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CBT found not to increase activity levels in 3 Dutch CFS studies

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jan 8, 2010.

  1. Dolphin

    Dolphin Senior Member

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    The report is at:
    http://www.inami.fgov.be/care/fr/revalidatie/general-information/studies/study-sfc-cvs/index.htm

    The main report is at: http://www.inami.fgov.be/care/fr/re...rmation/studies/study-sfc-cvs/pdf/rapport.pdf

    Unfortunately the information is in French.
    The report is also available in Dutch/Flemish elsewhere if people prefer.
    I only have 3 years of German and no Dutch so read the French version.

    There are some summaries in English I might report later.

    It wasn't a De Meirleir study - not sure if he was involved in these standardised rehab clinics for CFS. Unfortunately, it was an audit and hasn't been published in PubMed that I know of but I have referred to it in a letter and Twisk/Maes also referred to it a bit in one of their papers:

  2. oceanblue

    oceanblue Senior Member

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    If you can report the English studies that would be great since this looks pretty important (presumably n is very large).
  3. Frank

    Frank Senior Member

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    This was a study performed by a health control group of the Belgian government. I think it's not public sience.
  4. oceanblue

    oceanblue Senior Member

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    Frank - but it is published, if not strictly public, and potentially the largest follow-up of CBT there is, even if it wouldn't mee the 'rigours' of peer-reviewd research in this field?
  5. Dolphin

    Dolphin Senior Member

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    Yes, it's not a Randomised Controlled Trial (RCT). But it is an audit and can be referred to in the literature (I already have in Brain (a neurology journal)). I'll try to send some more info. in English later - doing something atm. ETA: now started a separate thread: http://www.forums.aboutmecfs.org/sh...f-Belgian-CBT-GET-rehab-clinics-(large-sample)
  6. Dolphin

    Dolphin Senior Member

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  7. Esther12

    Esther12 Senior Member

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    This could be an inappropriate bump, but it's late and I thought these cancer papers could be of interest:

    http://www.ncbi.nlm.nih.gov/pubmed/20930100


    http://www.ncbi.nlm.nih.gov/pubmed/19160308
  8. Valentijn

    Valentijn Activity Level: 3

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    Amersfoort, Netherlands
  9. Dolphin

    Dolphin Senior Member

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    Thanks. I could save the one I highlighted but if one wanted to copy and paste bits of the text, one couldn't while one can with that version.
  10. Dolphin

    Dolphin Senior Member

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    Thanks. I find the first one more interesting: I had got the impression that post-exertional symptoms wasn't as big a problem with Cancer fatigue so might have hypothesised that for a CBT intervention focusing on physical activity and psychosocial elements, that reductions in fatigue might be related to increases in activity. It makes me even less excited by fatigue as an outcome measure for such interventions that the reduction in fatigue wasn't mediated by activity increase.

    Full text of both are in Goedendorp PhD thesis: http://dare.ubn.kun.nl/bitstream/2066/89943/1/89943.pdf
  11. Simon

    Simon

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    Just a few comments on this trial. Aside from the the fact that CBT fatigue gains were not matched by physical activity ones, it's worth pointing out:

    Lack of controls properly matched for therapist attention
    • CBT consisted of up to ten 1-hour sessions, within 6 months, provided by two therapists
    • brief nursing intervention (BNI) consisted of two 1-hour sessions, 3 months apart, given by trained nurses, focusing only on physical activity. Cognitive behavior therapy
    • The control group received only usual care (UC)
    Modest gains of -5.6 (on 8-56 point CIS scale)

    Modest self-reported gains and lack of proper controls in unblinded study = doubtful findings.
    Not sure this tells us much. Normally Cochrane reviews provide full analysis of studies eg forest plots of effect size, checking for heterogeneity (ie are they comparing apples with plums?) but this one did not. Studies were only of 'moderate' quality, just one study used an intention to treat analysis and in some positive studies the sole therapist was the main author. Effect sizes were all over the place from 0.17 - >1. The review also points out there may be publication bias due to negative studies not being reported.

    Finally:
    Interesting acknowldgement of the importance of adherence there, but what's contamination?
    Dolphin likes this.
  12. Dolphin

    Dolphin Senior Member

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    Contamination in this context can mean that the therapist introduces elements of another therapy including one in another trial arm rather than sticking to the one therapy they are supposed to be testing.
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  13. biophile

    biophile Places I'd rather be.

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    In another context, contamination seemingly began and ended the XMRV saga. When referring to response bias and suggestibility affecting questionnaire-taking behaviour, "contamination" also began and will help end the CBT/GET saga.

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