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FITNET Trial: Effectiveness of internet-based CBT for CFS: an RCT (Nijhof et al, '12)

Discussion in 'Latest ME/CFS Research' started by Dolphin, Feb 29, 2012.

  1. Marco

    Marco Old blackguard

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    Here's the link and relevant extract.

    http://www.cfids-cab.org/cfs-inform/Ptsd/mccue.etal06.pdf

    Screening for psychological distress using internet administration of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome

    This would suggest that internet delivery might reduce the effects of social desirability bias and encourage more frank disclosure. On the other hand its difficult to tell what other biases might be introduced. People behave strangely on the 'net'. The may also behave differently when someone has their e-mail address.
     
  2. Dolphin

    Dolphin Senior Member

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    None that I can see.
     
  3. oceanblue

    oceanblue Senior Member

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    Thanks, Marco.

    It may be that the assessment in this study was face to face:
    @Dolphin. Thanks, I've now read the paper myself, and couldn't see any evidence in support of their approach either.
     
  4. oceanblue

    oceanblue Senior Member

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    More on school attendance

    I don't know if this is relevant:
    There appears to be a surprisingly small difference between a 'functionally-impaired' school attendance of 85% or less and a 'recovered' school attendance of 90% or more:
     
  5. Dolphin

    Dolphin Senior Member

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    Sorry, where are you getting the 9 at >95%? Thanks
     
  6. Dolphin

    Dolphin Senior Member

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    Nothing close to that, I think it's fair to say.

    The FITNET protocol is based on this:

    which can be read here: https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1009C&L=CO-CURE&P=R1774&I=-3
     
  7. Dolphin

    Dolphin Senior Member

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    I think that could be happening.
    There was a lot of pressure on these to attend school:

    (i) CBT therapist wanted it

    (ii) Parents were doing a type of CBT and being convinced this is what the children should do

    (iii) The children were prescribed a school monitor:
    (iv) the program in itself (what they had to read) would try to persuade the adolescent they should go to school.
     
  8. Dolphin

    Dolphin Senior Member

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    Technically they can get away with it. It is listed more in the predictors section, "Possible patient's predictors of treatment outcome":
    http://www.biomedcentral.com/1471-2377/11/23/table/T2
    But they did use it at 6 months as 12 months as well as baseline.

    As I mentioned above, we have no evidence that they never took the readings.
     
  9. Dolphin

    Dolphin Senior Member

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    @user9876 I still think one can make points asking for actometers to be used. There are lots of different ones on the market. It's generally accepted they are better than questionnaires and I think Nijs et al recently referred to as them as the gold standard way to measure activity.
     
  10. Dolphin

    Dolphin Senior Member

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    Protocol was submitted when the trial was almost finished

    The Lancet paper says:
    The protocol was received by the journal: 28 January 2011 (ref: http://www.biomedcentral.com/1471-2377/11/23).

    Seems a bit odd.

    It was registered so maybe they didn't change anything:
    http://www.controlled-trials.com/ISRCTN59878666 and http://www.clinicaltrials.gov/ct2/show/NCT00893438
     
  11. oceanblue

    oceanblue Senior Member

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    My point was that they are indeed referred to as a gold standard, but this is assumed rather than proven for 'free-living' humans. They give valuable information on activity and where actometers and questionnaires give confliciting answers that raises serious doubts about the validity of the findings - as happened in a previous CBT trial. So it's important to have the actometer data to help better gauge true activity levels and I agree it's worthwhile to ask for them to be used. I can't help feeling that if the actometer data strongly supported their findings, the authors would have mentioned it in this paper.
     
  12. oceanblue

    oceanblue Senior Member

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  13. Dolphin

    Dolphin Senior Member

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    Error in Appendix (I'm pretty sure) - may or may not be important

    Mean +2 SD = 40.
    This would mean that the SD is 5 and hence the mean is 30.
    That's not right - what I have seen before is some number in the teens (possible scores are 8-56)
     
  14. charityfundraiser

    charityfundraiser Senior Member

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    Take a look at Table 4. In the last two rows, they have practically the same physical functioning score but a 25% difference in school attendance. Rows 3 and 7 have practically the same fatigue severity score but almost a 30% difference in school attendance.
     
    oceanblue and Dolphin like this.
  15. Dolphin

    Dolphin Senior Member

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    Duration of illness at baseline

    The authors refer to 2 years at one stage:
    However using median and range the figures are:

    I'd expect adolescents who were ill for only that length of time to have a relatively good prognosis.
     
  16. Sean

    Sean Senior Member

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    My recall is that one of the few predictors of natural improvement is duration of illness at diagnosis. An earlier diagnosis in an adolescent may be more likely because 1) they are much younger and have had less time to have the disease, and 2) may just be more closely monitored in general than adults (so any health trouble will get picked up earlier). If so then they will naturally tend to have better outcomes, independent of other factors. Throw in that adolescents (and children in general) seem to have better overall recoveries than adults for a wide range of medical problems...

    That could account for a large chunk of the 'therapeutic' effect in this study.
     
    WillowJ and Dolphin like this.
  17. Marco

    Marco Old blackguard

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  18. Snow Leopard

    Snow Leopard Senior Member

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    Yes, but honest scientists don't 'get away with' not publishing the most useful objective data that they measured. I was taught to always show all data, null effect or warts and all.
     
  19. oceanblue

    oceanblue Senior Member

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    Here's some workplace data on CIS norms: Fatigue among working people: validity of a questionnaire measure, see Table 2

    White collar worker 20.3 (10.1) mean (SD)

    Blue collar: 21.9 (11.4)

    After hernia: 32.9 (11.7)

    Pregnant: 33.9 (13.0)

    Mental: 39.6 (12.1)

    On these figures (which are from some of the FITNET co-authors), 30 does look high for a healthy mean. Though maybe adolescents are more fatigued than adults...

    A nature paper on bone marrow transplation gives mean fatigue levels under 30 even though around 1/3 of theseare stated as having severe fatigue.

    I've also seen >35 as the threshold for severe fatigue eg a Bleijenberg paper on Rheumatoid Arthritis.


    Ah, maybe this is it: Is a Full Recovery Possible after Cognitive Behavioural Therapy for Chronic Fatigue Syndrome?
     
  20. PhoenixDown

    PhoenixDown Senior Member

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    I'd like agree with earlier posters who pointed out that school attendance shows us very little of their overall performance, what about improvement in grades? How long were they at school for? Did they take all the classes that healthy kids took? This could be a case of forcing attendance without significant improvement of the academic disability that this illnesses can cause.

    Disease, what disease is that then? What was the diagnostic criteria? Seems like they are letting anyone with 25% fatigue in to this illness category.

    It also looks like they are talking about general fatigue alone, where was the mention of balance problems, severe memory problems, vocabulary regularly disappearing into thin air, auditory processing disorders, POTS, slurred speech, tremors, severe concentration issues?

    It really is long over due for society to stop using this waste-basket term. This explains why I was once told by my doctor that "You can't be that ill, you only have CFS".
     
    Wildcat likes this.

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