Internet-Based CBT for CFS Integrated in Routine Clinical Care: Implementation Study (2019) Knoop, Worm-Smeitink, et al

Three Chord Monty

Senior Member (Voting Rights)
This is in the Journal of Medical Internet Research.

"All adult patients referred for the treatment of CFS could participate if the following criteria were met: (1) a physician had concluded that the patient suffered from severe and disabling fatigue not explained by a known somatic or psychiatric condition; (2)
the 2003 CDC consensus criteria for CFS were met (ie, severe, disabling fatigue was present, lasting for at least 6 months, accompanied by at least 4 out of 8 additional symptoms) or patients met criteria for idiopathic chronic fatigue (ICF) syndrome (ie, reported severe and persistent fatigue but did not meet all CDC criteria, <4 additional symptoms, or less impact on daily functioning."

Also "no specific exclusions." So, the precursor to the Reeves Criteria...or NO criteria. And why would peer reviewers care, anyway. It's just CFS. As for "Idiopathic Chronic Fatigue Syndrome," that's a new one on me. I did do a quick search & apparently it's a term that has been used before, not that it means anything. I have a feeling it's fairly exclusive to psychs/BPS, and ME denialists.

What I find particularly sad about this, is that actual, bona fide CBT for those who would benefit from it (not too many ME patients, I daresay) could be a good thing over the internet. But we're not going to find out much from these clowns. Given the presence of Knoop & the mockery of case definitions, it would seem there's absolutely nothing here that's going to do anybody any good, except for those who are hoping to integrate this sort of thing into clinical care/looking to score as many grants for further research as they can.

www.jmir.org/2019/10/e14037

 
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Wow. That is a complete mess, i.e. the usual. Who the hell approves this nonsense in the first place? It's almost impossible to select things that are wrong with it because it's basically most of it. It "compares" online CBT-GET by doing it online first, then face-to-face. No objective outcomes. Concludes they are equal. Equally useless, but obviously they reach the opposite.

The stepped thing is basically CBT then GET:
After [setting goals, sleep hygiene], patients start with a graded (physical) activity program, usually walking or cycling. The activity program is tailored to the patient, based on their activity pattern. The increase in activity is time contingent, irrespective of symptoms.
I have no idea how anyone thinks this is serious:
After the first module is finished (getting started and goal setting), the following 5 modules become accessible. These modules were as follows: regulate sleep-wake cycle, helpful beliefs about fatigue, how to communicate with others about CFS, and gradually increasing my activity. When the sixth module reaching my goals step by step is finished, the seventh module opens (evaluation and the future).
Measures:
For patients who received the full stepped care, outcomes were measured at baseline, after I-CBT (6 months after start), and directly after face-to-face CBT (posttreatment assessment). For patients who received I-CBT only, the outcome directly after I-CBT was used as posttreatment assessment.
Fatigue severity was measured with a fatigue questionnaire, the 20-item CIS
Physical and social functioning was measured with the Medical Outcomes Survey SF-36
Impairment in daily functioning was measured with the Work and Social Adjustment Scale
Absolute minimal subjective definition of improvement:
A clinically significant improvement in fatigue severity was defined as a statistically Reliable Change Index (RCI) of >1.96 SD in CIS fatigue severity [36], in combination with a CIS fatigue severity score of <35 on postassessment.
Results:
Data of all 100 participants were analyzed. Postassessment data of the primary outcome measure (CIS fatigue severity) of 87 participants (87/100, 87.0%) was present.

Bah. Honestly no point going any further. This is yet another nearly identical trial trying to influence responses on a questionnaire. Complete waste of everything.
 
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