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Cognitive remediation training improves performance in patients with chronic fatigue syndrome

Kati

Kati

Patient in training
Messages
5,497
(FWIW)

Cognitive remediation training improves performance in patients with chronic fatigue syndrome

McBride RL1, Horsfield S1, Sandler CX1, Cassar J1, Casson S1, Cvejic E2, Vollmer-Conna U3, Lloyd AR4.
Author information
1-UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
2-School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; University of Sydney, School of Public Health, Camperdown, NSW 2006, Australia. Electronic address: erin.cvejic@sydney.edu.au.
3-School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia.4-UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia; Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: a.lloyd@unsw.edu.au.

Link to abstract
Full text available on sci-hub.io


Abstract
Neurocognitive disturbance with subjectively-impaired concentration and memory is a common, disabling symptom reported by patients with chronic fatigue syndrome (CFS).

We recently reported preliminary evidence for benefits of cognitive remediation as part of an integrated cognitive-behavioral therapy (CBT)/ graded exercise therapy (GET) program.

Here, we describe a contemporaneous, case-control trial evaluating the effectiveness of an online cognitive remediation training program (cognitive exercise therapy; CET) in addition to CBT/GET (n=36), compared to CBT/GET alone (n=36).

The study was conducted in an academic, tertiary referral outpatient setting over 12 weeks (11 visits) with structured, home-based activities between visits.

Participants self-reported standardized measures of symptom severity and functional status before and after the intervention.

Those in the CET arm also completed standardized neurocognitive assessment before, and following, treatment.

The addition of formal CET led to significantly greater improvements in self-reported neurocognitive symptoms compared to CBT/GET alone.

Subjective improvement was predicted by CET group and lower baseline mood disturbance.
In the CET group, significant improvements in objectively-measured executive function, processing speed, and working memory were observed.

These subjective and objective performance improvements suggest that a computerized, home-based cognitive training program may be an effective intervention for patients with CFS, warranting randomized controlled trials
 
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Snowdrop

Snowdrop

Rebel without a biscuit
Messages
2,933
<sigh> they really haven't a clue. I doubt that there is actually any real lasting benefit.

Kati said:
significant improvements in objectively-measured executive function, processing speed, and working memory were observed.
Click to expand...

Colour me sceptical. Or at least I expect that none of the people involved were pushed to their personal PEM threshold for cognitive fatigue. I'm fine at my personal baseline doing cognitive tasks it takes a while to get to a point of fatigue (and it also varies depending on a host of other factors).
 
C

concepcion

Senior Member
Messages
118
There doesn't seem to be a way to comment on this article, which is probably then norm for academic journals. How do you suggest we let it be known to the authors and journal that any kind of ME "exercise" study, whether it be cognitive or physical, needs to use a definition which excludes patients who do not have post exertional malaise? These are exactly the kinds of publications which diligent doctors are reading.
 
R

RogerBlack

Senior Member
Messages
902
Snowdrop said:
Colour me sceptical. Or at least I expect that none of the people involved were pushed to their personal PEM threshold for cognitive fatigue. I'm fine at my personal baseline doing cognitive tasks it takes a while to get to a point of fatigue (and it also varies depending on a host of other factors).
Click to expand...

Pushing harder with cognitive tasks also fatigues me much faster, and though I can attain higher performance in spurts, both risks PEM and a prompt crash.
 
Art Vandelay

Art Vandelay

Senior Member
Messages
470
Location
Australia
Kati said:
(FWIW)

Cognitive remediation training improves performance in patients with chronic fatigue syndrome

McBride RL1, Horsfield S1, Sandler CX1, Cassar J1, Casson S1, Cvejic E2, Vollmer-Conna U3, Lloyd AR4.
Click to expand...

It's more dubious nonsense from Andrew Lloyd, who just happens to run a clinic which offers -- surprise surprise -- GET and CBT.
 
V

Valentijn

Senior Member
Messages
15,786
They say that CFS is "characterized by persistent fatigue and reduced capacity to sustain effortful physical and mental activity", but then recruit with Fukuda and use no such requirement. They also excluded people who didn't report enough cognitive problems, and people not comfortable with computers.

They claim that there's evidence that CBT and GET are "the only therapeutic interventions with consistent evidence for overall symptom reduction and improvement in functional status in patients with CFS", so presumably are a bit too daft to understand the research that they read. They also claim to have successfully conducted similar research in the past, so have some experience in spinning results and pretending anyone gives a fuck about subjective outcomes.

CBT/GET patients were vaguely encouraged to exercise cognitively (reading, etc), while the CET group did a program involving structured cognitive games on the computer.

Patients were offered CBT and GET before being selected for CET. So people who found those therapies useless or harmful would have already been long gone. The researchers assessing outcomes weren't blinded, and the CBT/GET included pacing in addition to the usual BS. They also included CBT for mood disorders on a personalized basis, which makes it impossible to determine which (subjective) effects are due to which particular therapy.

A quarter of all participants were students, which seems a bit odd. They make a bunch of comparisons, but don't seem to correct for the increased chance of getting a false positive. They only included the physical and social functioning subscales of the SF-36, which is really weird for a trial of a cognitive therapy.

The only significant result is a post-hoc one on a subjective scale. They also report that CET patients improved significantly on neuropsychological performance testing (which is pretty objective) but didn't test the control group (or didn't report control group results). So those results are pretty meaningless, since they can't be compared with a control group.

So we have yet another waste of time and funding. ME wasn't defined appropriately, patients were deliberately selected instead of randomly, there was no blinding, primarily subjective outcomes were used, and post-hoc torturing of the data was needed to report a positive result. Hopefully their funder (the Mason Foundation) will wise up and cut them off, so the money can go to advance science instead of a bunch of idiots playing researcher.
 
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R

RogerBlack

Senior Member
Messages
902
Valentijn said:
They also claim to have successfully conducted similar research in the past, so have some experience in spinning results and pretending anyone gives a fuck about subjective outcomes.
Click to expand...

Published or unpublished? Unpublished has obvious further issues.
 
N

NelliePledge

Senior Member
Messages
807
So its not just the UK and Netherlands that churn out this BPS claptrap well done Aussie you've got your own claptrap too
 
Art Vandelay

Art Vandelay

Senior Member
Messages
470
Location
Australia
NelliePledge said:
So its not just the UK and Netherlands that churn out this BPS claptrap well done Aussie you've got your own claptrap too
Click to expand...

According to some scuttlebutt in local ME/CFS groups, Peter White visited Australia a number of times and helped Lloyd and others from this Sydney BPS clinic lobby the previous government for increased funding.

While they may not be competent as doctors or researchers, they certainly are good at lobbying for taxpayers' money.
 
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