The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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Chalder - CBT for Post Stroke Fatigue(PSF) based on CFS-CBT

Discussion in 'General ME/CFS Discussion' started by slysaint, Aug 30, 2017.

  1. slysaint

    slysaint Senior Member

    Another waste of time money etc etc

    We adapted the intervention from a nurse-delivered behaviourally-oriented intervention for
    cancer-related fatigue [3] and a self-management cognitive behavioural approach for chronic fatigue syndrome [13]. We drafted a Participant Manual to provide an outline of each session. The provisional programme consisted of three two-hour sessions with two-week intervals between sessions."

    "In the long term, we envisage this intervention to be delivered by stroke nurses. However, we decided a clinical psychologist (KA) should test the feasibility in the current study."
    From July 2014 to October 2014, we screened 421 patients (who had had a stroke in the past three months to two years) and sent invitation letters to 120 potentially eligible patients. Forty-nine eligible patients completed questionnaires, of whom 31 reported fatigue by the single question and the other 18 did not. Of the 31 fatigued patients, 11 had a PHQ-9 score of 15 or more (indicating severe depression) and so were excluded; the remaining 20 patients were eligible for the intervention, of whom eight declined to receive it (reasons for decline see Fig 1)."

    "Four participants (all women) dropped out: one participant withdrew after the first session as, following discussion with the therapist, she explained that she did not desire an intervention for her fatigue but that her chief purpose in participation had been to contribute to the research; a second participant withdrew after the initial session and the third participant after the second session because of unrelated physical ill-health problems; the fourth participant failed to attend any of the sessions despite reminders and gave no reasons."

    "This intervention was based on a cognitive behavioural therapeutic approach to challenge patients’ cognitive representation of fatigue and to encourage them to increase their daily activities. By gradually increasing their physical activity in daily living, patients were able to break the vicious cycle that perpetuate fatigue."

    "However, this study did not have a control group, thus we do not know whether the improvement was due to the therapeutic effect or the natural resolution of fatigue."

    I'm all for recycling but.........
    Joh, MEMum, ladycatlover and 10 others like this.
  2. SilverbladeTE

    SilverbladeTE Senior Member

    Somewhere near Glasgow, Scotland
    "recycling" as in...manure? :p
    ladycatlover, GreyOwl and AndyPandy like this.
  3. NelliePledge

    NelliePledge plodder

    same old BS

    although maybe less dangerous? as presumably stroke patients actually get physical checks and tests that would indicate if they were physically able to manage increasing activity
    MEMum, ladycatlover and Webdog like this.
  4. anni66

    anni66 mum to ME daughter

    This research thing looks hell of a lot easier than my current profession. Perhaps i should retrain.....
  5. Esther12

    Esther12 Senior Member

    This is the one co-authered with Malcolm Macleod, who recently did the appalling attempt to smear-PACE critics at the SMC.

    PACE is reference 4:

  6. Philipp


    Can someone pick apart the citation for CRF?

    I mean, they do say that:

    Potential limitations of the current study include inadequate allocation concealment at the start of the study, lack of a control for the behaviorally oriented intervention, and possible observer bias. It is notoriously difficult to develop a placebo intervention to control for nonpharmacologic interventions; thus, we believed that it was more important to test whether the intervention was beneficial to patients who had significant fatigue. It was not possible to minimize the effect of observer bias by blinding the researcher (J.A.) who conducted the assessments regarding the group to which patients were allocated, because the researcher also was responsible for delivering the intervention. Thus, it is possible that the treatment effect may be attributable to outcome expectations of both the researcher and the patients.

    ...but just throwing it away because of this is boring and at this point I am actually genuinely curious if their 'CBT' (whatever that term may actually mean) is good for anything in any way. I mean, we thought that PACE had relatively good reported outcomes because the selection of patients wasn't very strict, but after the data were released it looked like even that didn't matter much.
    I can't get through the entire textblob myself and don't understand statistics very well. Any takers?
    ladycatlover, Valentijn and Esther12 like this.
  7. boombachi

    boombachi Senior Member

    Hampshire, UK
    Did I understand this right? It was a trial of 8 people?:eek: I hope they concluded that a proper study is NOT feasible. I wonder if they think stroke patients will be more grateful or did they just run out of justifications for more cfs trials. :woot::ill:
    Joh, Invisible Woman, MEMum and 5 others like this.
  8. trishrhymes

    trishrhymes Senior Member

    421 patients screened with the aim of finding 12 patients for a feasibility study.
    120 patients eligible sent letter.
    49 returned questionnaires.
    31 were fatigued.
    20 were not severely depressed but could be moderately depressed.
    12 agreed to participate (5 women, 7 men).
    8 actually participated (1 woman, 7 men) - note most of the women dropped out!
    5 of the 8 met the criteria for post stroke fatigue.

    What a lot of nonsense. So they cherry picked 5 patients with post stroke fatigue mixed in with 3 others who didn't meet the criteria, some or all of whom might also have been depressed, and they don't know whether outcomes were significant because there wasn't a control group and anyway the sample was way too small.

    So it's not a feasibility study for a realistic intervention at all. Out of 421 patients they found 5 who had PSF and participated (mostly or all men), most of whom didn't follow the sleep or false beliefs advice but liked being listened to and 'helped'.

    And the patients were all at least a year post stroke, so had already had whatever the normal post stroke treatment involves. Could it be that they were a group of lonely men who enjoyed the attention? Hence the need for a control group.

    What a waste of money.
  9. Jenny

    Jenny Senior Member

    I had a haemorrhagic stroke 12 years ago and the fatigue went on for a few months, in that I had to have a sleep twice a day and rest a lot. But it was nothing compared to the so- called 'fatigue' of ME. And the wonderful thing was that each week I felt a little bit better until I completely recovered. I didn't do any exercise. I thought at the time how good it was to have an illness where you could feel yourself getting better and better over time, in contrast to the waxing and waning of ME.
  10. A.B.

    A.B. Senior Member

    Maybe the therapists were young women dressed for maximum response bias, err... therapeutic effect.
  11. slysaint

    slysaint Senior Member

    blue cardigans with the top button undone?

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