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Graded Exercise Therapy for Patients with Chronic Fatigue Syndrome in Secondary care: a benchmarking study, 2021, Smakowski, Chalder et al

Discussion in 'PsychoSocial ME/CFS Research' started by Andy, Jun 30, 2021.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Abstract

    Objective
    We investigated the effectiveness of Graded Exercise Therapy (GET) delivered to patients with Chronic Fatigue Syndrome (CFS/ME) in a routine, specialist clinic by measuring patient-reported outcome data collected prospectively over several timepoints alongside therapy. Benchmarking analyses were used to compare our results with those found in randomized control trials (RCTs).

    Method
    Data was collected from patients, with a diagnosis of CFS/ME, who had been referred to a specialist clinical service in South London. Measures included Chalder fatigue questionnaire, physical functioning subscale of the short-form health questionnaire and the work and social adjustment scale. Change on each measure was calculated over time using linear mixed-model analyses. Within group effect sizes were calculated and compared with previous RCT’s.

    Results
    Fatigue scores were significantly reduced by session 4 (-5.18, 95%CIs -7.90, -2.45) and at follow-up (-4.73, 95%CIs -7.60, -1.85). Work and social adjustment and physical functioning progressively improved over the course of therapy, reaching significance at discharge and maintained at follow-up (WSAS -4.97, 95%CIs -7.97, -1.97; SF-36 10.75, 95%CIs 2.19, 19.31).

    Conclusions
    GET is an effective treatment for CFS/ME within clinical practice. However, effect sizes were smaller in routine clinical practice than RCT’s suggesting that avenues for augmentation need to be considered.

    Abstract only, https://kclpure.kcl.ac.uk/portal/en...re(fbd405e8-ae37-4690-9e75-54b3052690f4).html
     
    Skycloud, Barry, dangermouse and 5 others like this.
  2. Andy

    Andy Committee Member (& Outreach when energy allows)

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  3. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Is this frantic press of ever poorer quality BPS papers a desperate attempt to overwhelm service commissioners before the publication of the final NICE guidelines, even though they must know it is too late to influence the guidelines themselves; is it part of their bid to colonise Long Covid; or are they trying to convince themselves and their acolytes that there is still some scientific basis for their beliefs, despite increasingly losing the arguments over the validity of research methodologies relying solely on experimental slight of hand and manipulation of bias within subjective outcomes?

    Though I have little faith in the British medical and scientific establishment not to be swayed by the eminence of the handful of venerated professors still in attendance at the altar of GET and CBT, hopefully this endless repetition of the same flawed methodologies will eventually serve to undermine their proselytising.
     
    Atle, MSEsperanza, Louie41 and 15 others like this.
  4. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Interestingly, though Crawley in Bristol/Bath seems to be switching to research involving children with ongoing problems following their intervention, reported as successful with 95% of patients (if I remember the figures correctly), Chalder in London still seems to have enough patients to research on first time round.

    Does this mean that Crawley is beginning to realise that on objective measures the UK specialist services are failing to achieve the cure rates they believed to be possible, but Chalder is not? Or is Crawley [beginning] to hedge her bets, where as Chalder is just doubling down on the same old same old?
     
    Last edited: Jul 1, 2021
    MSEsperanza, Louie41, Lidia and 8 others like this.
  5. Hutan

    Hutan Moderator Staff Member

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    Which are alone more than sufficient to make the paper not convincing. Of course most people referred to the clinics will improve over time as the illness takes its natural course.

    But, we could add (with respect to the abstract):
    • No mention of dropouts
    • No mention of harms
    • No accounting for the problems with the Chalder Fatigue Questionnaire that make it easy for improvements to be recorded when an outcome actually stays the same
    • Possibility of additional outcomes that were not reported

    These papers are not science, they are propaganda. Chalder and her acolytes are not scientists.
     
    Last edited: Jul 1, 2021
  6. dave30th

    dave30th Senior Member (Voting Rights)

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    this was a huge problem in the CBT study she published last fall with Sir Simon.
     
  7. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    Yes, indeed.
     
  8. Hutan

    Hutan Moderator Staff Member

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    Having seen the rules for what evidence will be reviewed for the forthcoming German ME/CFS Guideline, I think the BPS crowd know that the war to retain control consists of many battles.
     
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  9. Andy

    Andy Committee Member (& Outreach when energy allows)

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  10. DigitalDrifter

    DigitalDrifter Senior Member (Voting Rights)

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    Yet again conflating ME with chronic fatigue and inflating the numbers. There's no way that many people in the UK have real ME. Typical BPS tactic.
    Yet more useless scales which don't measure PEM or even require it in the CDC 94 criteria. Open label study with no objective outcome measures.
     
  11. NelliePledge

    NelliePledge Moderator Staff Member

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    Same old tripe
     
  12. Milo

    Milo Senior Member (Voting Rights)

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    I wonder whether the stalling of the NICE guidelines is due to the fact that this (kinda, sorta) ‘new knowledge’ was going to be published and would make NICE changing their minds on GET after all :ill:
     
    Webdog, Louie41, Amw66 and 3 others like this.
  13. dave30th

    dave30th Senior Member (Voting Rights)

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    This is pretty bad. And again Chalder is making claims that these findings demonstrate "effectiveness" while claiming that the study design does not allow for causal explanations. To claim something is "effective" is making a causal claim. She has documented an association between people who receive GET and a proportion of those who report that they feel better. That is not demonstrating "effectiveness." it is demonstrating a chronological association which might mean something or might not. To her, it seems every association is an opportunity to claim causality.
     
  14. NelliePledge

    NelliePledge Moderator Staff Member

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    Effectiveness at keeping her in a job
     
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  15. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Trial By Error: More Science-as-Promotion from the GET Campaigners

    "Perhaps Professor Chalder and her colleagues believe that the volume of studies confers some sort of credibility on the content. That strategy might work in some cases, but not when the research is as misleading as the GET propaganda Professor Chalder and colleagues published in July in the journal Disability and Rehabilitation. (This publication comes after, among other instances, Professor Chalder’s misleading CBT paper last fall in the Journal of the Royal Society of Medicine, to which Professor Brian Hughes and I published a rejoinder; and Professor White’s misleading GET paper in the Journal of Psychosomatic Research, which was corrected to make it clear that the study had null results.)"

    https://www.virology.ws/2021/09/14/...cience-as-promotion-from-the-get-campaigners/
     
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  16. Barry

    Barry Senior Member (Voting Rights)

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    I do sometimes wonder if they really have the scientific nous to distinguish between the two. As if to them it is "so obvious" the relationship must be causal ... they just get mental dropouts of those rather important bits of scientific reasoning along the way. It's bordering on weird.
     
  17. dave30th

    dave30th Senior Member (Voting Rights)

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    I have thought the same thing. They might elide between the two without realizing it, because it is self-evident to them that the treatments are "effective."
     
  18. Adrian

    Adrian Administrator Staff Member

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    Some of the figures are interesting
    Graded exercise therapy for patients with chronic fatigue syndrome in secondary care – a benchmarkin (tandfonline.com)

    Number of patients coming into the clinic 1506
    1240 had CBT (note that in PLOS ONE: Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis its said that Maudsley is charging 176 per hour which for 12 sessions per patient would give them a revenue of £2618880)
    6 - had APT
    60 had both GET and CBT (so weren't included)
    83 - they failed to record what they had (~5% they didn't record treatment which implies poor record keeping!)

    So 117 patients just had GE
    - 12 were discounted for post-polio, cancer or other illnesses that could cause symptoms
    - 12 more excluded due to missing initial or invalid data
    - 1 had had GET before

    So they looked at 92 patients
    - 1 discontinied
    - 20 "completed treatment early" with no outcome measures (in other words dropped out)
    So figures are for 71 patients who completed

    They also imputted data when 25% or less was missing which I think is more than normal

    I thought it is interesting they do less than 10% GET but then I think Kings was pushing CBT with QMUL GET. But it doesn't suggest great confidence or that it is helping that many. We could perhaps compare these numbers to patient harms reports
     
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  19. Adrian

    Adrian Administrator Staff Member

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    It seems worse than that the appendix seems to have more numbers in it
    For the CGQ they started with 91 but at discharge had data from just 33 with 25 at long term followup
    Similar for the other figures
     
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  20. InitialConditions

    InitialConditions Senior Member (Voting Rights)

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    This thread from Keith Geraghty pulls apart this paper:
     
    Last edited: Sep 21, 2021 at 2:48 PM
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