Discussion in 'Latest ME/CFS Research' started by Dolphin, Mar 11, 2014.
(Not an exciting paper, IMHO)
*I gave each sentence its own paragraph
(these comments aren't that exciting but I thought I'd post them as I put myself through reading the paper)
The two sets of data they use are:
This is from the Nijmegen group who could be described as huge fans of CBT for CFS. As with lots of their papers (and many other CBT papers from other countries) it would have been more interesting if objective measures had been used. Here neither the dependent variable (fatigue) nor the possible moderators are objective. Somebody could report improved fatigue after CBT and still be quite ill. With CBT (and presumably the guided self-instruction intervention),
Adopting this sort of attitude could easily lower the quantity of fatigue one reports.
This is how "avoidance of activity" was measured:
They also investigated other potential moderators:
(This quote refers to liner regression, where fatigue is measured on a continuous scale.)
Similar results were found with regard to logistic regression. This involves dividing the outcome into two groups, "successful" and "unsuccessful" (my wording):
Similar results were found with regard to linear regression. However, physical functioning (SF-36 PF) was p=0.06 so I think that should be considered a borderline result so I don't think they should have tried to make the big distinction they did between SF-36 PF and SIP:
Also, talking about it as "in a previous trial performed in a tertiary treatment centre" seems to me a bit weird: the current paper is looking at the data from paper 9, plus another study.
Interesting that those who were most depressed reported benefiting least from self-instruction -I could cheekily suggest that's depressive realism counter-acting response bias!
Also, those who reported avoiding activity reported benefiting least from self-instruction designed to discourage people from avoiding activity... shouldn't it be the other way around? Shouldn't these be the people most likely to have the cognitive problems being targeted by the intervention? Did they say what they'd predicted at the start of the trial?
They described it as a post-hoc analysis and didn't mention any specific predictions, as I recall.
This is the introduction which lists previously findings:
Regarding the definition of "avoidance of activity":
Isn't this normal behavior for people suffering from fatigue? Patients with severe fatiguing illness such as cancer and MS will probably adopt the exact same behaviour, and anything else would be self harm. Who are the authors to decide that this is suddenly unhealthy pathological behavior?
In other words, the more fatigued people were, the less this form of CBT worked.
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