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AHRQ Evidence Review Changes Its Conclusions

Denise

Senior Member
Messages
1,095
"Mary Dimmock has led the way on this issue, and is co-author of this post.

In response to requests by U.S. patient organizations and advocates, the U.S. Agency for Healthcare Research and Quality (AHRQ) has issued an Addendum to its 2014 ME/CFS evidence review. This Addendum downgrades the conclusions on the effectiveness of cognitive behavioral therapy (CBT) and graded exercise therapy (GET), and this has tremendous implications for medical education and treatment recommendations."

The full post is available on Occupy M.E. (had you noticed the name change?)
 

halcyon

Senior Member
Messages
2,482
Asking as a non-American, does the AHRQ have a lot of input into policy change? Thanks.
I don't know a lot about them, but they are an operating division of the DHHS and their stated purpose is:

The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.
 

Solstice

Senior Member
Messages
641
I'm making a summary of important ME/CFS news on a couple of dutch news forums I frequent. This is gonna be in it, the decision about PACE, the work the groups around Davis and Lipkin are doing and I would like to add something about the IOM confirming this is a biomedical disease. I need some help with the latter though, is there an easy to comprehend article somewhere I can use for that?
 

Dolphin

Senior Member
Messages
17,567
The Oxford (Sharpe, 1991) case definition is the least specific of the definitions and less generalizable to the broader population of patients with ME/CFS. It could identify individuals who have had 6 months of unexplained fatigue with physical and mental impairment, but no other specific features of ME/CFS such as post-exertional malaise which is considered by many to be a hallmark symptom of the disease.3 As a result, using the Oxford case definition results in a high risk of including patients who may have an alternate fatiguing illness or whose illness resolves spontaneously with time.
 

Dolphin

Senior Member
Messages
17,567
As I said previously:
Note the Work and Social Adjustment Scale (WSAS) was used to measure employment measures. Some people pointed out in the comments on the draft that this was not a good measure esp. when actual employment measures were used, but they ignored this:


Here are the questions on the WSAS:

Please read each of the following questions and tick the appropriate box to indicate

No impairment Severe impairment
0 1 2 3 4 5 6 7 8

Because of my CFS/ME, my ability to work is Impaired.

Because of my CFS/ME, my social leisure activities (with other people, such as parties, bars, clubs, outings. visits, dating, home entertainment) are impaired.

Because of my CFS/ME, my home management (cleaning, tidying, shopping, cooking, looking after home or children,
paying bills) is impaired.

Because of my CFS/ME, my private leisure activities (done alone, such as reading, gardening. collecting, sewing, walking alone) are impaired.

Because of my CFS/ME, my ability to form and maintain close relationshipswith others, including those I live with, is impaired.
 

Dolphin

Senior Member
Messages
17,567
Conclusions

Although future studies should refrain from using the Oxford (Sharpe, 1991) case definition as eligibility requirements, this early work provided a foundation on which future work can expand. This addendum has delineated differences in treatment effectiveness and harms according to case definitions, highlighting studies that used the Oxford (Sharpe, 1991) case definition and how these studies impacted our conclusions. Additionally, results of studies evaluating CBT have been considered independently from other counseling and behavioral therapies. Our sensitivity analysis would result in a downgrading of our strength of evidence on several outcomes which can be attributed to the decrease in power, dominance of one large trial, or lack of trials using criteria other than the Oxford (Sharpe, 1991) case definition for inclusion. Blatantly missing from this body of literature are trials evaluating effectiveness of interventions in the treatment of individuals meeting case definitions for ME or ME/CFS.
 

medfeb

Senior Member
Messages
491
Thanks for posting, Mary. Zaher does a really nice job of connecting dots on how this and recent PACE events will require a response from HHS agencies. They can't as he says ignore an evidence review of one of their own agencies. To date, we have not seen a official change in position so it we will need to keep up the pressure.

Regarding the AHRQ Addendum - that addendum is only posted on the AHRQ website and its existence is noted as a short note at the end of the Evidence Review Executive Summary and also as a comment by Lily Chu on the Annals article publishing the original review. Neither of these are sufficient as the majority of readers will not see them. I have requested that the addendum conclusions be positioned at the beginning of the evidence review and also be included directly in the Annals article, not just in the comments. Waiting to hear what they say.
 
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