, Simbindi and 13 others like this.

Share This Page