Lloyd has been working on positioning himself in a post-PACE world for some time.
This just came out:
http://www.australiandoctor.com.au/...in-three-cfs-patients-improve-in-aussie-trial
Full text:
"More than one-third of patients with chronic fatigue syndrome improve when they undergo a program combining graded exercise and CBT, an Australian ‘real-world’ study shows.
The study included patients with CFS who followed personalised programs, including five one-hour consults with an exercise physiologist and 6-8 sessions with a clinical psychologist at the University of NSW's Lifestyle clinic in Sydney.
Of the 264 participants whose illness had lasted for an average of five years, 35% had a reduction in fatigue after the program, with their ‘capacity to walk more than 2km’ improving significantly.
Mood scores also improved, and this was associated with the patients’ enhanced social functioning, said the authors, led by Professor Andrew Lloyd from the University of NSW.
Improvement at 12-week follow-up was generally sustained at 24-week follow-up.
The patients least likely to benefit from the intervention were men and people with chronic pain.
“Uncontrolled pain can get in the way of this overall management program and it needs to be dealt with separately,” Professor Lloyd told Australian Doctor.
The approach aims to put together interventions such as graded exercise therapy and CBT, which have proved to be helpful in treating the condition, he said.
“In terms of what they can do in a day, the key limitation is this phenomenon that’s imposed by the disorder, where people do a certain amount physically — and sometimes it’s not very much — and, in Australian parlance, they’re then buggered for a long period of time," Professor Lloyd said.
“The same kind of thing happens with cognitive demand. Patients try and do something on the computer for an hour, and after that the brain’s fuzzy and stays bad for hours or days."
The UNSW team first looked at ‘pacing’ – finding the thresholds that lead to post-exertional exacerbation, and encouraging people to work up to, but not over, them.
They then introduced graded exercise therapy and CBT.
The Australian trial is being billed as the first real-world study of patients undergoing similar interventions as those shown to be effective in a controversial UK randomised controlled study (PACE).
The NSW results support the UK findings, but with somewhat lower effectiveness, the authors wrote in the Internal Medicine Journal.
This could be because the Australian intervention was only for 12 weeks, whereas PACE covered a year, the authors said.
Although the program was currently delivered by clinical psychologists and exercise physiologists, it could be delivered by other practitioners, including GPs, said Professor Lloyd.
The team is trialling an online manual explaining how to conduct the treatment, which could help other centres adopt the approach.
He said the UNSW method was worth trying, particularly as treatment of CFS was “a therapeutic desert”."
