I have just read the following paper. It is sometimes quoted as showing that CBT or GET have been shown to restore the ability to work. See underlined bit.
Free full text: http://archinte.ama-assn.org/cgi/content/full/164/10/1098 or http://archinte.ama-assn.org/cgi/reprint/164/10/1098
When one reads the full paper, there is not enough evidence to suggest that the underlined bit deserves to be in the abstract.
It seems to come from Table 6:
Here's the text:
With regard to GET, there were 66 people in the trial.
The actual figures in the Fulcher paper are:
Free full text: http://archinte.ama-assn.org/cgi/content/full/164/10/1098 or http://archinte.ama-assn.org/cgi/reprint/164/10/1098
Disability and chronic fatigue syndrome: a focus on function.
Arch Intern Med. 2004 May 24;164(10):1098-107.
Ross SD, Estok RP, Frame D, Stone LR, Ludensky V, Levine CB.
Source
MetaWorks Inc, 10 President's Landing, Medford, MA 02155, USA.
Abstract
BACKGROUND:
Evidence was sought in the published literature on how best to measure, monitor, and treat disability in patients with chronic fatigue syndrome (CFS).
METHODS:
A systematic review was performed of English-language literature published between January 1, 1988, and November 15, 2001. Interventional and observational studies of adults with CFS were eligible if they reported measures of disability and employment. A qualitative synthesis of results relating impairment measures to employment was performed.
RESULTS:
Of 3840 studies identified, 37 reported employment status and some measure of mental or physical impairment associated with disability. Most patients with CFS in these studies were unemployed. In 22 studies, the employment status of control subjects was also available. Only depression seemed to be associated with unemployment in patients with CFS. No other measurable impairment seemed to be consistently associated with disability or work outcomes. Only cognitive behavior therapy, rehabilitation, and exercise therapy interventions were associated with restoring the ability to work. No specific patient characteristics were identified as best predictors of positive employment outcomes. No quantitative syntheses of results were performed.
CONCLUSIONS:
For questions of disability and employment in CFS, the limitations inherent in the current literature are extensive. Methodologically rigorous, longitudinal, and interventional studies are needed to determine baseline characteristics that are associated with the inability to work and interventions that are effective in restoring the ability to work in the CFS population. Simple and consistent evaluations of functional capacity in patients with CFS are needed.
PMID: 15159267 [PubMed - indexed for MEDLINE]
When one reads the full paper, there is not enough evidence to suggest that the underlined bit deserves to be in the abstract.
It seems to come from Table 6:
Here's the text:
What Is the Evidence That in Individuals With CFS, Treatments Are Effective in Restoring the Ability to Work?
Among the 14 interventional trials with work or impairment
results after intervention, there were too few of any
single intervention with any specific impairment domain
to allow any assessment of association. Only 4 longitudinal
studies26-29 reported employment at baseline and
follow-up after intervention (Table 6). Two additional
studies11,30 reported employment at both times with no
interventions. In the 4 studies with interventions, the percentage
of patients with CFS who were employed at baseline
ranged from 0% to 39%; at follow-up (3-42 months
after baseline), employment ranged from 44% to 53%.
Interventions associated with increased employment at
follow-up included individualized rehabilitation programs,
27,29 cognitive behavior therapy,26 and exercise
therapy.28 The studies are not comparable, however, owing
to differences in study design, duration of followup,
and types of intervention. Furthermore, up to 29%
of patients were lost to follow-up. Still, all 4 studies showed
improved employment outcomes, whereas the 2 studies11,30
with no interventions showed worsening of employment
outcomes.
With regard to GET, there were 66 people in the trial.
The actual figures in the Fulcher paper are:
31/66 is where the 47% comes from. However, remember that half the group got another treatment initially (flexibility exercises and relaxation therapy) so one can't say that the GET was the reason for the increase. And there was no control group - these were Oxford criteria patients so maybe they would have improved anyway.Thirty one (66%) patients who completed exercise treatment were work ing or studying at least part time compared with 26 (39%) of all 66 patients before treatment (95% confidence interval of difference 9% to 44%).