"CBT and GET are effective"

[Dolphin]

All 30 questions for Metacognitions Questionnaire 30 are here:
http://digitalcommons.unf.edu/cgi/viewcontent.cgi?article=1399&context=etd
(pp.30 & 31)
(Doesn't give the factors)

 

[Dolphin]

They admit in the paper that all the measures were non-normally distributed but then go on to do parametric statistics for all the efficacy analyses.

Which tests?

 

[Dolphin]

Jesus, I think the UK will be the last redoubt of CBT/GET for ME. The only question is which will go first, CBT/GET, or the NHS?

CBT for CFS is big in the Netherlands also.

 

[Sidereal]

Which tests?

It just says this:

Kolmogorov-Smirnov tests suggested that all primary and secondary outcomes were significantly different from normal.

 

[Dolphin]

It just says this:
Kolmogorov-Smirnov tests suggested that all primary and secondary outcomes were significantly different from normal.

Yes, but which are the parametric tests they used?

ETA: Ok, I've re-read what you said and see now you may have been referring to them reporting means and SDs rather than the specific tests they used

 

[Sidereal]

Yes, but which are the parametric tests they used?

ETA: Ok, I've re-read what you said, maybe you're referring to them reporting means and SDs rather than the specific tests they used

They used linear mixed models as their main analysis. And yes they also reported all the (non-normally distributed) variables as mean (SD).

 

[Dolphin]

They used linear mixed models as their main analysis. And yes they also reported all the (non-normally distributed) variables as mean (SD).

Thanks. I'm afraid I still have to learn about linear mixed models and the like. Hope to get there eventually.

 

[Dolphin]

This study used Oxford criteria.

 

[Sidereal]

Thanks. I'm afraid I still have to learn about linear mixed models and the like. Hope to get there eventually.

It's basically a modern and much more complicated approach to analysis of longitudinal data than repeated-measures ANOVA which you're probably familiar with.

 

[Dolphin]

The CGI data are comparable to that obtained by the PACE trial (White et al.,2011) but the clinical change data are worse (for CBT, comparing PACE to this evaluation, it was 59% versus 50% and for GET 61% to 34.3%).

This is the comparison they make with PACE Trial:


"Clinical change data" refers to an improvement of 8 or more on SF-36 physical functioning and 2 or more on Chalder fatigue questionnaire.

The positive change % ("very much better" or "much better") in this were
(at follow-up):
CBT: 50.5%
GET: 51.2%

PACE Trial:
CBT: 41%
GET: 41%

These were for the PACE Trial entry criteria though they made an error (said SF-36 PF<=60 when it was <=65, CFQ (bimodal)>=60 which is correct).

There is a chance that this error helped them. The figures were a lot lower for the whole sample for CBT. Only 33% (vs. 50%) had the required improvement for CBT, not much difference for GET (33.3% for whole sample vs 34.3% for PACE entry criteria sample).

 

[Dolphin]

No mention of anything to do with biology in the whole paper (that I can recall) - like with the PACE Trial's Lancet paper (and probably other papers).

 

[Dolphin]

Reasons they say it's not necessarily comparable to the PACE Trial

This study is subject to some limitations that are unique to routine clinical practice. First, only patients who consented for their data to be used were included in this analysis, and if they did not provide consent at all three data points, their data were withdrawn. Second, patients not consenting for their data to be used in such study may be reflective of dissatisfaction with treatment modalities offered. Third, more confounding variables exist in routine clinical practice when compared to RCTs; for example, in routine clinical practice a wider range of patients tend to be seen with physical and psychiatric comorbidities, less commonly seen in patients in a RCT. Also, there is less control over treatment fidelity in routine clinical practice when compared to RCTs.

Info on drop-out rate:

One hundred and seventy-one patients began a course of either CBT (n=116) or GET (n =55) at the Fatigue Service at the Royal Free Hospital, London, UK, between 12 April 2010 and 4 March 2013. They provided signed consent for their data to be used in a service evaluation. Of the 171 patients who started therapy, 148 completed therapy (103 CBT and 45 GET patients), representing 86.5% completion rate, attending a mean of 13.7 (CBT) and 13.4 (GET) sessions. Ten CBT patients and seven GET patients dropped out of therapy without first agreeing to do so with their therapist. Three patients each from CBT and GET ended therapy with the consent of their therapist.

 

[Dolphin]

Info on therapy:

Fourteen sessions of either CBT or GET were administered; the first 12 of these being typically weekly or fortnightly. Following session 12, patients completed the posttreatment self-report measures booklet. Sessions 13 or 14 were follow-up or booster sessions, typically occurring at 4 to 8 week intervals after session 12. Patients completed their follow-up selfreport measures booklet at or shortly after session 14. On treatment completion, a physician or clinical nurse specialist conducted a medical review.

This difference [with the PACE Trial results] seems due to treatments in this study impacting more on fatigue than physical functioning. It is worth noting that the end point for follow-up measures was 12 months for the PACE trial and at or after session 14 for patients in this service, and this could represent as little as 6 months between pretreatment and follow-up. It may be that both CBT and GET require sustained application of therapeutic strategies for their full benefit to be felt.

They could have given us data on who long was the actual gap.

Also, the PACE Trial results (as I recall) didn't different that much between 24 and 52 weeks.

 

[Valentijn]

CBT for CFS is big in the Netherlands also.

Though admittedly the situation is a bit more chaotic here. Non-practitioners know it's a biological illness, and there's no national system really supporting CBT. But it's still considered the only treatment, and will usually get recommended.

When CBT/GET dies in the UK, I think the Netherlands will follow its lead. Though maybe we'll get lucky and the recent American developments will have an impact sooner.