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!
Join the National PR Campaign for ME: Power to the Patient (P2tP)
Have you had enough of all the neglect and abuse of ME/CFS patients? Gabby Klein says now is the time for a National PR Campaign for ME/CFS to impress a change. Join the Patient Revolution to restore power to ME patients ...
Discuss the article on the Forums.

The FINE Trial. BMJ ARTICLE. Nurse led, home based self help treatment for patients in primary care

Discussion in 'Latest ME/CFS Research' started by pollycbr125, Apr 23, 2010.

  1. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Vincent Deary, a therapist from Kings College London (home of Simon Wessely and Trudie Chalder) was brought in to major sure the therapy was like what they used. As I recall, he lived over there for a while (at least person was wondering about Leonard Jason when they learned about it).
    They also checked using fidelity ratings:
     
  2. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Or maybe:
    Placebo effect due to nurse's expectations - present
    Placebo effect due to subject's expectations - present
    Placebo effect due to assessor's expectations - not present
    Placebo effect due to statistician's expectations - present
     
  3. biophile

    biophile Places I'd rather be.

    Messages:
    1,403
    Likes:
    4,877
    Thanks.

    Hehe!
     
  4. V99

    V99 *****

    Messages:
    1,471
    Likes:
    1
    UK
    Reply from Wearden
    http://www.bmj.com/cgi/eletters/340/apr22_3/c1777

    [​IMG]

    [​IMG]

    Figure 1 Mean scores on the Chalder et al fatigue scale, scored 0123, at baseline(week 0), after treatment (week 20), and at one year follow-up (week 70) for patients allocated to the three treatment arms. *Significant difference between PR and GPTAU. GPTAU, general practitioner treatment as usual; PR, pragmatic rehabilitation; SL, supportive listening.
     
  5. oceanblue

    oceanblue Senior Member

    Messages:
    1,174
    Likes:
    343
    UK
    Thanks, V99

    I wonder if Sam Carter and Tomk have seen this yet? The results do appear to show a modest but unspectacular improvement with pragmatic rehab (approx 20% reduction in fatigue at 70 weeks versus 10% reduction for controls) but I'm not sure the figures really address the ceiling effect of the Chalder scale that Tom & Sam raised. The max score on the CF scale scored 0123 is 33 (I think), and the mean score at baseline is 29 which suggests that a signigicant number of patients are still at maximum score at the start of the experiment. This would make it impossible for their score to get worse, even if their condition were to deteriorate.
     
  6. alex3619

    alex3619 Senior Member

    Messages:
    7,684
    Likes:
    12,497
    Logan, Queensland, Australia
    Hi Bluebell, I totally agree. The history of psychiatry says this will happen again if someone doesn't fight it, because we aren't the first group, nor the second, nor the twentieth they have done this to without any hard evidence. Bye, Alex
     
  7. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    I have just sent in a response. I'm not sure if I was quite polite enough - we'll see. It's a delicate balance between on the one hand getting something up (a brilliant response that doesn't get up is pretty useless) and on the other making sure the point you want to make is made. People who are doctors have an advantage as they are seen as the target group so more of their stuff will likely get through I would think.
     
  8. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    BMJ Rapid Response

    BMJ Rapid Response

    Data on the level of maximal scoring (on the Chalder Fatigue Scale) would be useful
    http://www.bmj.com/cgi/eletters/340/apr22_3/c1777#236818

     
  9. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Sometimes research is only ever presented in abstract form.

    There are quite a lot of CFS papers at:
    http://abstracts.bps.org.uk/

    I don't have time to read them all but found this one. I'm not saying I think this is very interesting; however it is interesting to know some information about why people don't take part in CBT/GET/similar trials as one might be able to say/suggest that the people who took part aren't representative in some way:

     
  10. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Another FINE abstract, FWIW:

    http://abstracts.bps.org.uk/index.c...view&frmShowSelected=true&localAction=details
     
  11. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Mechanisms of change in pragmatic rehabilitation for chronic fatigue syndrome

    Another FINE abstract, FWIW:
     
  12. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    (One of?) Their excuse(s) for PR's lack of efficacy

    (One of?) Their excuse(s) for PR's lack of efficacy:

     
  13. Enid

    Enid Senior Member

    Messages:
    3,309
    Likes:
    841
    UK
    I hope this is Fiona Godlee of the BMJ (as she was this am trying to tell all of the impending disaster in much needed changes in UK NHS - and not getting much shrift either).
     
  14. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    I imagine in the "real world" if counselling was going to be made available, it would be given by qualified counsellors.
    I'm not an expert on counselling but I believe counsellors have to go through counselling themselves and generally would be better qualified than this group.
    One gets an eye how much out of their depth they are from:

     
  15. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    Main paper was "declined by the Lancet"

    Main paper was "declined by the Lancet"

     
  16. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    ------
    In the BMJ, in reply to a letter asking about this outcome measure, they said:
    I'm guessing the above papers may be on baseline levels (am not sure) but it is interesting they don't publish any data. I'm guessing if the data suited them, they would publish it. The total number of patients in this trial (n=296) was relatively large (for a CFS paper anyway) so there should still be a reasonable number who did the test (unless something odd happened).
     
    oceanblue likes this.
  17. Enid

    Enid Senior Member

    Messages:
    3,309
    Likes:
    841
    UK
    Dolphin whatever all the above comes to they are beating about the bush until the pathiogies are recognised and understood. Yes a kind hand as one's abilities severely deteriorate is rare but very much appreciated. So sorry SW et al not one of yours - very much wiser and much iller. Tell me (as my Neurologist at worst admitted "I don't understand yet"). Tell me on on that basis only I will accept.
     
  18. Vitalic

    Vitalic Senior Member

    Messages:
    119
    Likes:
    47
    First time I've heard of this term pragmatic rehabilitation, are there any commentaries on this paper and how it fits in with the PACE trial etc.? I'm struggling to see the significance as any biopsychosocial advocate would simply point to the PACE trial as evidence of efficacy and put this down to "social circumstances" or some other exuse.
     
  19. currer

    currer Senior Member

    Messages:
    1,324
    Likes:
    774
    The BMJ have refused to publish anything on the Fluge and Mella rituximab trial though. The reason they gave was that ithe rituximab trial was too small to be of interest to their journal.
    So why publish this rubbish?
     
  20. Dolphin

    Dolphin Senior Member

    Messages:
    6,868
    Likes:
    6,148
    This paper gives one theory:
     

See more popular forum discussions.

Share This Page