Are [CBT] and a group physical and mental health rehabilitation programme effective treatments for long COVID?... 2025, Vink and Vink-Niese

[Utsikt]

Vink M, Vink-Niese F. Are cognitive behavioral therapy and a group physical and mental health rehabilitation programme effective treatments for long COVID? Rethinking of a systematic review. SciBase Neurol. 2025; 3(1): 1026.
PDF Link

Thread on the review that the paper criticises:
Interventions for the management of long covid post-covid condition: living systematic review, 2024, Zeraatkar, Flottorp, Garner, Busse+

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Mark Vink has published an article on the review:
https://www.researchgate.net/public..._long_COVID_Rethinking_of_a_systematic_review

Abstract (with line breaks added):

In this article, we analyzed the systematic review by Zeraatkar et al. which concluded that cognitive behavioral therapy (CBT) and a group physical and mental health rehabilitation programme, are effective treatments for long COVID.

Our analysis of the review highlights the problems with the 2 studies that were used for this claim but also with the systematic review itself. These problems included relying on subjective outcomes in non‐blinded studies with poorly chosen control groups, selection, volunteer and self referral bias, response shift and allegiance bias, small study effect bias, selective reporting of the objective outcomes and selecting patients who didn’t have post-exertional malaise (PEM) but then claiming that exercise treatment is safe for long COVID patients with PEM.

Moreover, the CBT study and the systematic review ignored the fact that CBT did not lead to objective improvement. The group physical and mental health rehabilitation programme was labelled effective based on its primary outcome even though the threshold of minimal important difference was not reached at any of the three outcome points and the scores of its primary outcome (quality of life) remained lower than in diseases like cerebral thrombosis, acute myocardial infarction, MS, lung cancer and stroke.

Also, the study selected obese and older patients aged 56, with pre-existing health issues, who had been hospitalised for a severe COVID-19 infection and more than a third of them had been admitted to IC/HDU. Yet the average adult long COVID patient has a normal BMI, is much younger, used to be fit and well and developed long COVID after a mild infection with COVID-19. Consequently, one can not generalise the findings from that study to the average long COVID patient.

It’s unclear why the systematic review ignored all of that but also ignored the biases created by selective reporting and the widespread deviations from the intended interventions in both studies. Even though these two forms of bias are an important part of the risk of bias assessment according to the systematic review itself.

In conclusion, our analysis does not lend any support for the claim that CBT or a group physical and mental health rehabilitation programme are safe and effective treatments for long COVID patients who suffer from PEM.

 

[Trish]

That abstract is a very clearly written and damning critique of the original review. Thank you, @Mark Vink.

 

[rvallee]

the threshold of minimal important difference was not reached at any of the three outcome points and the scores of its primary outcome (quality of life) remained lower than in diseases like cerebral thrombosis, acute myocardial infarction, MS, lung cancer and stroke

It's so hard to take this industry seriously when they do stuff like this. I don't get it, aside from the absurd rationalization where pseudoscience is fine for pseudoillness. No one can claim confusion over how ridiculous this is, or how it's obviously invalid. It'd be like someone raising their income by 10%, still leaving them 50% below the poverty line, but because they decided that 10% relative increase is the aim, that it means that person is now financially stable.

They did the same thing with PACE, setting the functioning of an average 75 year-old as being OK for a normal healthy young adult, and no one cared. You can literally show it to actual professionals and they won't care about it. It's madness.

I'm not kidding when I say that I'm certain that there are ways to design experiments where most farm animals would see through this problem. It's ridiculous, and it's been a standard for decades. Hell, the entire problem with the CFQ is exactly that.

It’s unclear why the systematic review ignored all of that but also ignored the biases created by selective reporting and the widespread deviations from the intended interventions in both studies

When a bias makes outcomes randomly fall around it, it's a random bias. When a bias makes outcomes always fall in the same direction, even more so when that direction is less likely yet always preferred, it can only be deliberate, because no one with a graduate degree is foolish enough not to see what's happening.

Hell, no one with the ability to use basic math would be fooled by this. This isn't like the flop of the 1/3 pounder, because too many people thought it was less than a 1/4 pounder. It would involve people seeing the clearly larger burger and still insisting that it's smaller. It defies all common sense, basic ethics and professional obligations to go along with this farce.

 

[Mark Vink]

That abstract is a very clearly written and damning critique of the original review. Thank you, @Mark Vink.

Thank you for the compliment, much appreciated