Review Evaluating Pacing Therapy versus GET for improving fatigue, pain, and quality of life in adults with ME/CFS, 2025, Cooper

J

John Mac

Senior Member (Voting Rights)
Full title:
Evaluating Pacing Therapy (PT) versus Graded Exercise Therapy (GET) for improving fatigue, pain, and quality of life in adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Systematic Review.

https://www.sciencedirect.com/scien...c encephalomyelitis (ME,condition (NICE, 2021).

Abstract
This study aimed to evaluate the effectiveness of Pacing Therapy (PT) and Graded Exercise Therapy (GET) in improving fatigue, pain, and Quality of Life in adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), while also considering adverse events.

Data were sourced from PubMed Central, Academic Search Complete, CINAHL, MEDLINE, Cochrane Library, Google Scholar, and manual citation searches from 2013 to 2023. Studies were related to PT, GET, and outcomes of fatigue, pain, and QOL. Out of 925 studies, six met the inclusion criteria, analyzing a total of 2280 participants.

The methodological quality of these studies, assessed using the PEDro scale, ranged from good to poor.

GET showed the highest recovery rates for ME/CFS, with 33% on the CFQ and 53% on the SF-36PF, compared to 21-22% and 35-41% for APT and SMC.

Symptom improvements were reported by 44% post-PT, compared to 12% in GET (p<0.001).

GET also resulted in less frequent muscle and joint pain compared to APT and SMC. GES participants scored 4.2 points lower on the CFQ and 6.3 points higher on the SF-36PF than SMC.

APT and SMC showed significant improvements in fatigue and physical function at 2.5 years (p<0.0001).

Adverse events were reported in two studies, with over 50% experiencing NSAEs, and serious deteriorations in fatigue and physical functioning noted across all groups.

In conclusion, PT and GET are more effective than SMC, with GET being particularly favoured for improving pain, fatigue, and physical function. Adverse effects suggest that GET and PT are safer options than SMC.
 
They used the PEDro scale, which does not assess the type of outcome measure. So they completely ignored the issue with the combination of subjective outcomes and lack of blinding.

These are the categories that are assessed:
1: Eligibility criteria; 2: Random allocation; 3: Concealed allocation; 4: Groups similar at baseline; 5: Blinded participants; 6: Blinded therapy administration; 7: Blinded assessors of outcomes; 8 Outcomes obtained from >85% of participants; 9: Intention-to-treat analysis; 10: Statistical between-group comparisons for at least one key outcome; 11: Point estimates and variability.
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GET showed the highest recovery rates for ME/CFS, with 33% on the CFQ and 53% on the SF-36PF,
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Is that the GET which had so little effect that its main proponents had to redefine recovery to mean continued disability in order to be able to make misleading claims about recovery?

It seems that the authors of this study were also misled.
 
Utsikt said:
They only included studies from 2013 to 2023 for some reason. PACE is from before that.
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"Study Characteristics

Five of the included studies in this review compared the effectiveness of PT versus GET for improving fatigue, pain, and QOL in adults with ME/CFS (White et al., 2013; Bourke et al., 2014; Sharpe et al., 2015; Clark et al., 2017; Geraghty, Hann and Kurtev, 2019). One study explored the adverse effects of these interventions (Dougall et al., 2014). Across the 6 studies, with adjustments for the 4 PACE trial follow-up studies (White et al., 2013; Bourke et al., 2014; Dougall et al., 2014; Sharpe et al., 2015), the total sample size equates to 2280. Drop-outs (n=486) meant the final analysis across the studies included 77% of the initial sample. The age of participants ranged from 35-39. 78.5% (n=1420) of recruits identified as female. Ethnicity data showed 92% (n=783/852) identified as White/Caucasian, excluding one study where ethnicity data was not reported (Geraghty, Hann and Kurtev, 2019). ME/CFS illness duration ranged from 16 months to 9.5 years. Study duration ranged from 3 months to 2.5 years."

Out of six studies included, four were based on data from PACE, one was the GETSET results, and the other was an analysis of survey responses....
 
Andy said:
"Study Characteristics

Five of the included studies in this review compared the effectiveness of PT versus GET for improving fatigue, pain, and QOL in adults with ME/CFS (White et al., 2013; Bourke et al., 2014; Sharpe et al., 2015; Clark et al., 2017; Geraghty, Hann and Kurtev, 2019). One study explored the adverse effects of these interventions (Dougall et al., 2014). Across the 6 studies, with adjustments for the 4 PACE trial follow-up studies (White et al., 2013; Bourke et al., 2014; Dougall et al., 2014; Sharpe et al., 2015), the total sample size equates to 2280. Drop-outs (n=486) meant the final analysis across the studies included 77% of the initial sample. The age of participants ranged from 35-39. 78.5% (n=1420) of recruits identified as female. Ethnicity data showed 92% (n=783/852) identified as White/Caucasian, excluding one study where ethnicity data was not reported (Geraghty, Hann and Kurtev, 2019). ME/CFS illness duration ranged from 16 months to 9.5 years. Study duration ranged from 3 months to 2.5 years."

Out of six studies included, four were based on data from PACE, one was the GETSET results, and the other was an analysis of survey responses....
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Oh, that’s a weird way of doing it. I was just going by this exclusion criteria:
Study not published within years 2013-2023
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The paper said:
Pacing Therapy
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Ah, well, here's your first mistake: pacing isn't a therapy. Not exactly off to a good start when the entire premise contains this much confusion. Not sure it's really worth looking beyond that, I wouldn't expect pacing to be implemented in the form of an active therapy to be any better evaluated than GET.

The results sure do seem to be appropriately all over the place. Also: CFQ? Pffft.
 
I have tried to read this paper, but keep coming across things that make me suspect either it's written by ChatGPT, or is written by someone who just copied bits out of various research papers and arranged them in sections without engaging their brain.

I suspect this is a student project by someone determined to squeeze in as many quotes from papers as possible without actually digesting and understanding any of what they are putting together. How else would they come up with so many daftly contradictory and silly conclusions.
 
So how does this review conclude that GET is curative when the NICE guideline concludes it's not?
 
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