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

[PhysiosforME]

It seems we have work to do! Thank you for tagging us

 

[NelliePledge]

It seems we have work to do! Thank you for tagging us

Yeah sorry for adding to your to do list but I thought you’d want to know
All the best

 

[bobbler]

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/science/article/pii/S1360859225002025#:~:text=The terms myalgic 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.

the fascinating bit is that the person writing the conclusion probably now believes in themself that it tallies with the results, but most of the points above it (and of course htat adverse events one we know is a common gap that isn't really covering what would/should be adverse events in me/cfs but also the coercive environment and level of illness involved with deterioration mean most aren't collected) but to me it doesn't with most of those points.

they've just tried to use the sandwich technique/primacy-recency to put the stuff that claims get is better as the first point hoping people won't read the acronyms properly to realise the rest say the opposite?

eg isn't this the only one that gets near mattering - as only whether a 'therpay' makes someone long-term more debilitated or less is what matters, and if that makes someone worse then it means it should be contraindicated - whatever the claims are when someone is in the middle of treatment x weeks in?

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

 

[Eleanor]

Just noticing this is now dated October 2025, don't know if there have been any significant amendments.

https://www.sciencedirect.com/science/article/pii/S1360859225002025

 

[Utsikt]

Just noticing this is now dated October 2025, don't know if there have been any significant amendments.

https://www.sciencedirect.com/science/article/pii/S1360859225002025

That’s just the date of the volume of the journal that the study is published in.

The original dates are still listed:

Received 7 September 2024, Revised 6 May 2025, Accepted 25 May 2025, Available online 30 May 2025, Version of Record 6 June 2025.

 

[Eleanor]

That’s just the date of the volume of the journal that the study is published in.

The original dates are still listed:

ah, thank you

 

[Nightsong]

An analysis of this review due to Vink & Vink-Niese, published on Elsevier's SSRN preprint server -

The systematic review by Cooper and Papadopoulos, is based on two RCTs from the same investigator which are presented as five different trials by the reviewers even though four of them are all follow-up studies from the same study. A systematic review should never be based on just a single researcher or group's work. Moreover, one of the two studies that was used to determine the efficacy and safety of pacing and GET, did not include a group to examine pacing and the other study examined an amended form of pacing.

The systematic reviewers ignored the null effect on the objective outcome measures in the study that examined the efficacy and safety of pacing and GET. The other study in the review was a large survey into the safety of CBT, GET and pacing which found that GET is very harmful in 54 to 74% of patients. This confirms the findings by the Oxford Brookes University which highlighted the harmfulness of GET yet those findings were also ignored by the systematic review. Consequently, the conclusion of the systematic review should have been that both treatments are ineffective and that GET is harmful. Additionally, pacing is not a treatment but a way of life for patients to try and avoid relapses by staying within their limits.

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