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Family-focused CBT versus psycho-education for adolescents with CFS: long-term follow-up of an RCT

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 3, 2013.

  1. Dolphin

    Dolphin Senior Member

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  2. Dolphin

    Dolphin Senior Member

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    I can't say I find this very convincing.
    Also they don't give any other data, apart from whether somebody satisfied a 70% attendance and:
    70% attendance is not a good attendance rate for people who are supposedly recovered.
    If there were some people who were studying part-time plus working, that could have been reported separately.
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  3. Dolphin

    Dolphin Senior Member

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    They measured global functioning:
    This is presumably a seven point CGI scale.

    This was not used as part of the recovery definition i.e. one could say one was the same or only a little better but be counted as recovered.
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  4. Dolphin

    Dolphin Senior Member

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    So a Chalder Fatigue Questionnaire score of 18 or less and 70%+ attendance rate and one was counted as recovered. Not a very rigorous definition of recovery.
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  5. Dolphin

    Dolphin Senior Member

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    Here are some overall figures:

    Table 3
    Secondary outcomes over time.
    Measure and time point Family-focused CBT mean (SD) Psycho-education mean (SD) Effect F-statistic (df ¼ 1) p Value

    Fatigue (Chalder Fatigue Scale)
    Baseline 22.26 (5.71) 29.43 (4.66) Group 0.43 0.51
    6 Month follow-up 13.31 (5.90) 14.16 (8.42) Time 0.03 0.86
    12 Month follow-up 10.40 (5.70) 12.15 (4.79) Group  time 0.03 0.87

    Physical functioning (SF-36)
    Baseline 51.25 (26.34) 41.67 (24.34) Group 1.05 0.32
    6 Month follow-up 80.36 (20.19) 64.00 (36.38) Time 0.10 0.75
    24 Month follow-up 76.79 (29.81) 71.20 (27.99) Group  time 2.71 0.12

    So we have an average Chalder Fatigue Scale that is less than 11. I maintain these scores show the problems with this scale particularly with CBT studies. These people are saying they have less fatigue than before they were ill effectively. Healthy people score 11 out of 33.
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  6. Dolphin

    Dolphin Senior Member

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    Small error, I think:
    I think they gave scores out of 8, not 40

    as:
    Measure and time point Family-focused CBT mean (SD) Psycho-education mean (SD) Effect F-statistic (df ¼ 1) p Value
    Impairment (SAS)a Median (IQR) Median (IQR) Z score
    Baseline 4.90 (3.45e5.60) 5.00 (4.40e6.50) Group 
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  7. Valentijn

    Valentijn Activity Level: 3

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    70% attendance would result in students typically being flunked where I went to school, and that was true for high school, university, and law school.
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  8. Dolphin

    Dolphin Senior Member

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    Probably last observation.
    30% didn't respond, although no particular evidence this would bias the results




  9. Simon

    Simon

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    Some thoughts:

    • School attendance was self-reported, as opposed to monitored and reported by the schools, as it has been in other studies. That leaves scope for self-report bias: ask a teenager how much they've been attending school as a result of the programme they are on - and you might not get entirely accurate responses, you might even get overstated attendance.
    • The results don't really seem to add up. There was no control group so there can be no robust conclusion on whether or not CBT or Psycho-education actually works. That said, some of the gains were awesome, with teenagers on CBT reporting that on average they had even less fatigue than before they were ill (as Dolphin says above). Psycho-education too got people back to normal in 6 months. The fact that 4 hours of anything can get those with severe fatigue back to normal in 6 months makes me very sceptical. It could mean that natural recovery rates are very high (and treatments have little effect), or they have found the answer to CFS. Either way, such strange results make me doubt the findings.
    Less important
    • Hard to tell if the high attrition rate biased results. The study was very small with a 30% loss to follow-up at 24 months. That limits the power of the study to detect baseline differences between those who were followed up (44) and those who were not (19) - and of course they wouldn't know if people had lost contact because they had become severely-affected.
    • The small study size also makes it hard to detect any real differences between CBT & Psycho-education.
    • Note that Psycho-education were much more fatigued at baseline than CBT (29.4 vs 22.3), which was significant, and more impaired (SF36 41.6 v 51.2), which was not significant but with such small sample differences have to be huge to be significant. So the most-impaired group got the least treatment (4 hours) while the least impaired got 13 hours, making for a lopsided experiment.
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  10. alex3619

    alex3619 Senior Member

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    To get through a science degree at my university, there was a mandatory near 100% attendance for labwork. You could miss a couple with a doctors certificate, but not many. This was why one subject I really wanted to do but had a very very heavy lab component was put in the too hard basket.
  11. Dolphin

    Dolphin Senior Member

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    The good prognosis/recovery rates in children make me consider the results of research of interventions for them less reliable. Get a reasonable percentage of adults who has been diagnosed* an average of five years, say, (and none less than say three years) back to good functioning and I can find that impressive enough - there seems a good chance it might not be due to chance. Do this for the same percentage of children (or even a much higher percentage) and I still wonder was it natural recovery as well as advice in the early stages of the illness.

    *I make a distinction with length ill because if you have not known what was wrong with you, there's quite a good chance you weren't managing the illness well for one reason or another (including pressure from outside sources e.g. expected to work or study full-time); after getting diagnosed, many people, particularly those able to and inclined to read up on it, will improve a bit.
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