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Differential effects with GET in CFS: Systemic review and meta-analysis

Discussion in 'Latest ME/CFS Research' started by deleder2k, Jun 8, 2015.

  1. deleder2k

    deleder2k Senior Member

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    Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis

    http://www.sciencedirect.com/science/article/pii/S0272735815000896

    Highlights


    •Interventions including physical activity have beneficial effects on chronic fatigue.

    •The number of trials is modest and there is heterogeneity between them.

    •Type of setting and provider of treatment moderate fatigue severity effect sizes.

    •Minimal direct contact interventions are promising.




    And the criterias:

    Not sure whether this belongs in the ME research forum or in the other forum (with respect to the non existent criteria used)
     
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  2. Esther12

    Esther12 Senior Member

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  3. Bob

    Bob

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    So an intervention that is intended to increase physical activity and reduce disability, in patients with idiopathic chronic fatigue and chronic fatigue syndrome, failed to significantly increase activity post-treatment. I think that says it all really. Instead, the modest post-treatment changes are seen only in subjective outcomes in open label (I assume) trials. It's no surprise to us, because the lack of significant improvement in physical activity is a repeating pattern for GET in CFS trials and clinical practice. (Note that there may have been a significant effect for physical activity at follow-up but, from the abstract, we don't know if that is a small or medium effect.)
     
    Last edited: Jun 8, 2015
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  4. deleder2k

    deleder2k Senior Member

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    Hear hear
     
  5. Sean

    Sean Senior Member

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    Zombie science at its finest.
     
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  6. Snow Leopard

    Snow Leopard Hibernating

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    With respect to the effect sizes, such effects only make sense with respect to the underlying measurement itself (eg change in questions answered on the questionnaire, or physical activity).
    So such effect sizes are comparable to other interventions using the same underlying measurement, but are not really comparable to other underlying measurements. Eg. this does not meant that an effect of 0.6 or whatever actually means there is a moderate improvement. The effect size for physical activity of 0.11 and on fatigue questionnaires of 0.6 could in fact be the same effect, simply that the questionnaire was more responsive to small changes.

    edit - the methodology is weird, they've included CBT studies as "behavioral interventions with a graded physical activity component" aka GET.

    Secondly, basically no discussion of harms/adverse effects.
     
    Last edited: Jun 8, 2015
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  7. Dolphin

    Dolphin Senior Member

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    This study was excluded:
    This was also excluded from the Malouff et al. review and possibly others because Andrew Lloyd (the corresponding author) didn't give reviewers extra data they needed e.g. standard deviations.

    As this study found no benefit for CBT, excluding it increases average improvement for CBT.

    Here's the abstract:

     
    Last edited: Jul 5, 2015
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  8. Dolphin

    Dolphin Senior Member

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    Another fail for CBT that wasn't included because the author(s) wouldn't pass on the necessary statistical information:


     
    Last edited: Jul 5, 2015
  9. Dolphin

    Dolphin Senior Member

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    The authors found some evidence that there might have been reporting bias i.e. unsuccessful trials or results that have not been published:

     
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  10. Dolphin

    Dolphin Senior Member

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    The following is included in Appendix C

    The worst item by far is:
    24: Allegiance to therapy:
    All but one score 0 (that includes the PACE Trial). The odd one out is Prins et al. (2001) that scores 1 (out of 2).

    Anyone know what this is? I'm guessing it's whether the paper reports any allegiances of the investigators to the therapies.
     
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  11. Dolphin

    Dolphin Senior Member

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    Another category where trials did very badly was:
    13-Assessor blinded.
    Score of 0: 13
    Score of 1: 2 (Wearden et al., (2010); Deale et al. (1997))
    Score of 2: 1 (O'Dowd et al. (2006))
     
  12. Dolphin

    Dolphin Senior Member

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    Another category where trials did very badly was:
    15-Treatment side effects

    This presumably refers to the reporting of treatment side effects/harms.
    Score of 0: 11
    Score of 1: 4 (Fulcher & White (1997); Wearden et al. (2010), Sharpe et al. (1996), O'Dowd et al. (2006))
    Score of 2: 1 (White et al. (2011))

    These results are in line with:
    Free at: http://iacfsme.org/ME-CFS-Primer-Ed...of-Harms-Associated-with-Graded-Exercise.aspx
     
    Last edited: Jul 5, 2015
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  13. Dolphin

    Dolphin Senior Member

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    It would be interesting to see whether Cochrane reviews have reported similar deficiencies in the CBT and GET literature.
     
  14. Dolphin

    Dolphin Senior Member

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    The authors don't give the impression they think this is a biological condition that needs more than just management techniques to recover.
     
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  15. Dolphin

    Dolphin Senior Member

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    If patients fear activity and this causes reduced levels of physical activity, why would you necessarily find a "boom-and-bust pattern"? If people fear things, they tend to avoid them them not do lots of the activity sometimes.
     
  16. Dolphin

    Dolphin Senior Member

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    It is good that the authors recognise there are different types of exercise program:
     
  17. Snow Leopard

    Snow Leopard Hibernating

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    Notice how they didn't actually provide a citation showing evidence of a boom-and-bust pattern? Because this isn't an evidence-based statement (it isn't a thing for most patients - there isn't a boom, just a bust after trying normal/modest activities).
     
    Last edited: Jul 5, 2015
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