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Do more people recover from chronic fatigue syndrome with CBT or GET than with other treatments?

Dolphin

Senior Member
Messages
17,567
http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1288629

Do more people recover from chronic fatigue syndrome with cognitive behaviour therapy or graded exercise therapy than with other treatments?

M. Sharpe, T. Chalder, A. L. Johnson, K. A. Goldsmith & P. D. White
Pages 1-5 | Received 25 Jan 2017, Accepted 26 Jan 2017, Published online: 15 Feb 2017
ABSTRACT
Background: Wilshire et al. suggest that we have overestimated the number of patients that recover from chronic fatigue syndrome (CFS) after receiving a course of either cognitive behaviour therapy (CBT) or graded exercise therapy (GET), as reported in a secondary analysis of outcome data from the Pacing, graded Activity and Cognitive behavior therapy; a randomized Evaluation (PACE) trial. We provide counter-arguments to this view.

Purpose: To provide an alternative view to that offered by Wilshire et al.

Methods: We review the two different analyses of PACE trial outcome data to estimate recovery, and compare these to other published trials and cohort studies.

Results: While there is no gold standard for recovery from CFS, previous trials and cohort studies provide support for our analysis of recovery in the PACE trial. Our finding that 22% of participants recover from the current episode of CFS after either CBT or GET, compared to 8% after adaptive pacing therapy and 7% after specialist medical care alone, is consistent with the literature.

Conclusions: Our original conclusions that ‘ … recovery from CFS is possible, and that CBT and GET are the therapies most likely to lead to recovery’ is an important, reasonable, and hopeful message for both clinicians and patients.


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Chronic fatigue syndrome, myalgic encephalomyelitis, cognitive behaviour therapy, graded exercise therapy, recovery
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
I'm surprised it's not open access.

But the argument seems to be "our results are consistent with other results therefore our methodology must have been right", completing ignoring the fact that their methodology was screamingly and demonstrably wrong.

So if a faulty methodology produces similar results to other studies, it suggests that something was wrong with those other studies too.

Except in PACEland, apparently.
 
Messages
2,158
So what they are basically saying is, we made sure we changed the criteria for recovery so our results would be in line with previous research - which was all small studies, mostly done by us, and using equally invalid measures...

So that's all right then...

In fact what they are admitting, though they may not be bright enough to realise it, is that there was no point doing the PACE trial, since the sole aim was to fiddle the data to fit previous results.

They show a breathtaking lack of understanding of scientific method.

:rolleyes::cry::vomit::bang-head:
 

Sidereal

Senior Member
Messages
4,856
Finally, Wilshire et al. believe that the PACE participants’ self-reported outcomes may have been influenced by the expectations they had of the therapy they were allocated to [7]. This is most unlikely however, as we measured these expectations before participants started treatment, and found that 72% were confident about APT, compared to 57% about CBT [1]; yet three times as many participants were found to be recovered after CBT than after APT [8].

Bizarre argument I haven't seen trotted out before. No one claimed that baseline expectations influenced self-reported outcomes at 12 months but that the CBT/GET which consists of altering patient beliefs and expectations over months and months of "treatment" influenced how they rated their symptoms at the end of the study.
 

A.B.

Senior Member
Messages
3,780
While there is no gold standard for recovery from CFS, previous trials and cohort studies provide support for our analysis of recovery in the PACE trial. Our finding that 22% of participants recover from the current episode of CFS after either CBT or GET, compared to 8% after adaptive pacing therapy and 7% after specialist medical care alone, is consistent with the literature.

That the results are consistent with SOME of the rest of the literature doesn't mean that they are correct. The typical CBT/GET trial suffers from bad methodology in the form of lack of blinding, subjective primary outcomes and an inadequate control intervention just to name the most obvious problem.

A useful analogy here is that throwing a loaded dice over and over again will give nicely consistent but biased results.

Wilshica et. al. are telling them the dice is loaded. They respond by saying that the results are nicely consistent.
 
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user9876

Senior Member
Messages
4,556
We changed these thresholds for our detailed analysis plan because,
after careful consideration and consultation, we concluded that they were simply too strin-
gent to capture clinically meaningful recovery [8].
I think this is a lie. They didn't mention recovery in there statistical analysis plan. They refer to their paper which is a post-hoc evaluation and not a detailed analysis plan.

If it is meaningful to recover at an sf36-pf of 60 I would challenge them to give an example set of answers that they think are recovered.
 

user9876

Senior Member
Messages
4,556
I notice they have not responded to the issue that the sf36 distribution is wrong for using the mean and SD

Second, whilst definitions of recovery can be disputed, the literature supports our con-
clusions that ‘...recovery from CFS is possible, and that CBT and GET are the therapies most likely to lead to recovery.
To claim most likely even on their terms they would need to demonstrate that for all therapies theirs have a chance of recovery that is statistically significantly more than other therapies. However, in their papers they appear ignorant of other therapies and hence they cannot make this claim.

I think their data may support occasional recovery or remission is possible because I seem to remember one or two patients who did seem to have good walking distances - but this was at random (SMC group if I remember).

They don't seem to have tackled the objective vs subjective issues either.

Given that there is no ‘right answer’ to what is recovery, we might reasonably ask which of the two definitions of recovery is
most clinically valid.
An interesting insight into their reasoning processes. There is no right answer but their are definitely wrong answers, given there is set of possible reasonable definitions of recovery (right answers) their definition falls well outside of that.
 

user9876

Senior Member
Messages
4,556
As usual their response fails to address the main issues with their recovery paper but this is to be expected. The response is very very weak which suggests they must know that there paper is undefendable - yet they still defend it. They should simply have issued an apology and withdrawn their recovery paper - it is so obviously wrong that even a casual glance says it is dodgy.

There response really does say that they don't understand basic principles of running a trial and this should be enough to block them from getting any new research money. Unfortunately it won't.
 

user9876

Senior Member
Messages
4,556
They do provide a better explanation here about their fudging the Oxford definition that in their recovery paper. Since it is obvious in the data they had to release maybe they no longer care. But the figures provided for those no longer meeting the Oxford criteria in the recovery paper included a number of patients who met the criteria as judged by a doctor by simply no longer met the trial entry criteria.

At the time they published their paper some of their supporters were justifying their results as patients no longer had ME according to the oxford definition but that was untrue.
 

user9876

Senior Member
Messages
4,556
Minor point:
They incorrectly refer to the paper as Matthees et al. rather than Wilshire et al. on at least a couple of occasions

I wondered if that was refering to the virology blog post with the detailed reanalysis? They do include it in the references. I think the analysis holds water as they have failed to manage to give any sensible criticisms of it.
 
Messages
2,158
Since PACE was a study of people with at least 6 months fatigue, not a study of CFS or ME, the results are irrelevant, except in so far as they proved that their 'therapies' don't even work for this much wider group.

And, of course at long term follow up it proved to be a null trial, even by their own definitions.
 
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30
Sharpe et al said:
Purpose: To provide an alternative view to that offered by Wilshire et al.

I think they mean, "getting the last word". Is that why we produce papers these days? Is it truly necessary to provide an alternative view every time someone uses your work for further analysis? It smacks of something other than comradely scientific discourse given the regularity with which it occurs from this particular group.
 
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Messages
13,774
In a five-year follow-up study
of a trial comparing CBT to relaxation therapy, Deale and colleagues [11] found that 24% of
25 patients met operationalised criteria for recovery at 5 years, compared to 4% of 28
patients with relaxation therapy. This study used criteria for recovery closer to Matthees
et al.'s analysis (although in Deale’s study recovery was measured five years after the
trial had ended, with a greater chance of recovery with time [10]). Despite the more strin-
gent criteria used, this long-term follow-up study supports the validity of our finding that
22% of participants were recovered after receiving CBT.

WTF? So a study which used criteria closer to the Matthees analysis had similar results to White's analysis, and this somehow supports the validity of White's criteria?

The more obvious interpretation is that exciting early findings in small cheap trials were undermined by the null results from PACE.

Then they move on to the Flo study which used the same [similar] BS criteria as PACE... how can they think that this is helping to justify their criteria changes? It's just noise.
 
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13,774
'Great work' to everyone involved in the Wilshire paper.... White at al. clearly had nothing of substance that they could pick up on.

I think this is a lie. They didn't mention recovery in there statistical analysis plan. They refer to their paper which is a post-hoc evaluation and not a detailed analysis plan.

If it is meaningful to recover at an sf36-pf of 60 I would challenge them to give an example set of answers that they think are recovered.

I'm surprised that they said that. They must have known that it was not true.
 
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