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Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for CFS Vos-Vromans

Discussion in 'Latest ME/CFS Research' started by Dolphin, Aug 28, 2015.

  1. Dolphin

    Dolphin Senior Member

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    New study with an intervention that did better than CBT.

    Lots of comments to follow

     
    Last edited: Aug 28, 2015
    Valentijn, Esther12, Roy S and 2 others like this.
  2. Dolphin

    Dolphin Senior Member

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    Lots and lots of questionnaire data in this paper.

    There is one set of objective measurements from an actometer:

    Multidisciplinary rehabilitation treatment
    So a 5.8% increase.

    cognitive behavioural therapy
    So a 6.55% increase

    Note however that this was over 12 months and people after they get diagnosed are more likely to improve than disimprove, I think it's fair to say.

    Quite a lot of people were in fairly early stages so quite likely to improve:

    Even the people who are ill more than >5 years might improve "naturally", without therapy, if they have only been diagnosed. I think lots of people get a bounce in the year after getting diagnosed.

    There is quite a lot of missing data with the activity monitors:
    The researchers don't mention any sort of analysis to see whether the groups are different.
     
    Last edited: Aug 28, 2015
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  3. Hutan

    Hutan Kina solidarity

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    So, no control group with standard care.

    And for the only objective measure, activity levels as measured by an actometer, both treatment groups show a very marginal increase. But there's no evidence that the CBT has a worse impact on activity than the multidisciplinary rehabilitation treatment (in fact some very weak evidence to the contrary). And yet the abstract is written to make it sound as though the rehabilitation treatment is a great success.

    Presumably the actometer was only used for a week or so at each time of measure? And both treatment groups would have been told pretty clearly that increased activity was a sign that they were good diligent people. I wonder how the patients felt in the week after the actometer measurement.
     
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  4. Dolphin

    Dolphin Senior Member

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    The therapies were not matched for contact hours. MRT involved 44.5 contact hours and CBT 16 contact hours. This could affect how people might respond to questionnaires.
     
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  5. Dolphin

    Dolphin Senior Member

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    These therapies, especially MRT, would not be cheap.

    Also 44.5 hours isn't the full cost of MRT. There would also be some discussion time between the people working with the patient
    e.g.
    and
     
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  6. Dolphin

    Dolphin Senior Member

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    One of the Dutch ME charities co-funded this study:
     
  7. Dolphin

    Dolphin Senior Member

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    There's an open access protocol. I haven't read it. This provides descriptions of the therapies.

    It would be interesting if somebody compared the protocol and what was actually published.


    Free full text: http://www.trialsjournal.com/content/13/1/71

     
  8. alkt

    alkt Senior Member

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    i have not always been able to keep up with the press/news over the past 25 years. but the only instances of violence involving people with m.e that has come to my attention has been when the person with m.e has been assaulted. in one case the victim of assault died. he was assaulted in a supermarket cue in the uk.
     
  9. Dolphin

    Dolphin Senior Member

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    There were stark differences based on level of education. There was only a difference between people with MRT and CBT for people with a low level of education:


    This is what they say in the discussion:

    I wonder could there be other things going on. Might low levels of education be associated on average with social deprivation and a greater array of problems in people's lives than perhaps could be helped a bit with all the contact hours they got with MRT?
     
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  10. Dolphin

    Dolphin Senior Member

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    Not sure what the relevance of this is to what I wrote/the thread?
     
  11. Dolphin

    Dolphin Senior Member

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    I thought I'd copy in the descriptions of the therapies as some people might never follow the links:

    (From the protocol: http://www.trialsjournal.com/content/13/1/71)

     
  12. Dolphin

    Dolphin Senior Member

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    Description of MRT from the protocol: http://www.trialsjournal.com/content/13/1/71

     
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  13. alkt

    alkt Senior Member

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    in advertisements for clinical posts .in two different uk c.f.s clinics the wording in the job descriptions made it seem like people with m.e c.f.s are more prone to dangerous violent outbursts. basically setting the background for respondents to see people as mentally ill. sorry i have mixed this up with an earlier post about the psychiatric treatment of patients with m.e c f s.in reference to the patient handout in liverpool. it was a carry on from that.
     
    Last edited: Aug 28, 2015
  14. Dolphin

    Dolphin Senior Member

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    Ok. Thanks for replying. I still don't see how that directly relates to what I wrote/you quoted but I suppose worthwhile mentioning now and again.
     
  15. Dolphin

    Dolphin Senior Member

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    I find it disappointing when they do this. One can't see who said "dissatisfied or very much dissatisfied" as opposed to simply "neutral".
    Similarly, one can't find who said "declined" and "very much declined" as opposed to "neutral".
     
  16. Dolphin

    Dolphin Senior Member

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    Withdrawals.

     
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  17. Dolphin

    Dolphin Senior Member

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    Adherence (70% is an arbitrary figure):
     
  18. Dolphin

    Dolphin Senior Member

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    35 is a fairly arbitrary figure though it does tend to be used quite a lot in Dutch CBT studies.
     
  19. Dolphin

    Dolphin Senior Member

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    For MRT, the CIS-fatigue scores were:
    baseline: 51.47 (5.08)
    52 weeks: 33.84 (14.33).

    The scale is 8-56, so if one translates the scores to a 0-48 scale they're:
    43.47 (out of 48) (or 90.5625% fatigued)
    25.84 (out of 48) (or 53.8333% fatigued)

    That's a big difference compared to the the objective change (mentioned previously above) i.e.

    A 5.8% increase from baseline to 52 weeks.
     
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  20. Dolphin

    Dolphin Senior Member

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    2 big differences between MRT and CBT:

     
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