The Power and Pitfalls of Omics: George Davey Smith’s storming talk at ME/CFS conference
Read about the talk that stole the show at a recent ME/CFS conference in Simon McGrath's two-part blog.
Discuss the article on the Forums.

Effects of a Self-regulation Based Physical Activity Program (The "4-STEPS") for Unexplained CF

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 21, 2014.

  1. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
     
    Snow Leopard and Esther12 like this.
  2. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    I think (although am not sure) this won't show up in CFS systematic reviews as it didn't involve all CFS patients.

    However, there were quite a lot of CFS patients in it: 40 out of 45 in the intervention group (88.9%) and 43 out of 45 in the control group (93.5%).

    Assesment:
    The authors do point out this limitation:

     
    Simon and Esther12 like this.
  3. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    Here are the main results Marques 2014 Table 2.jpg

    Note that subjective fatigue is the fatigue subscale of the CIS-20 (8 questions). Fatigue severity is all 20 questions. So the fatigue subscale questions are counted in both - strip them away and the other 12 questions (concentration, motivation and activities) may not be significant.
     
    Simon and Esther12 like this.
  4. Esther12

    Esther12 Senior Member

    Messages:
    8,449
    Likes:
    28,522
    Snow Leopard, Simon and Dolphin like this.
  5. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    Here's info on goal progress:
    Mean of 4.16, although an improvement over the control group, is a long way from 10.
     
    Simon and Esther12 like this.
  6. Scarecrow

    Scarecrow Revolting Peasant

    Messages:
    1,891
    Likes:
    5,328
    Scotland
    @Esther12 I was going to post something along the following lines. Then I noticed you already had - two years ago.

     
    Esther12 likes this.
  7. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    There was a big change in this score (from 41.56 to 120.67):
    However, the change in the average daily step count was quite small: 6629 to 7077 (6.8% increase). This suggests people may have cut out other activities to do increased leisure-time activity (or perhaps they didn't do as much leisure-time activity as they claimed).
     
  8. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    They improved on 4 measures and disimproved on 7. None of the changes look that large but still can be enough to change something from not statistically significant to statistically significant. But people with CFS tend to improve a small bit on average overtime and say they are a bit better again if they have had some sort of therapy, so not an ideal control group.
     
    Last edited: Sep 21, 2014
    Valentijn, Simon and Esther12 like this.
  9. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    Discussion of the pedometer results:
    Note that they groups were already at 6500-8500 before the trial.

    Ref. 42 is the PACE Trial (the increase in the 6-minute walking test was small in the GET group, but there was no change in the CBT group).
     
    Esther12 likes this.
  10. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    More studies should probably highlight this issue. Although some/many of those who did not take part may have done so as they didn't feel they could exercise any more.
     
  11. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    They don't mention the bigger trial of pragmatic rehabilitation, the FINE Trial, which flopped.
     
    Valentijn and Esther12 like this.
  12. Esther12

    Esther12 Senior Member

    Messages:
    8,449
    Likes:
    28,522
    I only had a quick read of that (with a mild migraine), but thought I'd post my first thoughts.

    So 'Leisure Time Physical Activity' is just self-report, while 'Physical Activity' was measured objectively with a pedometer and did not find a significant improvement.

    Their control group certainly did much worse than PACE's SMC, but it's difficult to know if that shows my concerns about their control were justified - we need control for their control!

    @Dolphin re Goal Progress: I was just thinking the same thing, especially considering the emphasis placed upon goals in this intervention in the protocol:

    I don't really know what sort of scores are to be expected for an outcome measure like this though. Not sure how much time to invest in digging in to this.

    I'm not too happy with their justification for what should be seen as a clinically significant improvement.

    So according to their pre-determined primary outcome, this was a null result?

    I've got some sympathy for the argument that the sample size was too small... but I think patients have suffered more than researchers because of exaggerated claims about the efficacy of these sorts of interventions. If the effect size is smaller than you expected then you need to run a larger trial, and ideally one with a better control group.

    Or it could be that those patients most likely to benefit from this sort of intervention are those most likely to pursue it. It is possible that patients have some awareness of the nature of their problems and can make informed decisions about what therapies are likely to be most helpful.

    Yeah, I noticed that too.
     
    Last edited: Sep 22, 2014
    Valentijn and Dolphin like this.
  13. Dolphin

    Dolphin Senior Member

    Messages:
    10,671
    Likes:
    28,172
    I'm just looking at the protocol (thanks to Esther12 for drawing my attention to its existence). There's no sign of quite a lot of these (including the CFS diagnosis as an outcome measure, which should assess whether they satisfy it or not at the end, otherwise it's not an outcome measure).

    http://www.biomedcentral.com/1471-2458/12/202

     
    Esther12 likes this.
  14. Esther12

    Esther12 Senior Member

    Messages:
    8,449
    Likes:
    28,522
    In no way is this a solid piece of evidence, but from popular science/medicine blog, I got some vague info on pedometer data that might be of interest to people:

    2000-3000 steps: About half an hours walking.

    Apparently "The average U.S. adult walks about 5,900 steps daily" - whoa - I suddenly feel like I was really active before falling ill.

    These classifications could be totally made-up:

    http://walking.about.com/cs/measure/a/locke122004.htm

    That info makes the improvement report by this 4 Steps physical activity programme look even worse, but also the starting levels of physical activity look quite high.

    I didn't see data specifically for the YAMAX SW-200 pedometer, but I did find people saying it was reliable and accurate.
     
    Snow Leopard and Valentijn like this.
  15. Snow Leopard

    Snow Leopard Hibernating

    Messages:
    4,613
    Likes:
    12,435
    South Australia
    As I (and others) specifically predicted in 2012.

    Right. Translation: CFS patients on the whole are active enough so that deconditioning does not explain their fatigue.
     
    Valentijn and Dolphin like this.
  16. Esther12

    Esther12 Senior Member

    Messages:
    8,449
    Likes:
    28,522
    Some of the PhD this is a part of is now available here: https://openaccess.leidenuniv.nl/handle/1887/31422

    The rest should be available next Jan, including this bit:
    http://www.sciencedirect.com/science/article/pii/S0272735815000896

    Maybe of interest?

    "Subgroup analyses revealed that minimal contact interventions had additional beneficial effects upon fatigue (g= 0.96) and depression (g= 0.85)."

    Yeah, I find that minimal contact with them perks me up a bit too.
     
    Sean and Dolphin like this.
  17. Esther12

    Esther12 Senior Member

    Messages:
    8,449
    Likes:
    28,522
    New paper on this from twitter:



    http://www.jpsychores.com/article/S0022-3999(16)30635-3/abstract
     
    Valentijn, Cheshire and Dolphin like this.
  18. Snow Leopard

    Snow Leopard Hibernating

    Messages:
    4,613
    Likes:
    12,435
    South Australia
    Another null result when it comes to objective measures...

    Also notable that 55% of participants were working before being involved in this study... (98% of participants were women).
     
    Esther12 likes this.

See more popular forum discussions.

Share This Page