1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
Dr. Kerr, I presume?
Clark Ellis brings us a rare interview with British researcher Dr. Jonathan Kerr who is now living in Colombia.
Discuss the article on the Forums.

Process of CBT for CFS: Which perpetuating cognitions & behaviour changes related to fatigue reductn

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jul 22, 2013.

  1. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    It's a pain: they only give the results in figures:
    [​IMG]

    This means it is possible for a responder to only drop one point (out of 56) and be counted as a responder as the entry criteria require a fatigue score >=35.
    Last edited: Mar 1, 2014
    Valentijn likes this.
  2. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    Fatigue did actually correlate with objective activity on completion, although it didn't at baseline or at the two interim time points:
    [​IMG]
  3. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    This study didn't use a SF-36 physical functioning threshold for entry.

    The mean (SD) SF-36 physical functioning scores at baseline were 57.5 (20.1). This is close to the "normal functioning" threshold of SF-36 PF>=60 that was used in the PACE Trial (one could also be recovered with a score of 60). This means that probably somewhere close to 50% of those with CFS (Fukuda) had "normal functioning" at baseline (i.e. before any therapy) if one uses the PACE threshold!
    Valentijn likes this.
  4. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    I tried to make an estimate of objective figures.
    On completion, it looks like something like:
    non-responders (n=52): 67.6
    fast (n=42): 76.7
    mid-term (n=44): 76.7
    slow (n=41): 78.04
    Gives a mean of: 74.36.

    This contrasts with a mean of 91 in healthy controls reported in Wiborg et al (2010):

    The baseline scores in this study are a little higher here - I'm too tired to try to calculate - maybe around 67.5-68.
    Valentijn likes this.
  5. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    Here's talk about deconditioning/increasing exercise:

    Introduction:

    Methods:

    Results:

    Discussion:

    *Average levels of activity were similar (a few percentage points higher) to the pre-treatment levels in the three studies looked at in Wiborg et al. (2010) and Van der Werf (2000) also had similar scores to Wiborg et al. (2010). All a long way from the mean healthy controls of 91.

    Last edited: Mar 2, 2014
    MeSci, Valentijn and Esther12 like this.
  6. Dolphin

    Dolphin Senior Member

    Messages:
    6,701
    Likes:
    5,517
    This should set off people's mental alarms that CBT may lead to response bias in how questions about fatigue are answered.
  7. Sean

    Sean Senior Member

    Messages:
    1,214
    Likes:
    1,961
    If thine objective results please thee not, then cast them aside.
    MeSci, Valentijn and Dolphin like this.
  8. Esther12

    Esther12 Senior Member

    Messages:
    5,262
    Likes:
    5,445
    Was unsure whether it would be worth starting a new thread on this paper from 2009. Didn't look revelatory, but still relevant to the objective capacity vs subjective fatigue thing:

    http://www.pmrjournal.org/article/S1934-1482(09)00436-5/abstract

    Valentijn and Dolphin like this.
  9. Snow Leopard

    Snow Leopard Senior Member

    Messages:
    2,302
    Likes:
    1,761
    Australia
    With respect to the aforementioned paper by Esther, is it necessarily that fatigue was not correlated with VO2 peak, or that fatigue questionnaires are not precise enough/of sufficient quality (too vague etc) to be correlated with VO2 peak...
  10. A.B.

    A.B. Senior Member

    Messages:
    643
    Likes:
    1,812
    There is no reason to assume that fatigue should correlate well with VO2 peak in the first place.
    Valentijn likes this.
  11. Firestormm

    Firestormm Guest

    Messages:
    5,824
    Likes:
    5,974
    Cornwall England
    What might be the impact of us adapting our abilities to our condition, when we are told to 'exercise to the max'? What I mean to say is, I have been adapting to my health restrictions - and pushing against them - improving and relapsing as I am permitted - but have I adapted to such an extent that this has impacted on my ability now to 'exercise'? Has my body accommodated itself? And if, you caught me in a period of relative 'remission' what impact might that have on any physiological measure for ME? Or perhaps this can be said to have been taken into account in these kind of studies? :)
  12. Valentijn

    Valentijn Activity Level: 3

    Messages:
    6,262
    Likes:
    8,935
    Amersfoort, Netherlands
    Deconditioning has very little impact on ME/CFS patients, as evidenced by our ability to instantly function pretty normally during abrupt remissions.

    It's also been shown in two-day CPET tests that the reaction of ME/CFS patients to repeated maximal exertion is strikingly different from that of deconditioned (sedentary) controls. Deconditioned people have improved performance on the 2nd day, whereas ME/CFS patients get much worse.
  13. Firestormm

    Firestormm Guest

    Messages:
    5,824
    Likes:
    5,974
    Cornwall England
    But what I am saying - being cack-handed as usual - is that the 'disease' that is ME may not be playing a role here (or indeed it might). Rather, this testing is measuring our functional abilities - and those might have been compounded by our efforts to adapt. Say, you do this test (I think you have), and I do it (I haven't). We both have and can meet the various diagnoses for ME. But, I know that you have more 'things wrong with you' than I do, and so we will both have a different functional capacity unrelated - I think at least it is fair to say - to our ME. Or it can't be said that ME is exclusively the cause of our functional impairments. Unless the inability to meet the results of those without a diagnosis of ME, can be discovered to be a direct result of our primary (perhaps) diagnosis...

    I'll come back to that. Sorry. Am a bit BLURGH this morning :)
  14. Valentijn

    Valentijn Activity Level: 3

    Messages:
    6,262
    Likes:
    8,935
    Amersfoort, Netherlands
    If we both have ME/CFS (which should include PEM) then we should both have reduced VO2max results on day 2 compared to our results for day 1. How bad our results are, either at the 1st day or compared to the 1st day, would vary from patient to patient. Gender, for example, has a huge impact.

    I suppose it would be possible that some actual deconditioning in reflected in the results. But since results are much worse on day 2 (whereas merely deconditioned controls improve), it would seem that the PEM-inducing disease process is having a much bigger impact than deconditioning. If both influences were roughly the same, I'd expect ME patients to see little change on day 2, as the conditioning effects of day 1 would approximately balance out the decrease in function caused by the disease.

    But because there is a large decline in VO2max the 2nd day, this suggests that deconditioning is having a negligible impact in counter-acting the decline shown in the day 2 results.
    Last edited: Mar 3, 2014

See more popular forum discussions.

Share This Page