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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. Bob

    Bob

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    What is the second positive RCT that you are referring to, Dolphin? (Assuming that PACE is the first.)
     
  2. Dolphin

    Dolphin Senior Member

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    The NICE guidelines last time used this systematic review as the basis - it lists the RCTs, including those which were seen as positive, etc:

     
  3. Bob

    Bob

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    Thanks Dolphin.
    I think there may also have been a number (or at least a couple that I seem to have read, but I haven't been keeping track of them) of review papers over the past couple of years or so, that have framed CBT/GET in a negative light. I haven't followed them closely, but I imagine you might have done.
    Do you think there might be enough evidence, as per those reviews, and papers like the 'harms' paper, that might provide the right kind of evidence to present to NICE next time?
    I'm not saying that they'll change their minds, but do you think we've got enough of the right kind of evidence to give the psychiatric lobby a good run for their money?
    Just interested in your thoughts, off the top of your head, based on any research you've been following.
     
  4. Dolphin

    Dolphin Senior Member

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    Well, off the top of my head, I think if one looks at objective measures* like the 6-minute walking test, with no difference for CBT and only a small improvement for GET, and then combine it with the evidence about potential harms, I think one has quite a good case against these treatments. However, things like the SF-36 "physical functioning" scale tends to be seen as actually measuring physical functioning, and there are more results for that than for the 6MWT, which I don't think has been used in other CBT or GET studies (off the top of my head) (or not many anyway).

    However, a problem is that I don't think other treatments can easily be pushed for.
    I think patients should have tried to stay away from NICE in the ME/CFS area. So many patients seem to push for things, focusing on possible good outcomes, rather than thinking negative outcomes are also possible and weighing things up. It's a bit like how so many people can be wont to recommend exercise for M.E. patients.

    But I think it's probably worth the fight: one might win some battles, put doubt in people's mind about the so-called evidence and then by the next time around, one might be in a stronger position: then there could be a drug on the table with sufficient effidence and it'd be CBT/GET vs the drug.

    * I know it may not be perfect test. But it seems reasonable to call it an objective measure. A blood test reading could be described as an objective measure, but that doesn't mean that there can't be confounders that affect its interpretation.
     
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  5. Dolphin

    Dolphin Senior Member

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    http://psychologyatmanchester.edubl...wearden-by-as-level-work-experience-students/

    A reminder of the FINE Trial's abstract:
    The primary outcome point was at one year follow-up.
     
  6. Esther12

    Esther12 Senior Member

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    Unblinded trial that relies on subjective self-report measures and found 'treatment' failed to lead to an improvement at their primary outcome point.. while the editorial dwells on the less rigorous but more successful earlier trial...

    Reminded me of this blog from James Coyne:


    http://blogs.plos.org/mindthebrain/2013/11/13/2127/

     
    Last edited by a moderator: Apr 5, 2014
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  7. Esther12

    Esther12 Senior Member

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    This seperate Coyne blog contained a bit kind of relevant to FINE:

    http://blogs.plos.org/mindthebrain/...ogy-in-the-schools-the-uk-resilience-project/

    Generally, I'm always keen to get as much data out as possible, but the way in which the FINE trial has been presented as a positive result in other contexts does show the danger of "continuing onto subgroup analyses".

    Not sure what I think about that, and not a strong enough point to probably ever be worth bring up, but I thought that it could still be of interest.

    The blog was about a positive psychology program teaching school children resilience (yuck - fortunately I expect most teenagers would instinctively rip the piss).

    This from the comments is relevent to all manner of trials for psychosocial interventions:

     
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  8. Tom Kindlon

    Tom Kindlon Senior Member

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    For what it's worth: Somebody who was in the FINE Trial who responded to the (UK) ME Association survey:
    http://www.meassociation.org.uk/2015/05/23959/
     
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  9. Tom Kindlon

    Tom Kindlon Senior Member

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    Oops, I didn't mean to post this here as it is not to do with the FINE Trial. I posted it here: http://forums.phoenixrising.me/inde...ry-treatments-for-me.37782/page-6#post-652380 along with a lot of other extracts from the ME Association survey.

    CBT
    Page 117-118

     
    Last edited: Oct 18, 2015
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  10. Tom Kindlon

    Tom Kindlon Senior Member

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    Did anyone store their reply, either from here or from the BMJ site: http://www.bmj.com/rapid-response/2011/11/02/fatigue-scale-0

    The BMJ updated their website and the table isn't there (same thing happened with the Phoenix Rising site). A quick Google search for
    suggested it isn't on the web elsewhere.

    If you want, e-mail me the info at: tomkindlon @ gmail dot com . It may be useful for something I'm working on. Thanks.
     
  11. Dolphin

    Dolphin Senior Member

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  12. Dolphin

    Dolphin Senior Member

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