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(PACE Trial) Training, supervision and therapists' adherence to manual-based therapy

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 19, 2013.

  1. Dolphin

    Dolphin Senior Member

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    http://www.ijtr.co.uk/cgi-bin/go.pl/library/abstract.html?uid=97926
  2. Dolphin

    Dolphin Senior Member

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    For what it's worth:


  3. Dolphin

    Dolphin Senior Member

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    Not sure this paper is worth spending time reading for most people interested in ME/CFS (and perhaps a lot of other people also!).

    As far as I can see, it doesn't contain any new quantitative data.

    The results section is really short for a 7-page paper:


    Table 1. Adherence to therapy and therapy manuals is just data from Table 2 in White et al, 2011 on five items:

    i.e.


  4. Dolphin

    Dolphin Senior Member

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    This reminds me of something in the main PACE Trial paper in the Lancet I thought I'd highlight again:

    From Appendix:
    This is clearly not CFS experience as most didn't have any (see next set of figures). So I find the underline quote potentially misleading.

    Also,
    So 54% for CBT.

    Also, I think they should have given the figure for CFS on its own, rather than also including "chronic pain". I'm suspicious the reason they didn't is because the figures for APT would have been lower again.
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  5. Dolphin

    Dolphin Senior Member

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    So all therapists, APT, GET & CBT, told there was evidence for GET & CBT but not for APT.
  6. Dolphin

    Dolphin Senior Member

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    So they're acknowledging the PACE Trial is an artificial environment.

    Here is what they had said earlier about the efficacy inside and outside trials/what they said about Bazelmans et al., 2004:
  7. Dolphin

    Dolphin Senior Member

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    It may well be an accurate description of what currently does happen; but it's not necessarily good that routine clinical practice would be like this and it shouldn't be encouraged (i.e. the view that adverse events are not relevant for clinical practice) particularly with graded activity/exercise-oriented therapies.
  8. WillowJ

    WillowJ Senior Member

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    Could this be because GP's have no allegiance to CBT?
    http://blogs.scientificamerican.com...-effect-why-psychotherapies-never-get-better/
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  9. Snow Leopard

    Snow Leopard Senior Member

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    Wait, why did they claim the APT therapists were the most experienced, when it was the CBT therapists who were the most experienced? *confused*
  10. WillowJ

    WillowJ Senior Member

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    It looks to me like the longer amount of experience they say counted, was in any field other than CFS or chronic pain. So could have been eating disorders, GAD, OCD, substance abuse, insomnia, and whatever else they normally use cognition/behaviour-modification CBT for.

    Or, you know, coping skills for living with a disease you can't change CBT (not that none of the others are permanent diseases, just that psychiatry doesn't see them as not having a significant cognitive behavioural component... then again, they think cancer fatigue does, too!) but I sort of doubt PACE would hire someone with that experience.
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  11. Roy S

    Roy S former DC ME/CFS lobbyist

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    Hear Ye! Hear Ye! Hear Ye!


    Fantastic news! As we have made clear (well,... of course only to those superior beings who are able to see -- and you know who you are) The Emperor's New Clothes were elegantly designed and mass produced with proven precision. Even the House of Cards they were made in is precise. And even though we are aware (of course) that meta-analyses of other clothes prove that they are no better than those in other wardrobes ... that clearly doesn't apply to ours and we have proven it because we have said that before.
    You know, someone who is really good at parody could do a series with things like alternate names with objectives, methods, results, and conclusions.

    Resurrect Monty Python!
  12. Bob

    Bob

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    There's some interesting stuff in that article (my emphasis):
    The text that I've bolded applies to CBT vs APT in the PACE trial, where CBT patients were told that they had the potential to improve and recover, whereas APT patients were told that they could expect to manage their illness. (I'm paraphrasing, as I can't remember the exact wording of the methodology.)
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  13. biophile

    biophile Places I'd rather be.

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  14. Valentijn

    Valentijn Activity Level: 3

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    Hilarious :D And oh so accurate!
  15. Graham

    Graham Senior Moment

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    I think we should have had Engineer Chalder blaming the hull for thinking that it was suffering from metal fatigue, and collapsing when there was no real need.

    According a survey carried out of elderly hulls in various ship breaking yards, it is quite normal for them to be showing signs of some fatigue.
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  16. Dolphin

    Dolphin Senior Member

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    :)

    Yes, after that intervention from Engineer Chalder, the (metal) fatigue was measured and found to be in the normal range for ships that exist.

    Initially it was announced that this rate of metal fatigue was in the normal range for ships of working age but after a good-for-nothing pointed out this was not the case, Engineer Chalder agreed that it was the normal range for ships of all ages.
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  17. WillowJ

    WillowJ Senior Member

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    There's a link from the SciAm provider allegiance article to a PDF of a paper on meta-analysis, but it's highly technical. Some of the maths/stats people would probably like it.

    It's the Dodo paper under "allegiance effect" in one of Bob's quotes. The Dodo Bird from Alice in Wonderland (or possibly Through the Looking Glass) organizes a haphazard "race" and at the end he decides, "Everybody has won and all must have prizes" (which Alice must supply).

    Hence the SciAm blogger's conclusion "All are losers, and none must have prizes."
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  18. Dolphin

    Dolphin Senior Member

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    Regarding allegiance, I thought I'd point out some promised data which followed some comments on the protocol:

  19. biophile

    biophile Places I'd rather be.

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    A variation of Dolphin's theme: The definition for normal range in the ship's function after revival overlapped with the definition of unseaworthiness during the original inspection of the ship.
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  20. Snow Leopard

    Snow Leopard Senior Member

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    More data that hasn't been published... Seems to be a trend.
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