Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Knoop et al., 2007

[Dolphin]

Psychother Psychosom. 2007;76(3):171-6.
Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome?
Knoop H1, Bleijenberg G, Gielissen MF, van der Meer JW, White PD.
Author information

Abstract
BACKGROUND:
Cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) leads to a decrease in symptoms and disabilities. There is controversy about the nature of the change following treatment; some suggest that patients improve by learning to adapt to a chroniccondition, others think that recovery is possible. The objective of this study was to find out whether recovery from CFS is possible after CBT.

METHODS:
The outcome of a cohort of 96 patients treated for CFS with CBT was studied. The definition of recovery was based on the absence of the criteria for CFS set up by the Center for Disease Control (CDC), but also took into account the perception of the patients' fatigue and their own health. Data from healthy population norms were used in calculating conservative thresholds for recovery.

RESULTS:
After treatment, 69% of the patients no longer met the CDC criteria for CFS. The percentage of recovered patients depended on the criteria used for recovery. Using the most comprehensive definition of recovery, 23% of the patients fully recovered. Fewer patients with a co-morbid medical condition recovered.

CONCLUSION:
Significant improvement following CBT is probable and a full recovery is possible. Sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes.

PMID: 17426416

DOI: 10.1159/000099844

 

[Dolphin]

When I initially read this I thought that the SIP8 criterion <=203 was part of the definition of full recovery. However looking back on it again I think maybe it is not included (and that if it was used the figure for full recovery might be lower).

If one looks at the group of those with comorbidities in Table 4., "No disabilities in all domains" = 9%. However, "Combining criteria of fatigue, disabilities and perception of health and fatigue" = 12%. This latter figure should really be 9% or lower if "No disabilities in all domains" is a criterion, though I suppose if there was missing data on some items, it would be possible to get an overall percentage of 12%.

If one looks at table 1, the part below the line seems to be set of criteria used for full recovery. The SIP8 part is not used there.



Similarly the text says:

Combining Fatigue, Disabilities and Perception
This comprehensive definition of recovery was operationalized by combining the cut-off scores on the CIS-fatigue, the SF-36 scales of physical functioning and social disabilities, the general health perception and the FQL.

I.e. no mention of the SIP8

 

[Hutan]

In my family, 100% (3 out of 3) of us have improved compared to how we were 6 months after becoming ill. 33% of us have essentially recovered.

What did we do? Well, we tried lots of things but had no CBT and no GET.

(Maybe it was the goat cheese, we started eating quite a lot of it because it was so delicious. Come to think of it, there was a dose dependent relationship between goat feta eaten and the degree of improvement. Ha, I think I'll call it Goat cheese Eating Therapy. ....Or Cheesy Bytes Therapy - order your cheese online so it's cheaper. I wonder if the goat farmers would be interested in funding a trial - I can pretty much guarantee a good result.)

Where's the placebo control treatment, researchers? Weren't you paying attention in the Experimental Design 101 class?

Do they say anything about rates of spontaneous recovery over time (significant in the first two years as demonstrated in the Dubbo study)? Do they say how long the trial participants had been ill before being treated?

Did they account for 'intention to treat' or did they screen and treat a lot of patients before they found the 96 who had the stamina and belief to make it to the end of the CBT course? ?

The abstract doesn't actually say that the participants met any criteria for CFS before treatment - just that they were treated for CFS. I wonder how were the participants selected?

 

[Trish]

I note this paper is from 2007.

I have only read the abstract. No energy for the whole thing.

CONCLUSION:
Significant improvement following CBT is probable and a full recovery is possible. Sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes.

This part of the conclusion:

'Sharing this information with patients can raise expectations of the treatment, which may enhance outcomes'

makes me wonder whether it influenced their thinking on the PACE trial. I can just imagine Peter White saying to himself:

'Let's tell the patients the treatment works, then we'll get better results on the questionnaires.'

Which is exactly what they did.

 

[Alvin]

Nice try, how much did they massage their data? When you start with a conclusion and work backwards your ethics are compromised

Fewer patients with a co-morbid medical condition recovered.

This is meant to prove ME/CFS is all in our heads because people with "real" conditions didn't improve

Typically i look for procedural errors but this study smells like rotten fish, they either falsified their data, selected patients without ME/CFS or used a flawed design. Maybe all of the above

It seems these authors like to "prove" ME/CFS is psychosomatic, one even authored a paper with our "friend" Esther

https://www.ncbi.nlm.nih.gov/pubmed/?term=Knoop H[Author]

https://www.ncbi.nlm.nih.gov/pubmed/?term=Bleijenberg G[Author]

https://www.ncbi.nlm.nih.gov/pubmed/?term=Gielissen MF[Author]

https://www.ncbi.nlm.nih.gov/pubmed/?term=van der Meer JW[Author]

https://www.ncbi.nlm.nih.gov/pubmed/?term=White PD[Author]

 

[Sean]

I note this paper is from 2007.

This part of the conclusion:

'Sharing this information with patients can raise expectations of the treatment, which may enhance outcomes'

makes me wonder whether it influenced their thinking on the PACE trial. I can just imagine Peter White saying to himself:

'Let's tell the patients the treatment works, then we'll get better results on the questionnaires.'

Which is exactly what they did.

Agree.

They have developed a general modus operandi that basically involves maximising known experimental confounders for this type of research, making sure objective measures are not used properly or at all, arbitrarily tweaking statistical thresholds to ensure the confounder effect exceeds significance but the control or competing therapy arms don't, declaring the resulting numbers to be beneficial therapeutic effects, and indulging in the most ludicrous twisting of words to mean anything they want – e.g. 'recovery'.

 

[chrisb]

Presumably, like true scientists, they were asking this question to seek to refute the supposition that a full recovery after CBT for CFS is not possible.

 

[Dolphin]

When I initially read this I thought that the SIP8 criterion <=203 was part of the definition of full recovery. However looking back on it again I think maybe it is not included (and that if it was used the figure for full recovery might be lower).

If one looks at the group of those with comorbidities in Table 4., "No disabilities in all domains" = 9%. However, "Combining criteria of fatigue, disabilities and perception of health and fatigue" = 12%. This latter figure should really be 9% or lower if "No disabilities in all domains" is a criterion, though I suppose if there was missing data on some items, it would be possible to get an overall percentage of 12%.

If one looks at table 1, the part below the line seems to be set of criteria used for full recovery. The SIP8 part is not used there.

View attachment 1656

Similarly the text says:

Combining Fatigue, Disabilities and Perception
This comprehensive definition of recovery was operationalized by combining the cut-off scores on the CIS-fatigue, the SF-36 scales of physical functioning and social disabilities, the general health perception and the FQL.

I.e. no mention of the SIP8

What prompted me to look at this was the Twisk & Corsius paper. They seem to say different things at different stages.

*j The SIP 8 score was not included in “the most comprehensive definition of recovery”.

If percentiles of representative populations were employed to define ‘normal values’ and the SIP 8 score was included in the “the most comprehensive definition of recovery” the ‘recovery rate’ based
on the subjective measures used would drop dramatically.

Most comprehensive definition of recovery *n: CIS F ≤27 (“level of fatigue comparable to healthy people”), SF-36 PF ≥80 (“no physical disability”), SF-36 SF ≥75 (“no social disability”), SF-36 GH ≥65 (“normal health perception”), and number of factors of the FQL scoring negative =0 (“no negative perception of fatigue”)

but

Using ‘more strict’ criteria for recovery (CIS F ≤27, SIP8 ≤203, SF-36 SF-36 PF ≥80, SF-36 Social Functioning subscore ≥75, SF-36 General Health subscore ≥65, and no factors scoring negative on the Fatigue Quality List), the recovery rate drops to 23%. However, even “the most comprehensive definition of recovery” isn’t based on stringent criteria. Curiously, the SIP 8 score, used as a criterion to select patients (caseness) in this study [35] and other trials [7], isn’t included in these two definitions of recovery.