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"CBT & exercise in Chronic Fatigue Syndrome have no evidence" (Translation of Swedish pretty good)

Dolphin

Senior Member
Messages
17,567
https://translate.google.ie/transla...d-kronisk-trotthet-saknar-evident/&edit-text=

Alternative link: http://www.twitlonger.com/show/n_1snca05
Twitter link: https://twitter.com/TomKindlon/status/638397479181021184

(Some automated translations are not that good but this one seems pretty good)

CBT and exercise in chronic fatigue syndrome have no evidence

Lack of objective outcome parameters that the utility of CBT and gradually increasing exercise in chronic fatigue syndrome must be questioned. Furthermore, the risk of deterioration after training considered in treatment recommendations, writes Stone Helmfrid and Johan Edsberg.

Authors:
Stone Helmfrid, Associate Professor of Physics
sten.helmfrid@bredband.net
Johan Edsberg
a specialist in internal medicine, medical clinic Mälarsjukhuset, Eskilstuna

The past 20 years it has published a number of studies of cognitive behavioral therapy (CBT) and gradually increasing exercise in chronic fatigue syndrome (ME / CFS) [1-3]. The results of the studies vary. Cochrane analysis suggests a cautiously positive trend [4, 5], but the evaluation has apart from the studies almost totally relies on subjective outcome parameters. This has led to that the benefit of treatment methods have been overstated and the risks ignored.

The treatment model is based on a biopsychosocial approach launched by British psychiatrist in the late 1980s. [6] They claimed that ME / CFS is perpetuated by cognitive processes (fear of deterioration after activity) and behavioral responses (avoidance of activity) [7]. Symptoms are caused by this model of cognitive attitudes and reduced fitness, and disease can thus be cured with CBT and gradually increasing exercise.

The biopsychosocial theory has been received with great skepticism by biomedical researchers and patient organizations [8, 9]. The assumption of an activity phobia are misaligned with our knowledge of the disease. When patients overexert themselves trigger is often a deterioration and then a period of reduced activity capacity ("push-crash cycle«) [10]. If lack of condition would cause symptoms ought to ME / CFS-like symptoms occur in individuals who are inactive for other reasons, such as people who are in plaster for a long time or prisoners in isolation.

Criticism has also been extensive studies on the treatment of CBT and gradually increasing exercise. It has addressed, inter alia selection criteria. The British psychiatrists created its own criteria for the disease that only require a prolonged severe fatigue that occurred at a time [11]. The patient group chronically tired covers about 10 percent of the population [12] and include many different diseases. It is unlikely that the results for a broader defined group is also representative of a narrowly defined group of patients with neurological and immunological symptoms. A study of chronic fatigue individuals in the UK primary care [13] shows that a strong predictor of poor outcome with CBT and gradually increase the training is that the patient meets the CDC (Centers for Disease Control and Prevention) criteria for ME / CFS [14] .

A more fundamental problem with the studies of CBT and gradually increased training in ME / CFS is that they almost completely relies on subjective self-reports. In clinical trials of drugs are always compared the treatment results of a blinded randomized reference group that received placebo. This is not possible at the psychological intervention, but there are opportunities for objective evaluation. The patients' activity levels could be measured with a aktometer, a device the size of a wristwatch attached to the ankle or wrist.

The few objective evaluations that have been made have generally contradicted subjective signs of improvement. A Dutch group went through data from aktometrar in three studies of CBT. Although the patients themselves reported a decrease in fatigue did not increase the measured level of activity [15]. In another study of CBT in which the subjective cognitive impairment declined were the neuropsychological test results before and after the study remain unchanged [16].

In the British PACE study was one six minute walking test to compare the different treatments. All groups showed a small improvement, but the group that underwent progressive exercise improved a bit more than the others [1]. The results of the fitness tests that were also made, however, was unchanged [17], suggesting that the improvement was due to the change in attitude rather than enhanced exercise capacity [18].

It has consistently been difficult to demonstrate results of practical importance for patients treated with CBT and gradually increasing exercise. A follow up of the PACE show that the treatment does not lead to any significant reduction in either the number of sick days or paid out in sickness compensation [19]. The same picture emerged from an examination of the four Belgian specialist centers. The patients' physical abilities after 6-12 months of treatment were unchanged, and working hours decreased [20]. In two independent surveys of patient associations in which different treatments evaluated were the percentage of positive responses for CBT and gradually increase workout lower than for homeopathy (ie in practice placebo) [21, 22].

Gradually increase the training means that patients increases the activity level according to a predetermined plan. The treatment has been criticized because exertion may trigger a period of deterioration. Independent studies have shown that ME / CFS patients have poorer performance on day two at maximal exercise stress test of oxygen uptake that are repeated every 24 hours [23-25]. It has also demonstrated the immunological changes [26] and cognitive impairment [27] after the effort. Data from ten independent patient surveys in four countries shows that 52 percent felt worse and 33 percent much worse by the progressive exercise [21, 22, 28]. Studies have reported a lower proportion than the surveys impaired patients, but on the other hand not have control over how the protocols followed. Comparison with aktometrar shows that self-reports of activity levels are unreliable [29] and that patients have difficulty following a progressive exercise program [30, 31].

Competing interests: The authors work for voluntary patient association RME.

REFERENCES
1. White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behavior therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomized trial. Lancet. 2011; 377: 823-36.
2. Wearden AJ Dowrick C, Chew-Graham C., et al. Fatigue intervention by the Nurses Evaluation (FINE) trial writing group and the fine trial group. Nurse ranks, homebased self help treatment for the patient in primary care with chronic fatigue syndrome; randomized controlled trial. BMJ. 2010; 340: c1777.
3. Nunez M, Fernandez-Solà J, Nunez E, et al. Health-related quality of life in patient with chronic fatigue syndrome: group cognitive behavioral therapy and graded exercise versus usual treatment. A randomized controlled trial with 1 year of follow-up. Clin Rheumatol. 2011; 30: 381-9.
4. Price JR, Mitchell E, Tidy E, et al. Cognitive behavior therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008: (3): CD001027.
5. Larun L, Brurberg KG, Odgaard-Jensen J, et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2015; (2): CD003200.
6. David AS, Wessely S, Pelosi AJ. Post Viral Fatigue Syndrome: Time for a new approach. Br Med J (Clin Res Ed). 1988; 296: 696-9.
7. Sharpe M, Hawton K, Simkin S, et al. Cognitive behavior therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996; 312: 22-6.
8. Chronic fatigue syndrome / myalgic encephalomyelitis. Primer for clinical practitioners. 2014 Edition. Chicago International Association for Chronic Fatigue Syndrome / Myalgic Encephalomyelitis; 2014.
9. ME Association. ME Association position on graded exercise therapy (GET).Http://www.meassociation.org.uk/2008/05/mea-position-on-graded-exercise-therapy-get/
10. Pemberton S, Cox, DL. Experiences of daily activity in chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME) and Their Implications for Rehabilitation Programmes. Disabil Rehabil. 2014; 36: 1790-7.
11. Sharpe MC, Archard LC Banatvala JE, et al. A report - Chronic Fatigue Syndrome: Guidelines for research. JR Soc Med. 1991; 84: 118-21.
12. Son CG. Review of the prevalence of chronic fatigue worldwide. J Korean Oriental Med. 2012; 33: 25-33.
13. Darbishire L, Seed P Ridsdale L. Predictors of outcome Following treatment for chronic fatigue. Br J Psychiatry. 2005; 186: 350-1.
14. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994; 121: 953-9.
15. Wiborg JF, Knoop H Stulemeijer M, et al. How does cognitive behavior therapy Reduce fatigue in patient with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010; 40: 1281-7.
16. Knoop H, Prins JB, Stulemeijer M, et al. The effect of cognitive behavior therapy for chronic fatigue syndrome on self-reported cognitive Impairments and neuropsychological test performance. J Neurol Neurosurg Psychiatry. 2007; 78: 434-6.
17. Chalder T, Goldsmith KA, White PD, et al. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. Lancet Psychiatry. 2015; 2: 141-52.
18. Knoop H, Wiborg JF. What makes a difference in chronic fatigue syndrome? Lancet Psychiatry. 2015; 2: 113-4.
19. McCrone P, Sharpe M, Chalder T, et al. Adaptive pacing, cognitive behavior therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis. PLoS ONE. 2012; 7: e40808.
20. STORDEUR S, N Thiry, M. Eyssen Chronisch vermoeidheidssyndroom: diagnose, behandeling a zorgorganisatie. KCE reports 88A. Brussels: Federaal Kenniscentrum voor de Gezondheidszorg; In 2008.
21. ME Association. Managing my ME what people with ME / CFS and Their carers want from the UK's Health and Social Services. 2010. http://www.meassociation.org.uk/wp-content/uploads/2010/09/2010-survey-report-lo-res10.pdf
22. Bringsli GJ, Gilje A, Getz Wold BK. ME-fore Association brukerundersøkelse, ME syke NORWAY - Continued bortgjemt? Oslo: Norwegian Myalgic Encephalopathy-compound; In 2013.
23. Snell CR, Stevens SR, Davenport TE, et al. Discriminative validity of metabolic and workload measurements for Identifying people with chronic fatigue syndrome. Phys Ther. 2013; 93: 1484-92.
24. Keller BA, Pryor JL, Giloteaux L. inability of myalgic encephalomyelitis / chronic fatigue syndrome patient to reproduce VO2peak indicates functional impairment. J Transl Med. 2014; 12: 104.
25. Vermeulen RCW, Kurk RM, Visser FC, et al. Patients with chronic fatigue syndrome Performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity. J Transl Med. 2014; 8: '93.
26. Nijs J, Nees A, Paul L, et al. Altered immune response to exercise in patient with chronic fatigue syndrome / myalgic encephalomyelitis: a systematic literature review. Exerc Immunol Rev. 2014; 20: 94-116.
27. Meyer, JD, Light AR, SK Shukla, et al. Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression. Fatigue. 2013. 1: 190-209.
28. Kindlon T. Reporting of Harms Associated with graded exercise therapy and cognitive behavioral therapy in myalgic encephalomyelitis / chronic fatigue syndrome. Bull IACFS ME. 2011; 19: 59-111.
29. Friedberg F, Sohl S. Cognitive-behavior therapy in chronic fatigue syndrome: Ice improvement related to Increased physical activity? J Clin Psychol. 2009; 65: 423-42.
30. Black CD, McKully KK. Time Course of exercise induced alterations in the Daily activity in chronic fatigue syndrome. With Dyn. 2005; 4: 10th
31. Friedberg F. Doe graded Activity Increase activity? A case study of chronic fatigue syndrome. J Behav Ther Exp Psychiatry. 2002; 33: 203-15.
 

Dolphin

Senior Member
Messages
17,567
Original in Swedish:
http://lakartidningen.se/Opinion/Debatt/2015/06/KBT-och-traning-vid-kronisk-trotthet-saknar-evident/


KBT och träning vid kroniskt trötthetssyndrom saknar evidens

Brist på objektiva utfallsparametrar gör att nyttan av KBT och gradvis ökad träning vid kroniskt trötthetssyndrom måste ifrågasättas. Dessutom måste risken för försämring efter träning beaktas vid behandlingsrekommendationer, skriver Sten Helmfrid och Johan Edsberg.




Sten Helmfriddocent i fysik
sten.helmfrid@bredband.net





Johan Edsbergspecialist internmedicin, medicinkliniken Mälarsjukhuset, Eskilstuna


De senaste 20 åren har det publicerats en lång rad studier av kognitiv beteendeterapi (KBT) och gradvis ökad träning vid kroniskt trötthetssyndrom (ME/CFS) [1–3]. Resultaten i studierna varierar. Cochraneanalyser antyder försiktigt en positiv trend [4, 5] men i utvärderingen har man bortsett från att studierna nästan helt förlitar sig på subjektiva utfallsparametrar. Detta har lett till att nyttan av behandlingsmetoderna har övervärderats och riskerna nonchalerats.

Behandlingsmodellen bygger på en biopsykosocial syn som lanserades av brittiska psykiater i slutet av 1980-talet [6]. De hävdade att ME/CFS vidmakthålls av kognitiva processer (rädsla för försämring efter aktivitet) och beteendemässiga responser (undvikande av aktivitet) [7]. Symtomen orsakas enligt denna modell av kognitiva attityder och nedsatt kondition, och sjukdomen kan därmed botas med KBT och gradvis ökad träning.

Den biopsykosociala teoribildningen har mottagits med stor skepsis av biomedicinska forskare och patientorganisationer [8, 9]. Antagandet om en aktivitetsfobi stämmer dåligt med vår kunskap om sjukdomen. När patienter överanstränger sig utlöser det ofta en försämring och därefter en period med lägre aktivitetsförmåga (»push–crash-cykel«) [10]. Om bristande kondition skulle förorsaka symtom borde ME/CFS-liknande symtom förekomma hos individer som är inaktiva av andra skäl, till exempel personer som är gipsade under lång tid eller fångar i isolering.

Kritiken har också varit omfattande mot behandlingsstudierna av KBT och gradvis ökad träning. Den har bland annat gällt urvalskriterierna. De brittiska psykiaterna skapade egna kriterier för sjukdomen som bara kräver en långvarig svårartad trötthet som uppkommit vid ett tillfälle [11]. Patientgruppen kroniskt trötta omfattar cirka 10 procent av befolkningen [12] och inkluderar många olika sjukdomstillstånd. Det är inte troligt att resultaten för en bredare definierad grupp också är representativa för en snävt definierad grupp patienter med neurologiska och immunologiska symtom. En studie av kroniskt trötta individer i den brittiska primärvården [13] visar att en stark prediktor för dåligt behandlingsresultat med KBT och gradvis ökad träning är att patienten uppfyller CDC:s (Centres for Disease Control and Prevention) kriterier för ME/CFS [14].

Ett mer grundläggande problem med studierna av KBT och gradvis ökad träning vid ME/CFS är att de nästan helt förlitar sig på subjektiva självrapporter. I kliniska studier av läkemedel jämförs alltid behandlingsresultaten med en blindad randomiserad referensgrupp som fått placebo. Detta är inte möjligt vid psykologisk intervention, men det finns möjligheter till objektiv utvärdering. Patienternas aktivitetsnivå kan till exempel mätas med en aktometer, en apparat stor som ett armbandsur som fästs på vristen eller handleden.

De få objektiva utvärderingar som har gjorts har i regel motsagt subjektiva tecken på förbättring. En holländsk grupp gick igenom data från aktometrar i tre studier av KBT. Trots att patienterna själva rapporterat en minskad trötthet ökade inte den uppmätta aktivitetsnivån [15]. I en annan studie av KBT där den subjektiva kognitiva funktionsnedsättningen minskade var de neuropsykologiska testresultaten före och efter studien oförändrade [16].

I den brittiska PACE-studien gjordes ett sex minuters gångtest för att jämföra olika behandlingar. Alla grupper uppvisade en liten förbättring, men gruppen som genomgått gradvis ökad träning förbättrade sig lite mer än de andra [1]. Resultatet i det konditionstest som också gjordes var dock oförändrat [17], vilket tyder på att förbättringen berodde på ändrad attityd snarare än ökad fysisk kapacitet [18].

Det har genomgående varit svårt att påvisa resultat av praktisk betydelse för patienter som behandlats med KBT och gradvis ökad träning. En uppföljning av PACE visar att behandlingen inte medförde någon signifikant minskning vare sig i antalet sjukdagar eller i utbetalad sjukersättning [19]. Samma bild framträdde vid en granskning av fyra belgiska specialistcentra. Patienternas fysiska förmåga efter 6–12 månaders behandling var oförändrad, och arbetstiden minskade [20]. I två oberoende enkäter från patientföreningar där olika behandlingsmetoder utvärderats var andelen positiva svar för KBT och gradvis ökad träning lägre än för homeopati (det vill säga i praktiken placebo) [21, 22].

Gradvis ökad träning innebär att patienterna höjer aktivitetsnivån enligt en förutbestämd plan. Behandlingen har kritiserats eftersom ansträngning kan utlösa en period av försämring. Oberoende studier har visat att ME/CFS-patienter får sämre resultat dag två vid maxtest av syreupptaget som upprepas med 24 timmars mellanrum [23–25]. Man har också påvisat immunologiska förändringar [26] och nedsatt kognitiv förmåga [27] efter ansträngning. Data från tio oberoende patientenkäter i fyra länder visar att 52 procent mådde sämre och 33 procent mycket sämre av gradvis ökad träning [21, 22, 28]. Studier har rapporterat en lägre andel försämrade patienter än enkäterna, men man har å andra sidan inte haft kontroll över hur protokollen följts. Jämförelse med aktometrar visar att självrapporter av aktivitetsnivån är otillförlitliga [29] och att patienterna har svårt att följa ett gradvis ökande träningsprogram [30, 31].

Potentiella bindningar eller jävsförhållanden: Författarna arbetar ideellt för patientföreningen RME.

REFERENSER

1. White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behavior therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomized trial. Lancet. 2011; 377: 823-36.
2. Wearden AJ Dowrick C, Chew-Graham C., et al. Fatigue intervention by the Nurses Evaluation (FINE) trial writing group and the fine trial group. Nurse ranks, homebased self help treatment for the patient in primary care with chronic fatigue syndrome; randomized controlled trial. BMJ. 2010; 340: c1777.
3. Nunez M, Fernandez-Solà J, Nunez E, et al. Health-related quality of life in patient with chronic fatigue syndrome: group cognitive behavioral therapy and graded exercise versus usual treatment. A randomized controlled trial with 1 year of follow-up. Clin Rheumatol. 2011; 30: 381-9.
4. Price JR, Mitchell E, Tidy E, et al. Cognitive behavior therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008: (3): CD001027.
5. Larun L, Brurberg KG, Odgaard-Jensen J, et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2015; (2): CD003200.
6. David AS, Wessely S, Pelosi AJ. Post Viral Fatigue Syndrome: Time for a new approach. Br Med J (Clin Res Ed). 1988; 296: 696-9.
7. Sharpe M, Hawton K, Simkin S, et al. Cognitive behavior therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996; 312: 22-6.
8. Chronic fatigue syndrome / myalgic encephalomyelitis. Primer for clinical practitioners. 2014 Edition. Chicago International Association for Chronic Fatigue Syndrome / Myalgic Encephalomyelitis; 2014.
9. ME Association. ME Association position on graded exercise therapy (GET).Http://www.meassociation.org.uk/2008/05/mea-position-on-graded-exercise-therapy-get/
10. Pemberton S, Cox, DL. Experiences of daily activity in chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME) and Their Implications for Rehabilitation Programmes. Disabil Rehabil. 2014; 36: 1790-7.
11. Sharpe MC, Archard LC Banatvala JE, et al. A report - Chronic Fatigue Syndrome: Guidelines for research. JR Soc Med. 1991; 84: 118-21.
12. Son CG. Review of the prevalence of chronic fatigue worldwide. J Korean Oriental Med. 2012; 33: 25-33.
13. Darbishire L, Seed P Ridsdale L. Predictors of outcome Following treatment for chronic fatigue. Br J Psychiatry. 2005; 186: 350-1.
14. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994; 121: 953-9.
15. Wiborg JF, Knoop H Stulemeijer M, et al. How does cognitive behavior therapy Reduce fatigue in patient with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010; 40: 1281-7.
16. Knoop H, Prins JB, Stulemeijer M, et al. The effect of cognitive behavior therapy for chronic fatigue syndrome on self-reported cognitive Impairments and neuropsychological test performance. J Neurol Neurosurg Psychiatry. 2007; 78: 434-6.
17. Chalder T, Goldsmith KA, White PD, et al. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. Lancet Psychiatry. 2015; 2: 141-52.
18. Knoop H, Wiborg JF. What makes a difference in chronic fatigue syndrome? Lancet Psychiatry. 2015; 2: 113-4.
19. McCrone P, Sharpe M, Chalder T, et al. Adaptive pacing, cognitive behavior therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis. PLoS ONE. 2012; 7: e40808.
20. STORDEUR S, N Thiry, M. Eyssen Chronisch vermoeidheidssyndroom: diagnose, behandeling a zorgorganisatie. KCE reports 88A. Brussels: Federaal Kenniscentrum voor de Gezondheidszorg; In 2008.
21. ME Association. Managing my ME what people with ME / CFS and Their carers want from the UK's Health and Social Services. 2010. http://www.meassociation.org.uk/wp-content/uploads/2010/09/2010-survey-report-lo-res10.pdf
22. Bringsli GJ, Gilje A, Getz Wold BK. ME-fore Association brukerundersøkelse, ME syke NORWAY - Continued bortgjemt? Oslo: Norwegian Myalgic Encephalopathy-compound; In 2013.
23. Snell CR, Stevens SR, Davenport TE, et al. Discriminative validity of metabolic and workload measurements for Identifying people with chronic fatigue syndrome. Phys Ther. 2013; 93: 1484-92.
24. Keller BA, Pryor JL, Giloteaux L. inability of myalgic encephalomyelitis / chronic fatigue syndrome patient to reproduce VO2peak indicates functional impairment. J Transl Med. 2014; 12: 104.
25. Vermeulen RCW, Kurk RM, Visser FC, et al. Patients with chronic fatigue syndrome Performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity. J Transl Med. 2014; 8: '93.
26. Nijs J, Nees A, Paul L, et al. Altered immune response to exercise in patient with chronic fatigue syndrome / myalgic encephalomyelitis: a systematic literature review. Exerc Immunol Rev. 2014; 20: 94-116.
27. Meyer, JD, Light AR, SK Shukla, et al. Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression. Fatigue. 2013. 1: 190-209.
28. Kindlon T. Reporting of Harms Associated with graded exercise therapy and cognitive behavioral therapy in myalgic encephalomyelitis / chronic fatigue syndrome. Bull IACFS ME. 2011; 19: 59-111.
29. Friedberg F, Sohl S. Cognitive-behavior therapy in chronic fatigue syndrome: Ice improvement related to Increased physical activity? J Clin Psychol. 2009; 65: 423-42.
30. Black CD, McKully KK. Time Course of exercise induced alterations in the Daily activity in chronic fatigue syndrome. With Dyn. 2005; 4: 10th
31. Friedberg F. Doe graded Activity Increase activity? A case study of chronic fatigue syndrome. J Behav Ther Exp Psychiatry. 2002; 33: 203-15.
 
Messages
13,774
Some discussion with Mats Reimer underneath. He doesn't seem up to it, and the responses from the authors are better than is needed. Fun to read.

Eyed patient organization

2015-06-21 08:42 | authors debate the article until the patient association's well-known position, that all the results suggest that CBT and graded exercise can help are either unreliable, or based on patients who were not "real me." However, the compound is not critical to the much poorer documented treatments. Gottfries clinic that provides mega doses of B12 sitting in the association's scientific advice and on the association's website, lay out Kenny De Meirleirs own theories of ME (including on the false virus XMRV):

http://www.rme.nu/kenny-de-meirleir

It bears repeating that Cochrane and Norwegian equivalent of the SBU make a different assessment than the patient association.

http://www.cochrane.org/CD001027/DEPRESSN_cognitive-behaviour-therapy-for-chronic-fatigue-syndrome

http://www.cochrane.org/CD003200/DE...nt-for-patients-with-chronic-fatigue-syndrome

Mats Reimer, Pediatricians, Child and Youth Medicine Mölnlycke

Disqualification: Blogged critically ME for many years

Come with factual arguments, Mats Reimer

2015-06-21 13:51 | Johan Edsberg and I are members of RME and has declared it as a conflict of interest, but we only represent ourselves and express our own opinions. Mats Reimer criticizes the conclusions of the article without substantially addressing some of the problems with the studies that we have highlighted, such as the lack of objective data.

Nowhere have we stated that the patients in the studies were not "real me." However, it is widely believed that the so-called Oxford criteria which are often used in studies of CBT and gradually increased training in ME / CFS played out its role [1]. If I'm not mistaken, Mats Reimer also kept up with this on his blog.

Nowhere in the article, we have discussed treatment with B12. What does that have to do with anything? Mats Reimer then point to RME's website contains an out of date link on Kenny the Meirleir information is false XMRV track. RME can certainly be criticized for not updating their information and for highlighting a researcher who is controversial, but what does it have with the article in question to do?

It bears noting that the international research and läkarorganisationen IACFS / ME [2] and the independent expert's report on ME / CFS, which was presented last spring on behalf of several US government agencies [3] is also critical of the methodology in studies of CBT and gradually increased exercise. The criticism will thus not only from patient organizations.

On one of Mats Reimers blogs about ME / CFS came PACE study for discussion in the comment fields. Several objections to the study were advanced, and Mats Reimer could not respond to them. He kept thinking that the results are dubious: "OK, then we in any case agree that CBT / GET is not a fantastic treatment for most". [4] Do not apply to that statement anymore? This type of inconsistency from Mats Reimers page gives a frivolous impression.

[REFERENCES INCLUDED AT ARTICLE]

Should not be Patient Association recommend the treatment that is best evidence ?

2015-06-22 13:25 | my factual arguments are as follows : several meta-analyzes have shown that CBT and / or graded exercise are moderately effective treatments for CFS . Debate article on the front alleged weaknesses of these studies , but they are still the best there is at present.
It is sad that the patient association would rather see " biomedical " treatment with significantly worse eveidens . Behind the vision I sense a contempt for the " mental " illness.

Mats Reimer , Pediatricians , Child and Youth Medicine Mölnlycke

CBT and gradually increase the training lacks evidence

2015-06-22 18:01 | In this article, we point out that CBT and gradually increased training in ME / CFS lack of evidence. Mats Reimer in its reply, still not responded to the weaknesses of the studies that we brought forward, such as the lack of objective outcome parameters. A meta-analysis reduces the sampling error in the material, but does not convert subjective outcomes to objective.

In the case of gradually increasing exercise, we have also pointed out that it did not have control over how the patients followed the protocol. In the PACE study increased the patients in the progressive exercise its results in the walk test from 312 m to 379 m. Average income for a healthy person is about 640 m. A result of 400 m corresponding to a severely disabled and used as a criterion of the patients with lung disease qualify for transplantation [1]. Patients can not reasonably have followed training protocol, whose goal was full recovery. It is therefore impossible to argue that the PACE study demonstrated that the treatment is safe. There are many independent reports on worsening, and it would be unethical to recommend gradually increase the training with reference to a modest improvement in subjective parameters (and no improvement in the fitness test).

The problem with subjective outcomes in CBT studies have attracted attention even in diseases other than ME / CFS [2]. The criticism of the shortcomings have come not only from patient organizations and biomedical scientists, but also from psychologists [3].

It would ultimately gratifying about Mats Reimer could stop by her continual caricatures of opponents, for example, that the authors would entertain any sort of contempt for mental illness.

[REFERENCES INCLUDED AT ARTICLE]

"A meta-analysis reduces the sampling error in the material, but does not convert subjective outcomes to objective."

Mats seems to want to avoid discussing the evidence, and instead just defer to authority.
 

Jonathan Edwards

"Gibberish"
Messages
5,256

Interesting piece. What sort of journal/newspaper is this, Dolphin?
 

anciendaze

Senior Member
Messages
1,841
This is not a matter of lack of evidence. The PACE trial showed that a year of CBT had no measurable effect on physical performance.

On the GET arm of the study there were numbers indicating a very modest increase in distance walked in six minutes. The argument that this is significant confuses clinical and statistical significance. This alleged improvement would not be considered clinically significant in very serious illnesses like congestive heart failure where we know gains are very difficult. Improvement in the control arm of the study was virtually ignored. If this was a true control, why did that group gain 22 meters distance?

The statistical significance also rests on very dodgy assumptions. If the distribution is not normal, the p values are meaningless. The original distribution was definitely not normal (Gaussian), which means the distributions in the different arms can only be normal because sampling that distribution was truly independent. The fact that authors changed criteria in the middle of the study strongly suggests sampling was not blind and independent of previous results.

Even if you believe those distributions in different arms really were normal the fact that 1/3 of all patients declined to participate in one or more of the walk tests would reduce a measure like Cohen's d to meaninglessness. The values you get from the people you did measure depend on assumptions about the people you did not measure, and there were enough of these to alter outcomes. With the very plausible assumption that those who had reduced capacity to exercise after therapy were more likely to decline an optional test the entire gain vanishes.

Finally, the separate "step test" of physical condition confirmed a complete lack of measurable improvement -- even in the GET arm.

The evidence is there, for those who are willing to see it.
 

deleder2k

Senior Member
Messages
1,129
Interesting piece. What sort of journal/newspaper is this, Dolphin?

Wiki: Läkartidningen is a Swedishmedical journal which was first published in 1965 by the Sveriges Läkarförbund (Swedish Medical Association), an organisation founded in 1904.

More:
Läkartidningen is a Swedish magazine and the body of the Swedish Medical Association, which organises doctors in Sweden. The magazine was founded in 1904.

Läkartidningen comes out 42 times a year and has a circulation of 40 000 copies. It is therefore one of the major medical journals in Europe.

Many items in Läkartidningen are of novelty, or give practitioners an overview in any medical field. The articles that present their own data reviewed by external peer reviewers, known as peer review. Läkartidningen is also the only Swedish-language journal that is indexed in MEDLINE - International Database for Medical Science. It is therefore the only medical journal in Swedish that can be said to be a scientific journal.
 
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worldbackwards

Senior Member
Messages
2,051
Mats Reimer said:
2015-06-21 08:42 | authors debate the article until the patient association's well-known position, that all the results suggest that CBT and graded exercise can help are either unreliable, or based on patients who were not "real me." However, the compound is not critical to the much poorer documented treatments. Gottfries clinic that provides mega doses of B12 sitting in the association's scientific advice and on the association's website, lay out Kenny De Meirleirs own theories of ME (including on the false virus XMRV)
From Wiki:
A straw man is a common form of argument and is an informal fallacy based on giving the impression of refuting an opponent's argument, while actually refuting an argument which was not advanced by that opponent.
 
Messages
1,446
Doctors are happy if patients complete a year of therapy? What about the patients. After 2 sessions of so called CBT I refused to be shut in a room with the CBT lunatic ever again. So much of what is now called CBT, isn't. CBT used to be the province of clinical psychologists, who at least understood what CBT is, and many of them are not impressed with the bargain basement, poor training CBT that is being perpetuated in the NHS currently. Now any old garbled dogma or advice is called CBT.
 
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Helen

Senior Member
Messages
2,243
Just wanted to bump this still actual thread and article also with a good reference list. The writers are Drs. of Technology resp. Medicine. Yes, it was published in the Swedish equivalent to BMJ (British Medical Journal).
 

eafw

Senior Member
Messages
936
Location
UK
Just wanted to bump this

Thanks for the bump, interesting article given current debates. Shows that there are people out there who understand the problems with CBT/GET, and yet these articles never get a mass audience (of course because they don't have the full force of the BPS/SMC propaganda-machine behind them)
 

Helen

Senior Member
Messages
2,243
Thanks for the bump, interesting article given current debates. Shows that there are people out there who understand the problems with CBT/GET, and yet these articles never get a mass audience (of course because they don't have the full force of the BPS/SMC propaganda-machine behind them)
In fact this article reached most Swedish doctors as it was published in their monthly journal, but you are right, the article deserves a lot more readers. About propaganda machine, I think results from ME research, that will be presented in a not too far future, will change a lot for us to the better - but not for Dr. Wessely.
 
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