Sly Saint
Senior Member (Voting Rights)
this is the 2007 updated report:
https://www.york.ac.uk/media/crd/crdreport35.pdf
"DISCUSSION
Methodological quality of included studies
There are now a considerable number of studies evaluating interventions for the treatment and
management of CFS/ME and many of them have used robust research methods; the majority of the
included studies were RCTs and many of these were of high methodological quality (Table 8).
However, RCTs generally scored poorly for concealment of treatment allocation and many failed to
use an intention-to-treat analysis. These issues should be addressed in designing future clinical trials of interventions for CFS/ME."
"Interventions
Although we have discussed all the studies evaluating a particular intervention together, the treatment offered to patients receiving a particular type of therapy in practice may vary considerably, particularly for behavioural interventions. For example, in the CBT study by Stulemeijer et al.93, participants in the intervention group received ten individual therapy sessions over 5 months in a hospital child psychology department, whereas in the study by Whitehead et al.95 the intervention was a form of ‘brief CBT’ delivered by general practitioners. Further standardisation of methods for delivering behavioural interventions in research and practice would be desirable."
"
Participants in included studies and diagnostic criteria
The studies included in our review also show a lack of uniformity in terms of case definitions for
CFS/ME, study inclusion and exclusion criteria and the basic information provided about the
participants. For example, baseline functional status and duration of illness are not always reported.
This makes it difficult to assess the generalisability of the findings of many of these studies."
Withdrawals and drop-outs
Some studies of behavioural interventions have reported significant rates of withdrawal from
treatment or loss to follow-up, as high as 20–40% in some studies9596. This update did not find any
new evidence of adverse effects (sufficient to cause withdrawal from treatment) associated with GET
or CBT. However, reasons for withdrawals were often poorly reported and should be investigated in
more detail in future studies. The new studies included in the update confirmed previous reports of
withdrawals because of adverse events associated with immunological/antiviral and pharmacological
interventions.
Patients with severe CFS/ME
There remains a lack of studies evaluating the effectiveness of interventions for patients severely
affected by CFS/ME. The protocols for many clinical studies require patients to attend a clinic for
treatment and/or assessment. These conditions may exclude people severely affected with CFS/ME
from taking part. The balance between effectiveness and adverse effects of interventions may be
different in more severely affected compared with less severely affected patients and methods of
delivery/doses may need to be different. Research to evaluate the effectiveness of interventions for
severely affected patients should be considered a priority."
CONCLUSIONS
A total of 70 trials investigated the effectiveness of seven different categories of intervention:
behavioural, immunological, antiviral, pharmacological, supplements, complementary/
alternative and other.
• Overall the interventions demonstrated mixed results in terms of effectiveness. All
conclusions about effectiveness should be considered together with the methodological
inadequacies in some of the studies.
• Interventions which have shown evidence of effectiveness include CBT and GET.
• There is insufficient evidence about how sub-groups of patients may respond differently to
treatments and further studies investigating additional subgroups are needed.
• In some of the included studies bed or wheelchair restricted patients and children have been
excluded, which raises questions about the applicability of findings to all people with CFS/ME.
• CBT and immunoglobulin G are the only interventions which have been investigated in young
people.
• There is insufficient evidence for additive or combined effects of interventions where more
than one therapy is used.
• Future research could usefully compare CBT and GET and there is a need to evaluate the
effectiveness of pacing, ideally in comparison to CBT and GET."
Don't know how this conclusion came about!!!!
"
• Future research needs to combine scientific rigour with patient acceptability.
• The large number of outcome measures used makes standardisation of outcomes a priority
for future research."
Having read their 'analyses' of the studies they selected for inclusion how they came up with their conclusions is baffling, but then I'm no 'expert'.
eta:
find this very confusing:
"
The remaining three RCTs reported a beneficial effect of CBT when compared to controls.22, 25, 26
All three RCTs found a significant short term improvement in physical functioning, fatigue, and global improvement, but neither of the two studies that assessed depression found any differences between groups.22, 25
One of these RCTs also followed patients for five years after the intervention.
At the five year follow-up assessment global improvement was greater in the intervention group, as was the proportion of participants who completely recovered,23
however, no differences were reported between the groups in terms of physical functioning, fatigue, general health, symptoms, relapses or
the proportion of participants that no longer met the UK criteria for CFS."
What does this mean?
eta2: this is also an interesting document as it shows how they assessed/scored the research papers that were under consideration. Although, how the GDG finally came to the conclusion it did based on this evidence is another question.
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