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Disability and chronic fatigue syndrome: a focus on function. (Ross et al., 2004)

Discussion in 'Latest ME/CFS Research' started by Dolphin, Oct 27, 2011.

  1. Dolphin

    Dolphin Senior Member

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    I have just read the following paper. It is sometimes quoted as showing that CBT or GET have been shown to restore the ability to work. See underlined bit.

    Free full text: http://archinte.ama-assn.org/cgi/content/full/164/10/1098 or http://archinte.ama-assn.org/cgi/reprint/164/10/1098

    When one reads the full paper, there is not enough evidence to suggest that the underlined bit deserves to be in the abstract.
    It seems to come from Table 6:

    [​IMG]

    Here's the text:
    With regard to GET, there were 66 people in the trial.
    The actual figures in the Fulcher paper are:
    31/66 is where the 47% comes from. However, remember that half the group got another treatment initially (flexibility exercises and relaxation therapy) so one can't say that the GET was the reason for the increase. And there was no control group - these were Oxford criteria patients so maybe they would have improved anyway.
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  2. Esther12

    Esther12 Senior Member

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    Thanks - I'll come back for another look at this. I think this is cited uncritically in the CFS Treatment wikipedia article.
  3. Snow Leopard

    Snow Leopard Senior Member

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    By the way, the quoted drop out rate for Akagi et al. is wrong, they've mixed the results of controlled/crossover and uncontrolled trials together. And Fulcher & White is a masterful piece of cherrypicking since they didn't give the baseline figures for the GET only group (I guess you can get away with that with a mediocre crossover study).
  4. oceanblue

    oceanblue Senior Member

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    Thanks for this, Dolphin. I think they key line is:
    though of course, once that dodgy line about only cbt/get restoring the ability to work is out in the literature it can be uncritically cited at will.

    One small point: I don't think natural recovery is limited to Oxford-criteria patients; whatever criteria used they need a control group of sorts to distinguish between natural recovery (and experimental factors eg scales used) and improvement due to the specific therapy.
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  5. Dolphin

    Dolphin Senior Member

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    Are you referring to any trials other than this one?
    Good spot:
    The PhD text shows most were working or studying at baseline (again the first line isn't for all the data):
  6. Dolphin

    Dolphin Senior Member

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    Yes, agree. But research suggests that the looser the criteria for chronic fatigue/chronic fatigue syndrome, the better the prognosis.
    (ref: Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar;90(3):223 -33).
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  7. Snow Leopard

    Snow Leopard Senior Member

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  8. Dolphin

    Dolphin Senior Member

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    But some of these were included in the final analysis:

    Page 256:
  9. Snow Leopard

    Snow Leopard Senior Member

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    The 51 responses appear to have included 47 from the 'treatment group' and 5 who did not. But of those who were in the 'treatment group', 27.5% had actually dropped out and there was a response rate for the followup questionnaire of only 61%.

    All in all I think it is hard to draw conclusions from the way this data has been presented...

    This actually seems to be a trend unfortunately. I've been trying to put the employment related data from both controlled and uncontrolled GET and CBT studies into a neat table. But this is proving more difficult than I imagined as the data is often incompletely presented making comparisons difficult. (or poorly controlled like the Sharpe CBT trial where far more of the control group were employed compared to the intervention group at the baseline which means the results are difficult to compare).
  10. Dolphin

    Dolphin Senior Member

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    I was trying to see what you are saying. But 47+5=52 (not 51) - have you made an error or is this correct?
  11. Snow Leopard

    Snow Leopard Senior Member

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    You are right, I forgot to also mention the "but one reply had incomplete primary care attendance data." Which may explain why there are only 51 responses included.
  12. Dolphin

    Dolphin Senior Member

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    Ok.
    Best of luck compiling the employment related data. I would be interested in seeing what you put together.
  13. Esther12

    Esther12 Senior Member

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    This group had also written this report, which made some worthwhile comments in 2002: http://archive.ahrq.gov/clinic/epcsums/cfsdissum.htm

    The AHRQ are the American Agency for Healthcare Research and Quality

    Thanks to WillowJ for digging this stuff up.





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  14. alex3619

    alex3619 Senior Member

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  15. WillowJ

    WillowJ Senior Member

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    AHRQ has an ex-officio on CFSAC, Beth A. Collins Sharp, Ph.D., R.N.
    Senior Advisor for Women's Health and Gender Research
  16. user9876

    user9876 Senior Member

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    As well as trying to tabulate what data there is it is worth recording those trials with missing data. i.e. why it cann't be easily tabulated - as well as the underlying assumptions in the trial (e.g. diagnosis method) and other measurements.

    There do seem to be a very lot of small CBT and GET trials but they all seem to be structured so that results cannot be compared.

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