PACE Trial summaries/critiques/links thread - no discussion please

Dolphin

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http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724?scroll=top&needAccess=true


Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial Carolyn Wilshire, Tom Kindlon, Alem Matthees & Simon McGrath


To cite this article: Carolyn Wilshire, Tom Kindlon, Alem Matthees & Simon McGrath (2016): Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy?

A critical commentary and preliminary re-analysis of the PACE trial,

Fatigue: Biomedicine, Health & Behavior

To link to this article: http://dx.doi.org/10.1080/21641846.2017.1259724


Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath


ABSTRACT


BACKGROUND: Publications from the PACE trial reported that 22% of chronic fatigue syndrome patients recovered following graded exercise therapy (GET), and 22% following a specialised form of CBT. Only 7% recovered in a control, no-therapy group. These figures were based on a definition of recovery that differed markedly from that specified in the trial protocol.


PURPOSE: To evaluate whether these recovery claims are justified by the evidence.


METHODS: Drawing on relevant normative data and other research, we critically examine the researchers’ definition of recovery, and whether the late changes they made to this definition were justified.

Finally, we calculate recovery rates based on the original protocol-specified definition.


RESULTS: None of the changes made to PACE recovery criteria were adequately justified. Further, the final definition was so lax that on some criteria, it was possible to score below the level required for trial entry, yet still be counted as ‘recovered’. When recovery was defined according to the original protocol, recovery rates in the GET and CBT groups were low and not significantly higher than in the control group (4%, 7% and 3%, respectively).


CONCLUSIONS: The claim that patients can recover as a result of CBT and GET is not justified by the data, and is highly misleading to clinicians and patients considering these treatments.
 

Dolphin

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"The PACE trial: Where “recovery” doesn’t mean getting your health back" (December 14 blog post)

From Simon McGrath:

To recap, PACE relaxed the fatigue and physical function recovery thresholds so far that patients could (and some did) count as recovered at the same time as being fatigued and disabled enough to join the trial. They counted patients as recovered who said they weren’t “very much better”, but merely “much better”, and even if clinical staff judged them to still meet Oxford criteria for CFS. This is not recovery.

https://goo.gl/sbGLnq
i.e.
http://www.meaction.net/2016/12/14/...ecovery-doesnt-mean-getting-your-health-back/