Observations on protocol paper on CBT for Multiple Sclerosis RCT

Dolphin

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A couple of weeks ago, somebody sent me the following observations on this trial. I thought I'd make use of them by posting them here:
Pubmed just sent out a summary of an upcoming RCT of CBT for MS, which looks like it might be interesting for several reasons- the language used/intent of trial (management vs.
treatment), outcome measures used, 'service users being involved throughout this research' (wouldn't that be nice if it happened in CFS trials!), etc.

Also one thing I just noticed is that I don't recall the following argument being used very much- You know how Wessely et al. say that 'CBT is used for other conditions besides CFS such as cancer, MS, blah blah blah...?' It might be used as some sort of adjunct therapy but it's by no means used as a 'treatment'. I haven't seen this distinction made very much in objections to CBT, and it is kind of a trap Wessely et al. have set for themselves. Even if CBT were 'effective' in reducing fatigue (and we all know how nebulous even that statement is), so what? To say that just because it might reduce fatigue that it then qualifies as being a 'treatment' doesn't really make much sense given the context in how it's used in other diseases, no? And then if the CBT'ists start hemming and hawing about how 'well it's not really the same or used in the same way as other diseases...'
then you have them in a trap of their own design!
Free full text at: http://www.biomedcentral.com/1471-2377/10/43
BMC Neurol. 2010 Jun 16;10(1):43. [Epub ahead of print]

Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis.

Thomas PW, Thomas S, Kersten P, Jones R, Nock A, Slingsby V, Green C, Baker R, Galvin K, Hillier C.

Abstract
ABSTRACT:

BACKGROUND: Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice.

Methods/design: This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change.

DISCUSSION: This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration: Current Controlled Trials ISRCTN76517470

PMID: 20553617 [PubMed - as supplied by publisher]
 

Esther12

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Thanks.

CFS research is such a joke that it's easy to get CBT/GET promoted - but how these treatements are viewed in the context of other conditions is far more interesting. Wessely seems to be promoting them for MS, and I'm really interested to see how it goes down.