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Quantifying the Placebo Effect in Psychological Outcomes of Exercise Training: A Meta-Analysis

Discussion in 'Other Health News and Research' started by Dolphin, Mar 15, 2015.

  1. Dolphin

    Dolphin Senior Member

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    http://link.springer.com/article/10.1007/s40279-015-0303-1

    Thought there was a chance this might be interesting. Don't have the full text myself.

    They do reference a few CFS papers:
    1. Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;(3):CD003200.
    2. Edmonds M, McGuire H, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Libr. 2013;8:1–19.
    3. Castell BD, Kazantzis N, Moss-Morris RE. Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clin Psychol Sci Pract. 2011;18:311–24
    4. Cho HJ, Hotopf M, Wessely S. The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis. Psychosom Med. 2005;67(2):301–13.


     
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  2. Esther12

    Esther12 Senior Member

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    Looks interesting. They included fatigue and pain as psychological outcomes. I can't find a copy of it available.
     
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  3. Denise

    Denise Senior Member

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    Thanks for finding this abstract.
    I agree that this looks like an interesting read.
     
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  4. Esther12

    Esther12 Senior Member

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    I've just got a copy. I don't think that this paper is going to be particularly revelatory for most people here, and the limited evidence available made it difficult for the authors to provide really interesting results for us. It's good to see some of these problems being acknowledged, but I'm not sure that their recommendations for the future are that great. It is a difficult problem to overcome though, and I think that the most important change needed is ensuring that researchers and clinicians are always open about the problems with the research that underpins their claims about the value of exercise interventions.

    They note the problem of a failure to account for placebo effects leading to exaggerated claims about the value of exercise.

    They examine trials which have a 'real' exercise intervention and then a 'placebo' exercise intervention for which there is no good evidence of possible efficacy (eg: light hand exercises). I'm concerned that such 'placebo' interventions are less likely to induce bias and placebo effects than 'real' exercise interventions, and also, for CFS there has been a trend for GET promoters to try to argue (now that they've been busted over claims of fitness, activity levels, etc) that the 'real' value of exercise is in introducing patients to activity, and helping them overcome fears of it.

    The rest of this post is really just my notes and quotes I pulled out. The paper's 19 pages, so some won't want to read the whole thing themselves.



    They had a difficult job to do, but to me it sounds like the exercise interventions are more likely to lead to problems with bias than their placebo controls, so this review will only be able to say that certain unusually limited types of exercise intervention are associated with certain changes in questionnaire scores.

    This could still be interesting though:

    No CFS studies were included.

    From their discussion:

    I don't think that this is surprising, but might be worth keeping as a reference to cite/quote, although overall I'm not sure how helpful the paper is:

    I thought that this was interesting:

    Their recommendations for the future:

    On pain:

    Their conclusion:

     
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  5. Sean

    Sean Senior Member

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    Useful statement.

    (Not sure if psychological outcomes include any subjective self-report measure of physical capacity. I would think so, but others may not...)
     
  6. Esther12

    Esther12 Senior Member

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    They listed these as subjective outcomes from Tench et al. [86]. (Co-authored with PD White).

    Study here: http://rheumatology.oxfordjournals.org/content/42/9/1050.full

    They said:

    So it looks like the SF36-PF PF scale was not counted as subjective:

    Also, looking at this placebo study again reminded me that they released quite a lot of data I did not really go through. I only focussed on the main findings that they discussed.
     
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  7. user9876

    user9876 Senior Member

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    I can see an argument that says it is not subjective in that it asks questions about how you cope with different defined physical activities. However, unless you test people then the answers are perceptions of the individual at the time around how easy/hard an activity is. A couple of the questions are quite vague as well. So to improve a score you only need to change someones perception of the ease of an activity rather than how they can actually cope. Hence in reality it is subjective.

    An extra complexity comes in with ME in that someone may answer to say they have no problems walking several blocks and no problems climbing several flights of stairs. But the survey doesn't capture the idea that both couldn't be done on the same day or that there would be a long recovery time with PEM. Again this is an area where peoples perceptions may change or they could be encouraged to fill out a questionnaire differently.
     
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  8. Sean

    Sean Senior Member

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    Well, that is a problem right there. It is clearly subjective.
     
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