FITNET Trial: Effectiveness of internet-based CBT for CFS: an RCT (Nijhof et al, '12)

[Valentijn]

Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU.

I haven't read the full followup paper, but this raises an interesting question: How many of those "recovered" at the end of the trial were also "recovered" at the followup?

"Most" is not specific, and only indicates that it's more than 50%. It's not "all" or "nearly all", which seems to suggest that quite a few people went from being recovered after the trial to not recovered at the followup (and vice-versa).

If better numbers are available somewhere, it might indicate if much of the initial recovery was placebo effect, and that the loss of some recovered patients (due to the eventual failure of the placebo effect) was compensated for by the high likelihood of natural recovery in that age group.

If this is the case, it would undermine their claim that CBT should be offered for faster recovery.

 

[Bob]

Valentijn

Actually there weren't any meaningful differences there...

My understanding is that, for the FITNET group, 'recovery' at 6 months was 63%, and at LTFU it was actually higher, at 64%. (So there was actually a higher 'recovery' rate at LTFU in the FITNET group: Perhaps some of the originally 'recovered' patients deteriorated, but were replaced with an equal number of newly 'recovered' patients?)

But there are many other weakness of the study...
e.g:
The 'recovery' definition was decided post-hoc.
And also, a 'recovery' is not really a recovery.
(e.g. patients only had to say they felt 'much better', so they didn't have to say that they feel 'recovered'. Also it was acceptable to have a school absence rate of 1 day in 10.)

I haven't studied the fatigue or physical function requirements for a 'recovery', but I expect they are equally weak, in terms of defining a 'recovery'.

 

[Dolphin]

I haven't read the full followup paper, but this raises an interesting question: How many of those "recovered" at the end of the trial were also "recovered" at the followup?

"Most" is not specific, and only indicates that it's more than 50%. It's not "all" or "nearly all", which seems to suggest that quite a few people went from being recovered after the trial to not recovered at the followup (and vice-versa).

If better numbers are available somewhere, it might indicate if much of the initial recovery was placebo effect, and that the loss of some recovered patients (due to the eventual failure of the placebo effect) was compensated for by the high likelihood of natural recovery in that age group.

If this is the case, it would undermine their claim that CBT should be offered for faster recovery.

I've posted data from the paper on this in this post: http://forums.phoenixrising.me/inde...e-long-term-follow-up-2013.25380/#post-388740

This is part of a separate thread I set up on the follow-up paper: http://forums.phoenixrising.me/inde...igue-syndrome-long-term-follow-up-2013.25380/

 

[Bob]

This BBC News article has been posted on the thread previously, but I just came across it accidentally when searching on Google for something else.
It blindly regurgitates the supposed 63% recovery rate...

Chronic fatigue syndrome: Web therapy 'can help'
1 March 2012
http://www.bbc.co.uk/news/health-17209795

"Dutch researchers writing in The Lancet journal said 63% of those given psychotherapy online had reported making a recovery."

 

[Bob]

Here's a possible new FITNET paper (I don't know for a fact that it's a FITNET paper):
http://forums.phoenixrising.me/inde...ortisolism-in-chronic-fatigue-syndrome.28027/


The role of hypocortisolism in chronic fatigue syndrome
Sanne L. Nijhof, Juliette M.T.M. Rutten, Cuno S.P.M. Uiterwaal, Gijs Bleijenberg, Jan L.L. Kimpen, Elise M. van de Putte
Psychoneuroendocrinology
Available online 30 January 2014
http://www.sciencedirect.com/science/article/pii/S0306453014000420

 

[alex3619]

Here's a possible new FITNET paper:
http://forums.phoenixrising.me/inde...ortisolism-in-chronic-fatigue-syndrome.28027/


The role of hypocortisolism in chronic fatigue syndrome
Sanne L. Nijhof, Juliette M.T.M. Rutten, Cuno S.P.M. Uiterwaal, Gijs Bleijenberg, Jan L.L. Kimpen, Elise M. van de Putte
Psychoneuroendocrinology
Available online 30 January 2014
http://www.sciencedirect.com/science/article/pii/S0306453014000420

The seem to be saying that normal cortisol may be a marker for recovery, and poor cortisol is a bad indicator, and that sleep is associated with cortisol. I have not read the full paper.

 

[Bob]

The seem to be saying that normal cortisol may be a marker for recovery, and poor cortisol is a bad indicator, and that sleep is associated with cortisol. I have not read the full paper.

I'm sure they will attempt to use it to justify the use of CBT. FITNET was found to be ineffective at 2.5 year follow-up, so I assume that this paper measured cortisol at 6 months, not 2.5 years!

 

[Dolphin]

I'm just looking back on this. I don't have time to reread the thread. But I see in the protocol that actometer readings were taken at baseline and at 2 further time points. From what I can see, these were never reported even when 2 letters in reply highlighted their importance in the Lancet.