How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity, 2010, Wiborg, Knoop +

Not just rehabilitationist researchers, H. Knoop himself was among them.

 

Particularly as it predates the initial publication of Larun et al in 2015.

However if I remember correctly the protocol for this then new version of Cochrane’s exercise review explicitly excluded studies/data using such ‘objective outcomes’.

 

I forget but wasn't this the basis for the PACE trial steering committee abandoning altimetry as an endpoint in PACE be because it had been shown to be 'unhelpful' (i.e. not to give the predicted result).

 

My memory is unreliable, but certainly Larun et al’s protocol very narrowly limited the evidence they were considering.

 

Would this be some kind of proof against GET?

I know they did not test GET here, but if some physical activity doesn’t reduce fatigue, why would you suggest that even more physical activity would reduce fatigue?

 

How is that defendable. It seems ridiculous?

 

Just a side note on this point, while it is often described this way - as something they planned to do and then "dropped" - the trial management group meeting minutes tell a different story. They planned for actigraphy as a predictor, and then considered making actigraphy not just a predictor but also an outcome, but decided not to add it as an outcome.

The protocol paper, published in 2007, long after they started planning and indeed doing the trial, does not list actigraphy as an outcome measure, only as a predictor.

In the Trial Management Group minutes in 2004-5, you can see they they did consider whether or not they should make actigraphy not just a predictor, but also an outcome measure, and opted not to for well-dodgy reasons.

In the minutes the primary outcome measures were always questionnaires - Chalder Fatigue and SF36 physical function - right from 2003 (see the Trial Management Group minutes Meeting No. 2). In TMG meeting #7 they did discuss whether they should have an objective primary outcome measure, but clearly they ultimately decided not to. They seemed most interested in the potential of the 6 minute walking test:

I did not find further mention of objective outcome measures after this.

[For more on outcome vs predictor, see https://s4me.info/threads/paul-garn...es-and-other-media.15629/page-105#post-530333]

 

I could be confabulating given my memory, but my recollection is that this was justified by any such data being limited and not uniform enough to pool the various small studies. Though I agree not to mention it at all when much of it contradicts Larun et al’s theme of the wonderfulness of GET is inexcusable.

 

Because it doesn't give them the results they want. There are many instances of this. Even PACE noped out to avoid having to report failure.

Although ironically there is now a new cohort of rehabilitation researchers who aren't aware of this and are using wearables. That we haven't seen any research showing positive benefits says just as much as this.

 

But. That's literally the premise they have been asserting for decades. And still do.

It's things like this that make it clear that however harsh we are with these researchers, it's not nearly as much as they deserve. They know their stuff is wrong just as much as the tobacco companies knew about the harms of their products. It's completely indefensible to stick to feigned ignorance.

 

It seems like you’re trying to apply logic to BPS? They don’t like logic.

 

it didn't exclude the studies (PACE had "objective outcomes"). It excluded the objective outcomes from the studies--a change with the new protocol developed for the revised exercise guidelines.

 

Yes, they learned that a Dutch trial or trials had null results for it, so they decided it didn't accurately reflect "fatigue"--just as Knoop argued recently about why their CBT and Long Covid study didn't report their null actigraphy findings. But in correspondence regarding the protocol, the PACE authors responded to criticism for having dropped actigraphy (from Tom Kindlon, and one other person, I think) by giving another version. They claimed they dropped it because they decided it was too much of a burden for patients to do at the end of the trial--even though they had managed to do it at the beginning. This answer seems like it can be called a lie--they didn't mention that they had learned from their colleagues that the actigraphy didn't produce desireable results.

 

That's even worse...

 

It was interesting that they withheld the actigraphy data from all of the primary publications and only published them in this study,

 

yes, that strategy was very effective in making the data disappear.