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Cognitive behavioural therapy in chronic fatigue syndrome: RCT of group programme (O'Dowd et al, 200

Discussion in 'Latest ME/CFS Research' started by Tom Kindlon, Mar 26, 2014.

  1. Tom Kindlon

    Tom Kindlon Senior Member

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    Can an admin or mod change the heading to:
    Cognitive behavioural therapy in chronic fatigue syndrome: RCT of group programme (O'Dowd, 2006)


    It doesn't make much sense as it is as the moment in terms of the year.


    Free full text: www.cebp.nl/vault_public/filesystem/?ID=3781‎

     
    Last edited: Mar 26, 2014
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  2. Tom Kindlon

    Tom Kindlon Senior Member

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    I've a lot of notes on this so I'm going to post my 2007 Co-Cure post.

    --------
    I made some notes for myself as I went along - I suspect only a small percentage of the people who might be interested will read it, given it is over 100 pages, so thought I would send these notes/comments out. [My comments aren't all as wordy as the first set!]

    Also, Dr. Ellen Goudsmit has pointed out:
    ---
    They were still a long long way off a normal group.

    The CBT group started at: 24.3.
    After six months, were at 28.5
    and
    at 12 months were 28.9 (compared to the 67 shuttles in healthy controls mentioned above i.e. just 10.77% of the gap to the normal)

    ------
    [Aside: And we cannot be sure that this was not just from convincing patients exercise wasn't risky (whether this is true or not of course is a different thing). As they say at one stage part of the aims of the CBT was about "regaining confidence in movement".

    They claim that they tested to see whether everyone was exercising as hard by asking them how tired they were after the 6 minutes of walking. It would have been interesting, if they had been followed up for days afterwards like the Staci Stevens and co (University of the Pacific) have been doing, to see if the CBT group had worse postexertional malaise from pushing themselves harder. People with the illness in my opinion can sometimes get a bit of an adrenaline high and actually not feel too bad during or immediately after "over-doing" it - it often only hits many hours or sometimes days later.

    O'Dowd et al themselves say (p.11-12):
    It seems to me it would have been preferable if they had done the SATET (subanaerobic threshold exercise test) (which they had planned to do – see page 11) which seems more objective than a test partly based on how hard patients are willing to push themselves in 6 minutes.
    ---

    They also say at one stage about the shuttle walk:
    I question in particular excluding the high scores. 60 and 75 are normal scores for healthy people - if somebody recovers, one would expect such scores. It is different from excluding a score like on a blood test that looks like an error. These scores don't look like errors.


    This means this figure is not likely to continue to improve by very much over time.
     
    Last edited: Mar 26, 2014
  3. Tom Kindlon

    Tom Kindlon Senior Member

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    What they omit to say in the abstract is that initially the groups were at 37%, 16% and 38% so there is virtually little difference in the increase across groups: 9%, 10% and 6%.

    ---
    Aside in 2014: This is how normal was defined
    It is somewhat interesting to see all those in the normal range at baseline given the definition of recovery in the PACE Trial, etc.
     
  4. Tom Kindlon

    Tom Kindlon Senior Member

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    i.e. CBT did the worst of the three.
     
  5. Tom Kindlon

    Tom Kindlon Senior Member

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    Because of the way this is written it mightn't be immediately clear that the CBT group does the worst here for +15% increase in physical function
    CBT: 32%, EAS: 40% SMC: 49%
     
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  6. Tom Kindlon

    Tom Kindlon Senior Member

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    That’s debatable

    e.g. here’s what they say on the HADS (Depression and Anxiety) results:
    These claims (regarding mood, fatigue and physical fitness) are pretty debatable when one looks at the figures closely and sees the number of measures for which there was not a statistically significant difference. Saying something is "effective" for these measures, given the final values, could be said to be somewhat misleading (although other researchers seem to use this phrase too).
     
  7. Tom Kindlon

    Tom Kindlon Senior Member

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    Or other things such as employment status (the statistics for which they don't discuss in the abstract).

    Here's what they say in the executive summary:
    Overall in the executive summary they say, regarding the (minor) improvement:
     
  8. Tom Kindlon

    Tom Kindlon Senior Member

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    Other bits from the main text:

    NICE possibly should take their results on board

    -----------------------
     
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  9. Tom Kindlon

    Tom Kindlon Senior Member

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    If people want to get an idea of Hazel O'Dowd and her team's views and where they are coming from, Chapter One gives a background to their views (not much if any biomedical research mentioned there)
     
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  10. Tom Kindlon

    Tom Kindlon Senior Member

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    P.4-5 – What CBT is (might help settle some debates?)


     
    Last edited: Mar 26, 2014
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  11. Tom Kindlon

    Tom Kindlon Senior Member

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    Dropouts:

    Page 12:

    They say:

    But they don’t seem to comment much if at all on the higher drop-outs in the CBT in this trial


     
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  12. Tom Kindlon

    Tom Kindlon Senior Member

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    Chapter 2:

    Aims of CBT described: page 16

     
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  13. Tom Kindlon

    Tom Kindlon Senior Member

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    Chapter 3:
     
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  14. Tom Kindlon

    Tom Kindlon Senior Member

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    Chapter 4 also gives an idea where Hazel O'Dowd and the team are coming from.
     
  15. Tom Kindlon

    Tom Kindlon Senior Member

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    Appendix 6 gives the unanswered questionnaires (e.g. SF-36) which some people may find interest in
     
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  16. Tom Kindlon

    Tom Kindlon Senior Member

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    Appendix 8:
    (Trudie Chalder’s book "coping with chronic fatigue" was lent to the CBT patients)


     
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  17. Tom Kindlon

    Tom Kindlon Senior Member

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  18. Tom Kindlon

    Tom Kindlon Senior Member

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    Employment status

    Appendix 12:

    Page 106 lists their employment status at the end:

    It is somewhat awkward to see if there was any improvement for this improvement as at baseline so many people had "not specified": 42%, 34% and 39%. The figures for "no job" at baseline were: 38%, 44% and 31%.

    The authors do admit:
     
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  19. Tom Kindlon

    Tom Kindlon Senior Member

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    Final comment
    (remember this is copied from a 2007 Co-Cure post)

    [End of commentary on O'Dowd in particular] Given the extremely modest improvements found in this study (amongst those who were willing and able to take part and finish it) as well as the extremely modest improvements found in the adults in the various Belgian clinics:

    (ref: http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0701D&L=CO-CURE&P=R3379&I=-3& m=16601 or http://tinyurl.com/2uqoqs

    http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0701E&L=CO-CURE&P=R427&I=-3&m =16601 or http://tinyurl.com/366v5l

    http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0702C&L=CO-CURE&P=R4161&I=-3& m=16601 or http://tinyurl.com/yvjlwx )

    it seems patients should be on the lookout for any suggestions that CBT based on Graded Activity or Graded Exercise is anywhere near sufficient for this illness.

    There seems to be a lot of hype by certain individuals of these treatments. When one looks closely at the studies [especially those not simply involving the very vague Oxford CFS criteria (basically unexplained chronic fatigue for 6+ months) (or where Prins (2001) used CDC 94 but didn't require the patients to have any of the 8 CDC criteria!)], the results generally seem modest at best.
     
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  20. WillowJ

    WillowJ Senior Member

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    it seems they've gone out of their way to put a "better" figure from CBT next to a lower figure from some other treatment (even if the two don't compare, e.g. 64% mental health CBT...next figure one reads is 40% physical health EAS, although they should be comparing 32% physical health from CBT with that 40 figure from EAS)

    Many people speed read and could get the wrong impression.
     
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