Chronic Fatigue Service brochure/King's College

[Simon]

Tom Kindlon commented on this brochure from SLaM (South London & Maudsley) NHS Trust Chronic Fatigue Service, which provides CBT & GET overseen by King's College, featuring Trudie Chalder and Simon Wessely.

Thought I'd give it its own threadwith some quotes and comments to kick things off.

Recovery

Treatment is effective, with around 65% of people improving with either CBT or GET, and around 25% of people making a full recovery.

That sounds very impressive, especially the 25% recovery rate. However, it's not clear that this applies to CFS patients, since the Service also accepts referrals for patients with "Medically Unexplained Symptoms" and fatigue associated with illnesses like HIV and MS.

Other claims re effectiveness (these seem a little less amibitious to me)

CBT is an "effective" [my quotes] treatment for people with mild to moderate CFS and ME, and for those with medically unexplained symptoms.

... [GET] has been found to improve functioning, decrease disability and symptoms through carefully monitored, graded increases in physical activity and exercise.

... Expected outcomes may include:
›› Resuming daily activities

"For people whose symptoms interfere with their quality of life*, there is a real possibility of change" - Professor Trudie Chalder

[* huh? presumably patients wouldn't be at a fatigue clinic otherwise]

Misc stuff about treatments

Graded exercise therapy seems less amibitous than PACE trial

GET is regular physical activity or exercise, starting at a baseline level and gradually increasing until people’s goals are achieved. The duration of exercise is gradually increased to 30 minutes, and then the intensity is increased over time, aiming for a heart rate of 60-75 per cent.

A 60% heart rate as a goal over time is pretty modest and would probably equate to only moderate exercise for a healthy 40-year-old.

Expected outcomes may include:
›› Resuming daily activities
›› Establishing a sleep routine
›› Addressing associated anxiety or depression
›› Challenging problematic beliefs which interfere with progress, which may relate to the rehabilitation programme, perfectionism or low self-esteem
›› Making lifestyle changes which may help to prevent relapse at a later date

Ongoing Research
›› A pilot study evaluating the treatment of severely affected house-bound adolescents with CFS
personally, I think any research that recognises the existence and needs of the severely affected is a good thing. (The FINE trial found it's 'rehabilitative therapy' didn't help such people.)

Prospective studies examining:
›› a psycho-physiological model of CFS in adolescents
›› predictors and moderators of outcomes after a course of CBT for patients with CFS

Plus prospective studies examining the role of cognitive and behavioural factors in the development and perpetuation of fatigue in people with:
›› breast cancer
›› rheumatoid arthritis

 

[alex3619]

The natural recovery rate of adolescents with post viral fatigue is at least 96%. If these patients recover normally, what controls did they use to validate their claims? Dare I say: none? I hope I am wrong. In any case with this kind of therapy there are no blinded patients/controls, which substantially increases the risk of biased outcomes.

http://www.cfids-cab.org/rc/Katz.pdf

Could doing nothing be more effective than therapy? The only confounding factor is that their proposed study is on severe patients. That is known to increase the risk of more serious complications, based on the Dubbo study. Also if these are long term patients, then they might have genuine ME (or not) we just need to see how they were defined and subgrouped. My guess is they didn't bother with subgrouping. Again I hope I am wrong.

 

[Simon]

The natural recovery rate of adolescents with post viral fatigue is at least 96%. If these patients recover normally, what controls did they use to validate their claims? Dare I say: none? I hope I am wrong. In any case with this kind of therapy there are no blinded patients/controls, which substantially increases the risk of biased outcomes.

Yes, it's hard to judge the success without controls, particularly with such a mixed bag of patients - and as you say, there is a very high recovery rate from glandular fever.

Guesstimating

• Nb The 96% figure you mention is at 24 months, based on all initial infections: assuming no one gets referred until they have been sick for 6 months, the naturalrecovery rate for these referrals would be about 75%.
• If 10% of all referrals to the clinic were these adolescents with CFS @ 6 months, that would give a net 7.5% recovery rate, compared with the reported recovery rate of 25%.
• Or put another way, the recovery rate for the remaining 90% of cases (ie those without adolescent glandular fever) would still be 19%. Just playing with numbers here.