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Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for CFS Vos-Vromans


Senior Member
Lower education correlating with better treatment effect could mean that patients with less education are more easily impressed by psychobabble and therefore more susceptible to giving "positive" answers on questionnaires. This is something these CBT studies are seemingly designed to exploit.
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Senior Member
and the difference looks tiny and probably effected by those self reporting forms that a person with a fluctuating disease would fill out .differently depending on the time of day or night .


Senior Member
There's an accompanying editorial in the same journal by Nijs & Malfiet. See thread here:

Here are some of the things it says about the Vos-Vromans et al. (2015) study. The same points could be made about many studies in the ME/CFS field:

However, a few limitations should also be noted. First, outcome was limited to self-reported measures. Secondly, the treatment groups were unbalanced (i.e. the experimental group received more hours of treatment than the control group); this was a rational choice considering the authors’ efforts to maximally reflect routine clinical practice, but implies possible bias due to nonspecific treatment effects.

Future studies regarding rehabilitation for patients with ME/CFS may include objective in addition to self-reported outcome measurements. This would allow investigation of the effect of rehabilitation on established physiological dysfunctions in patients with ME/CFS, especially those potentially relating to rehabilitation effects. For instance, autonomic nervous system dysfunction has been demonstrated repeatedly in patients with ME/CFS [14– 17] and may respond to the mindfulness and body awareness sections of the rehabilitation programme. This might also be the case for other abnormal aspects of the stress response system in ME/CFS, including the dysfunctional hypothalamus–pituitary–adrenal axis [18, 19]. With regard to the grading of physical activity levels in the rehabilitation protocol of Vos-Vromans et al. [5], it would have been interesting to examine the possible impact upon established markers of immune hyper-responsiveness to exercise. Following exercise, ME/CFS patients have more pronounced complement system (i.e. elevated C4a split product levels) and oxidative stress system responses (i.e. enhanced oxidative stress combined with a delayed and reduced antioxidant response), and alteration of the gene expression profile of immune cells [20– 23]. Although these immune responses to exercise are known to be related to symptoms of postexertional malaise in patients with ME/CFS [20], it remains unclear whether they are normalized following (multidisciplinary) rehabilitation.

A reminder that there was one objective measure, an activity monitor: at 52 weeks, the MRT group had increased by 5.8% and CBT group had increased by 6.6% compared to baseline (there was no control group).
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