Review Systematic review of chronic fatigue syndrome treatment methodology, 2024, López Barbeta

https://www.sciencedirect.com/science/article/abs/pii/S2530299X24000219

Revista Científica de la Sociedad de Enfermería Neurológica (English ed.)
Available online 28 October 2024, 100164
In Press, Corrected Proof


Original article
Systematic review of chronic fatigue syndrome treatment methodology

Revisión sistemática de la metodología de tratamiento del síndrome de fatiga crónica

Sergio López Barbeta, Manuela Carrión Martínez, Alejandro Lendínez Mesa, Alberto Diliz Vieira, Carlos Díaz-Rodríguez
https://doi.org/10.1016/j.sedeng.2024.100164
Revisión sistemática de la metodología de tratamiento del síndrome de fatiga crónica
Revista Científica de la Sociedad Española de Enfermería Neurológica, Available online 4 June 2024, Pages 100164

Abstract

Introduction
Chronic fatigue syndrome (CFS) is a highly prevalent pathology that has not been clearly defined. Currently, there is no universally accepted treatment protocol, and the diagnostic markers, etiology, and specific pathophysiology for developing effective non-pharmacological treatments remain unknown.

Objective
To determine the currently established rehabilitation treatment methodologies for CFS. In addition, to establish an analysis of the efficacy of the treatment plans studied and to determine advances on the etiology of CFS.

Methods
A systematic review of randomized clinical trials (RCTs) published since 2011 was conducted. Studies evaluating non-pharmacological interventions for adult CFS patients were included, differentiating them according to chosen diagnostic criteria and variable measurement. The treatment hypothesis of the selected interventions was also taken into account.

Results
17 RCTs were included, 6 of which based their performance protocol on a self-management booklet and 11 of which did so through face-to-face involvement of a therapist and active therapy. The results of these studies were assessed primarily by patient-reported outcomes, and 5 of these studies reported on objective outcome measures.

Conclusion
There is no significant evidence on the efficacy of non-pharmacological interventions in CFS patients. In addition, the lack of consensus on diagnostic criteria makes it difficult to compare studies and to develop a standardised treatment plan. Advances in the aetiology and pathophysiology of CFS point to the need for a broader therapeutic approach.

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Resumen
Introducción
El síndrome de fatiga crónica (SFC) es una patología de alta prevalencia que no ha sido definida con claridad. En la actualidad, no existe un protocolo de tratamiento universalmente aceptado, y los marcadores diagnósticos, la etiología y la fisiopatología específica para desarrollar tratamientos no farmacológicos eficaces siguen siendo desconocidos.
Objetivo
Determinar las metodologías de tratamiento de rehabilitación establecidas actualmente para el SFC. Además, establecer un análisis de la eficacia de los planes de tratamiento estudiados y determinar los avances sobre la etiología del SFC.
Método
Se llevó a cabo una revisión sistemática de ensayos clínicos aleatorizados (ECA) publicados desde el 2011. Se incluyeron estudios que evaluaban las intervenciones no farmacológicas para pacientes adultos con SFC, diferenciándolos según criterios diagnósticos escogidos y medición de variables. Asimismo, se tuvo en cuenta la hipótesis de tratamiento de las intervenciones seleccionadas.
Resultados
Se incluyeron 17 ECA, 6 de los cuales basaron su protocolo de actuación en un folleto de autogestión y 11 lo hicieron a través de la participación presencial de un terapeuta y terapia activa. Los resultados de estos estudios se evaluaron principalmente mediante medidas de resultado informadas por el paciente y 5 de estos estudios informaron sobre medidas de resultado objetivas.
Conclusión
No existen evidencias de carácter significativo sobre la eficacia de las intervenciones no farmacológicas en pacientes con SFC. Además, la falta de consenso en los criterios diagnósticos dificulta la comparación entre estudios y la elaboración de un plan de tratamiento estandarizado. Los avances en la etiología y fisiopatología del SFC apuntan a la necesidad de un abordaje terapéutico más amplio.

 

As the full text is paywalled and it's an Elsevier publication, just a reminder that there's the option to get patient access:

 

Looking only only at the conclusion I would agree.

Skimming the full text I found their reasoning rather confusing though. It's not clear to me how they arrived at their conclusion.

Sorry not well enough to give examples.

 

I don't understand using the terminology of "systematic review" when most of the studies are excluded. This is anything but systematic, there have been far more than 17 trials, even since 2011, obviously none of which are controlled and most of them are poorly randomized, suffer from huge selection effects.

At least it's grounded in reality, but it's still overall a very poor way of doing anything. Pretty much all 'systematic' reviews have the exact same flaws. They conclude differently based on choices they make, on their biases and usually on starting from a conclusion. Obviously the quality of pragmatic rehabilitation studies and trials is awful and it takes a huge amount of bias and suspension of disbelief to see otherwise, but even when they get basic things right it's still very low quality overall.

Pretty much the only way to get things minimally right is like this here, and what NICE and IQWIG did, is to recognize that the quality of this type of academic brain rot is garbage and not only can nothing be concluded from them, they should be stopped entirely. But some institutions, like IQWIG, still see fit to make recommendations anyway. Just a giant FUBAR mess.

 

One exclusion was "It is not a physiotherapy treatment (n=264)"

 

So PACE (White et al, 2011) having been published in The Lancet, with an impact factor of 79.3, but PACE debunking (Wilshire et al, 2018) in BMC Psychology, with an impact factor of 1.2, presumably led to the statement —