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Dr. Enlander letter re. treatment outcome in adults with chronic fatigue syndrome


Senior Member



Fine, thank you
Well done to Dr Enlander again for writing to the scientific journals and challenging this kind of paper. I really do wish that more of our specialist clinicians and researchers would do this.


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australia (brisbane)
8% improvement, he is dam right its insignificant.
Just the general ups and downs of cfs can be a difference of 8%, even a couple of headache pills could do that.

Why cant the people that published the BS study see it??

Why isnt it being retracted like the XMRV study??



Senior Member
Cornwall England
Wasn't this point attempted to be addressed on the online clinic by Bavinton? Something about how they felt unable to entirely replicate the results of PACE as specialist clinics cannot afford to deliver the same degree of treatment: e.g. number of sessions or something like that? i.e. that comparisons to PACE were not 'like-for-like'? There was something similar said in the paper itself from memory; but I'm struggling today. Sorry.


Places I'd rather be.
I was just looking at this paper earlier. I am not sure I follow Enlander's argument properly. I guess the 8% figure comes from interpreting the regression coefficient of 0.81, since 1 = 10%? But Table 4 is for associations of baseline characteristics with physical function. The mean(SD) scores for this at baseline and at follow-up are found in Table 2, 4.4/100 points is a 9% improvement over baseline for physical function, but greater improvements for fatigue: an average difference of 6.8 points in fatigue score is about 21% of the total scale of 33 points, or about 26% of the average baseline score i.e. 26.5 points (or about 44% if taking into account that 11/33 points in Likert scoring is the 'neutral' score).

I think this paragraph is also interesting, particularly when there was no control group for natural course:

"About 74% (620 of 834) of patients had a decreased Chalder Fatigue score at follow-up and 64% (534 of 834) had improved by >2 points (our definition of a clinically useful improvement). In contrast, only 50% (416 of 834) of patients had an increased SF-36 physical function score at follow-up and only 16% (131 of 834) had improved by >11* points. In total, 14% (120 of 834) had clinically useful improvements on both scales."

* The text states >22, but this must be a typo because earlier it mentions >11, which is consistent with how they derived this threshold in the first place i.e. 0.5 SD of baseline score.