Graded exercise therapy compared to activity management for paediatric [CFS/ME]: pragmatic randomized controlled trial, 2024, Gaunt, Crawley et al.

" low intensity " . Is this number of sessions or the type of session ...

 

Exactly this .
It's how it's always worked .

 

It's GET - light .
How many would have rolling PEM without knowing it

 

If the number suggestion is correct then this is potentially a lot worse .
Not had a good night here so not up to reading paper itself

https://twitter.com/user/status/1764048985260454276


And what happened to the 100+ participants who didn't fill in questionnaires at 12 months? Did anyone check to see if they were any worse?

 

https://twitter.com/user/status/1764073058183078013


Don’t be fooled by fancy names and euphemisms. “Activity management” is a form of coercive control of patients with #LongCovid or #MEcfs. Please RT

 

I just added a red line to this plot to make it easier to visualise (for me at least). If a dot is above the line they improved if it's below they got worse. If they stayed on the line there's no change. Just a quick approximate count of all the data points above and below the line:

Activity management: 43 above, 44 below
GET: 46 above, 44 below

For both categories there are more red dots (people who did 0-2 sessions) above the line than below (so doing nothing looks like the best strategy). For the GET I count something like 13 blue (people who did 8+ sessions) dots below the line and 8 above - so around twice as likely to feel worse after GET at 6 months follow up than to feel better.

 

Indeed.
That's the logical explanation . Yet to see a " penny drop " moment from this team though .

 

The trend if anything looks to me like the fewer sessions you had the better your chances of improvement - for both activity management and GET.

 

???
How on earth do you make sense of any " treatment"
https://twitter.com/user/status/1764075579156889965


ETA a bit concerning re CBT being needed / used for subjects developing anxiety and/ or depression during the trial .
As we know many scales used for such diagnosis are inappropriate as symptoms are misinterpreted .
The power asymmetry is never acknowledged . The stress these families are under is also poorly acknowledged.
Many are in a classic double bind situation.

I hope that they got appropriate help .

 

They're going to have a hard time spinning this as GET and activity management being "equally effective" since neither was effective and the scores didn't budge in either group.

It looks like it took them 9 years since trial registration to conduct the trial and report it. My goodness. I wonder if the huge delays are due to the results being unfavourable to them.

 

Here are the descriptions of the therapies from the supplementary material provided with the 2019 protocol paper: https://bmjopen.bmj.com/content/6/7/e011255

And as Trish said 5 years ago...

 

Yes, GET by another name:

Although this focuses on cognitive activity rather than physical exercise, by introducing fixed increments does it run foul of the NICE prohibition of GET.

 

So the protocol described AM as essentially graded cognitive therapy, but in this paper they describe AM as a more general graded activity therapy, including both cognitive and physical activity:

 

And in the protocol paper itself AM is described differently to in the documents @Lucibee quoted: