Review: 'Through the Shadowlands’ describes Julie Rehmeyer's ME/CFS Odyssey
I should note at the outset that this review is based on an audio version of the galleys and the epilogue from the finished work. Julie Rehmeyer sent me the final version as a PDF, but for some reason my text to voice software (Kurzweil) had issues with it. I understand that it is...
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Mark Vink: Assessment of Individual PACE Trial Data: CBT and GET are Ineffective

Discussion in 'Latest ME/CFS Research' started by Cheshire, Jan 15, 2017.

  1. Cheshire

    Cheshire Senior Member

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    Assessment of Individual PACE Trial Data: in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Cognitive Behavioral and Graded Exercise Therapy are Ineffective, Do Not Lead to Actual Recovery and Negative Outcomes may be Higher than Reported

    Journal of Neurology and Neurobiology

    https://www.sciforschenonline.org/journals/neurology/article-data/JNNB-3-136/JNNB-3-136.pdf
     
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  2. A.B.

    A.B. Senior Member

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  3. TiredSam

    TiredSam The wise nematode hibernates

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    I'm running out of superlatives today, I've already used "brilliant" on the Things are Heating Up in Canada thread, so I'll just have to say

    Fabulous :thumbsup:

    to this.

    Hope there isn't any more good news today, having to find too many new words in such a short space of time can be a bit of a challenge.
     
  4. user9876

    user9876 Senior Member

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    I think it is a shame he didn't do a significance test on his version of improved with the 6mwt. I suspect this would show a lack of significance especially when using an ITT analysis. But I'm not convinced that the improvement measure he has used is a good one.

    I like that he has looked at a comparison of improvement for the 6mwt against the subjective measures but I feel looking at correlations here would be more interesting in terms of the improvement on scales rather then those marked as improved. Its not clear to me how many of those marked as improving on the subjective outcomes don't improve on objective outcomes due to a lack of data. To a certain extent is may be irrelevant since those refusing to do the 6mwt at the end may well be refusing because they are not up to it suggesting an improved label would be difficult.
     
  5. trishrhymes

    trishrhymes Senior Member

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    Bloody brilliant.

    I've only read the abstract so far, haven't enough brain cells left today to tackle the rest, but I can see it's a further demolition of PACE.

    Three cheers for Mark Vink.:balloons::balloons::balloons:
     
  6. Jenny TipsforME

    Jenny TipsforME Senior Member

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    My brain is hurting today. Please can someone explain in brainfog English how he gets to the 'negatively affected ' figures?
     
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  7. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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  8. Joh

    Joh Inactivist

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  9. Dolphin

    Dolphin Senior Member

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    Well done to him. His analysis makes lots of interesting points. However, some of it is written a bit differently to standard scientific papers which might take away a little credibility for some people reading it.
     
  10. Tom Kindlon

    Tom Kindlon Senior Member

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    Vink 2017 quote one.png
     
  11. Tom Kindlon

    Tom Kindlon Senior Member

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    Vink 2017 quote 2.png
     
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  12. Dolphin

    Dolphin Senior Member

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    I'm going to post a few minor criticisms I have.

    I liked an awful lot of this, too much for me to highlight.
    But I think it is important that readers know all the facts.
     
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  13. Dolphin

    Dolphin Senior Member

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    I think he should have said that by the improvement rates reported in the Lancet paper, 45% improved in the specialist medical care group. So the improvement rate wasn't really 6 times higher when you subtract the effect for specialist medical care.
     
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  14. Dolphin

    Dolphin Senior Member

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    There was a statistically significant improvement for the 6 minute walking test in the graded exercise therapy group. Though the improvement of 35 m over specialist medical care alone when adjusted for baseline factors is not that big given there was plenty of scope for possible improvement.
     
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  15. trishrhymes

    trishrhymes Senior Member

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    Statistically significant, but not clinically significant, which I think is the point he's making, and from memory, I think there was a higher proportion of Get patients who didn't do the second walk, which as far as I'm concerned invalidates that small statistical significance.
     
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  16. Dolphin

    Dolphin Senior Member

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    If he meant clinically significant, I think he should have used different language to this:
     
    Last edited: Jan 17, 2017
  17. Dolphin

    Dolphin Senior Member

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    A bimodal score of 0 is equivalent to a Likert score of 0 to 11.
    However I don't think he uses this in any of his analyses so it is not a big error it seems to me.
     
  18. Dolphin

    Dolphin Senior Member

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    These are people whose 6 minute walking test distances improved by at least 50%.

    Sometimes if somebody had a good baseline score, improving by 50% would be unrealistic. It would have been interesting if he had given data on the numbers of these (I suspect the number is quite small in this sample)

    Similarly for this calculation:
     
    Last edited: Jan 18, 2017
  19. Dolphin

    Dolphin Senior Member

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    I think it would have been good if he had explicitly said that "very much better" was an option. People who are ticking "much better" are saying they are not "very much better". You would expect people who recovered to take the top possibility.

     
  20. Dolphin

    Dolphin Senior Member

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    For this sensitivity analysis, I think he should also have highlighted that the other possibility is that nobody with ME was negatively affected.

    Also he should probably have given the figures for the specialist medical care group and possibly also the adaptive pacing group. There can be some random variation: you need to be careful how much you read into the scores of some people deteriorating.
    Vink 4.png
     

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