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Dr C. Wilshire:The problem of bias in behavioural intervention studies: Lessons from the PACE trial.

hixxy

Senior Member
Messages
1,229
Location
Australia
Findings from the trial showed that CBT and GET – as delivered here – can have modest effects on patients’ self-reports of fatigue and/or physical functioning, at least if those reports are elicited within several months of trial conclusion. The size of these effects did not exceed what might be expected from reporting bias alone, and they were no longer evident at long-term follow-up. These treatments do not improve more objectively measurable aspects of functioning, such as physical fitness or employment status. Finally, there was no evidence from the trial that patients can recover from CFS as a result of either of these treatments.

In my view, the implications of these findings are quite clear: there is no need to pursue the question further. CBT and GET are simply not effective enough as treatments for CFS (if at all). We need to do better. It is time to begin the search for entirely new treatments.

:p
 

charles shepherd

Senior Member
Messages
2,239
This is getting a bit like London buses -

You can hang around for ages waiting for the one you want - then three appear all at once!

Same here - and there are still more critical commentaries on the PACE trial to come in the JHP…...

Yesterday I wrote to the JHP editor to see if they could all be made open access - rather than most of them being restricted to 100 word abstracts as far as the public domain is concerned

Dr Charles Shepherd
MEA
 

missfire

Knock Down, Bounce Back
Messages
13
This is getting a bit like London buses -

You can hang around for ages waiting for the one you want - then three appear all at once!

MEA

Don't say that about London. I enjoyed the transportation system. Chronic fatigue is hard to work with when you're doing the Underground / Tube!
 

charles shepherd

Senior Member
Messages
2,239
Don't say that about London. I enjoyed the transportation system. Chronic fatigue is hard to work with when you're doing the Underground / Tube!

Yes - agree!

As someone who is up in London once or twice a week, I think there's a really good and reasonably priced public transport system in operation - apart from trying to use parts of it if you are using a wheelchair

And while Londoners sometimes moan about it, they should try using almost non existent rural public transport

But I still don't understand why some London buses on the same route still sometimes arrive almost one after another…….and then don't appear for ages
 

missfire

Knock Down, Bounce Back
Messages
13
But I still don't understand why some London buses on the same route still sometimes arrive almost one after another…….and then don't appear for ages

I will try to answer that question upon my return. I rather moan and groan about paper work than transit! :)
 

Cheesus

Senior Member
Messages
1,292
Location
UK
But I still don't understand why some London buses on the same route still sometimes arrive almost one after another…….and then don't appear for ages

As someone who used to catch the bus to work, I can tell you this happens because the bus in front has to keep stopping to pick people up, which clears the bus stops of people. The bus behind therefore does not need to stop, so it can catch up.

Once the second bus catches up with the first, they start leap-frogging each other: one is stopped whilst the other one passes, and then that bus has to stop at the next stop, allowing the first to pass. This allows the third bus to catch up, and now you have three busses travelling in a convoy.

You can tell my commute to work was terribly boring.
 
Messages
15,786
But I still don't understand why some London buses on the same route still sometimes arrive almost one after another…….and then don't appear for ages
In Seattle this would happen due to really bad traffic, such as from baseball games drawing a huge crowd. The traffic would be in a pretty small time period, then suddenly disappear entirely. And this creates a knock-on effect where the delayed bus has more and more people now at each stop, more stops to make, and a longer delay in people maneuvering around each other to disembark.

Then the following bus, which starts out on time, has very few people to pick up, and ends up ahead of schedule because they usually can't stop anywhere to wait a bit. So people miss that bus because it arrives too early, and the following bus is delayed by having extra passengers again.

The other factor was that buses usually have another route before starting on their current one, and delays build up again. One route I'd ride featured buses feeding in from two different routes. Buses from one route were consistently late, and the buses from the other route were usually on time.

So generally it was poor planning and/or a failure to respond adequately to different conditions, even when those conditions were predictable weeks in advance :p And a certain level of not caring how happy the customers are with the service probably contributes.
 

missfire

Knock Down, Bounce Back
Messages
13
As someone who used to catch the bus to work, I can tell you this happens because the bus in front has to keep stopping to pick people up, which clears the bus stops of people. The bus behind therefore does not need to stop, so it can catch up.

Once the second bus catches up with the first, they start leap-frogging each other: one is stopped whilst the other one passes, and then that bus has to stop at the next stop, allowing the first to pass. This allows the third bus to catch up, and now you have three busses travelling in a convoy.

You can tell my commute to work was terribly boring.

Yeah, in Canada. Bus 2 and 3 just park, read a book, could 20 minutes and proceed. LOL
 

user9876

Senior Member
Messages
4,556
Its a really good paper that summarizes the biases that are obvious from the way the trial was run and the ways that the PACE PIs have failed to understand or acknowledge the potential failures.

One of the points made is that the different treatment arms set different expectations which is very likely to lead to reporting biases in favor of CBT and GET. Hence this is another argument for the need to share the full data set so that we can understand the relationships between the subjective and objective outcomes.

It also makes points about the lack of robustness in the LTFU data which would lend support to the interpretation of reporting bias being the main cause of differences with CBT and GET.
 

Tom Kindlon

Senior Member
Messages
1,734
Findings from the trial showed that CBT and GET – as delivered here – can have modest effects on patients’ self-reports of fatigue and/or physical functioning, at least if those reports are elicited within several months of trial conclusion. The size of these effects did not exceed what might be expected from reporting bias alone, and they were no longer evident at long-term follow-up. These treatments do not improve more objectively measurable aspects of functioning, such as physical fitness or employment status. Finally, there was no evidence from the trial that patients can recover from CFS as a result of either of these treatments.

In my view, the implications of these findings are quite clear: there is no need to pursue the question further. CBT and GET are simply not effective enough as treatments for CFS (if at all). We need to do better. It is time to begin the search for entirely new treatments.
:p
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