Effectiveness of an ACT‐based rehabilitation program for the treatment of chronic fatigue: Results from a 12‐months longitudinal study, 2020, Brugnera

[Andy]

Acceptance and Commitment Therapy (ACT) is potentially effective for treating chronic fatigue. Given the paucity of studies on this topic, we aimed to assess long‐term trajectories of primary (fatigue, quality of life and functional abilities) and secondary outcomes (anxious and depressive symptoms) of an ACT‐based rehabilitation program for patients with chronic fatigue. Further, we examined if changes in potential process variables (psychological inflexibility, metacognitive beliefs, and cognitive and behavioral responses to symptoms) during ACT predicted change in all outcomes across follow‐up.

One‐hundred ninety‐five workers on sick leave (mean age: 43.61 ± 9.33 years; 80.5% females) with a diagnosis of chronic fatigue were enrolled in a manualized, 3.5‐week intensive return‐to‐work rehabilitation program based on ACT. All completed a battery of questionnaires at pre‐, post‐treatment, 6 and 12 months follow‐up.

We found significant longitudinal changes in most primary and secondary outcomes from pre‐ up to 12 months follow‐up. All process variables significantly decreased from pre‐ up to 12 months follow‐up, and pre‐to‐post changes in fear avoidance beliefs were most often associated with a greater change in outcomes across follow‐up. Depressive symptomatology showed a similar trajectory of change to fatigue, meaning that scores were correlated at each time point and tended to converge over time. This suggests that both symptoms influence each other substantially over a year following the treatment.

Concluding, results lend support to the effectiveness of an ACT‐based rehabilitation program for patients with chronic fatigue and provide preliminary evidence for the role of process variables and depressive symptomatology on subsequent change in outcomes.

Paywall, https://onlinelibrary.wiley.com/doi/abs/10.1111/sjop.12672
Sci hub, https://sci-hub.tw/10.1111/sjop.12672

 

[Trish]

Inclusion criteria for participating in the RTW rehabilitation program were: (1) age between 18-61 years; (2) having been on sick leave for at least 8 weeks due to musculoskeletal disorders, pain, fatigue and/or common mental disorders; (3) having been assessed and treated for any specific medical diseases prior to the program; (4) considered able to follow the daily activities of the rehabilitation program; (5) having a score of 5 or higher on the Chalder Fatigue Scale; and (6) having experienced fatigue for at least the last 6 months (a requirement for chronic fatigue established in previous studies, see for example et al., 1993; Pawlikowska, Chalder, Hirsch, Wallace, Wright & Wessely, 1994). Exclusion criteria were: (1) presence of severe mental illness (ongoing mania, psychosis or suicidal ideation); (2) substance abuse/addiction; and (3) pregnancy.

My bolding.

So they jumbled together people with all sorts of pain, depression and fatigue, and diagnosed them all with 'chronic fatigue', citing loads of CFS studies to back up their assumptions.

Sad that they seem to have no idea ME exists, let alone what it is. This study is meaningless.

Edit: and there was no control group.

Second edit: And they only had results for a little over half the patients at 12 month follow up. It gets more and more useless.

 

[Sly Saint]

After extolling the 'findings' of White, Wessely, Chalder, Knoop,Bleijenberg etc

Given the small effect sizes of CBT for chronic fatigue, further
treatment development and process research seem warranted.

oh the irony.

 

[Hoopoe]

Concluding, results lend support to the effectiveness of an ACT‐based rehabilitation program for patients with chronic fatigue

Without an adequate control group, it cannot be safely assumed that the treatment has any effect. It appears that the authors have no idea what they're doing.

 

[Snow Leopard]

I would have liked to see a scatter plot of hours worked vs change in hours worked, but alas this was not done. I mean it wasn't as if return to work was the primary outcome of the treatment. Oh wait, it was! Hmm...

 

[Snowdrop]

FUNDING This research received no specific grant from any funding agency,commercial or not-for-profit sectors. However, data to this study was taken from an original trial which received earmarked funding from the national budget over a five-year period (2010–2014) to establish and run the rehabilitation programs, including funding for scientific evaluation.

DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions

They get a fail on transparency.

 

[rvallee]

Meet the new study, exact same as the previous identical studies. Really adding weight to the fact that there is no crisis of replicability in psychology, it's actually a crisis of validity. There are at least dozens of identical such studies, all with the same recipe and outcome: more research is needed. More research always occurs in this field, somehow, hence no crisis of replicability, failure is consistently replicated. The problem is validity, none of this has anything to do with objective reality, or even subjective reality for that matter.

psychological inflexibility, metacognitive beliefs, and cognitive and behavioral responses to symptoms

Literally none of those things are of any relevance. This is complete BS. Might as well do feasibility studies for large civil engineering projects based on how influencers may find the perfect snapshot for their daily vanity stroll. Completely irrelevant factors.

 

[Ebb Tide]

Am I missing something re the hours worked?

At 12 month follow up they give the following for change in hours worked:

"At 12 months follow-up, 42 (55.3%) individuals reported to be
working more hours per week than before starting the treatment, 26
(34.2%) reported to work an equal amount of time, and eight (10.5%)
reported to work a lesser number of hours per week than before."

According to my calculator that adds up to n=76

What happened to the rest of 195?

 

[Invisible Woman]

What happened to the rest of 195?

Hmmm....

The abstract clearly states

All completed a battery of questionnaires at pre‐, post‐treatment, 6 and 12 months follow‐up.

Bolding mine.

*Raises voice to ask if anyone's got a copy of the latest BPS dictionary? I need to look up "All"*

 

[Sly Saint]

What happened to the rest of 195?

maybe they were not working at all ie no change as

"One-hundred ninety-five workers on sick leave..........intensive return-to-work rehabilitation"

presumably that means that none of them were actually working before the 'treatment' (?)

(so how could some be working less hours at follow up?)

 

[Hutan]

"One-hundred ninety-five workers on sick leave..........intensive return-to-work rehabilitation"

presumably that means that none of them were actually working before the 'treatment' (?)

A final primary outcome was the response given by participants to a single item about the ‘Working Status’: at the end of the study, they were asked if they worked less hours, an equal amount or more hours per week, compared to the period before the treatment started.

An 'increase in work hours' if a person's work hours before treatment was 0 certainly may not be very impressive. Add in the lack of a control arm and what seems to be a massive dropout for the final follow-up survey, and, well, it's less than convincing.

 

[Hutan]

I would have liked to see a scatter plot of hours worked vs change in hours worked, but alas this was not done. I mean it wasn't as if return to work was the primary outcome of the treatment. Oh wait, it was! Hmm...

Worth repeating.

Of note, the levels of physical health-related QoL did not significantly change over time. At 12 months after treatment, scores remained approximately one standard deviation below the mean of a normative sample (see Table 2), suggesting that physical impairments such as pain persist over time.

So physical health QoL didn't improve. But, never mind, that's not the aim with ACT.

Such a result would fit with the theoretical underpinnings of the ACT model and thus indicates the validity of ACT as a treatment model for chronic fatigue. As there is a growing literature showing the potential of the ACT model (Jonsj€o, Wicksell, Holmstr€om, Andreasson & Olsson, 2019; Simister, Tkachuk, Shay, Vincent, Pear & Skrabek, 2018), these results warrant a rigorous comparison with CBT when it comes to the treatment of chronic fatigue.

Whack-a-mole - if CBT is finally discarded as the treatment of choice, there's another therapy to take its place. And this one doesn't have to show any objective improvement in anything.

The treatment was a 3.5 week inpatient programme! The cost of such a treatment must be enormous.

Concluding, results lend support to the effectiveness of an ACT‐based rehabilitation program for patients with chronic fatigue and provide preliminary evidence for the role of process variables and depressive symptomatology on subsequent change in outcomes.

There was no control, people! Argh

 

[Hutan]

Another typical problem of studies like this is the use of survey instruments without giving comparison figures for healthy populations, or, ideally, populations of people with a clearly physical and disabling health condition. There's an implicit assumption that the way sick people think is faulty, without any evidence.

For example the Metacognition Questionnaire. I can't easily find good comparison data, but there is a Wells and Cartright Hatton 2004 study that reported that the mean score was 52 in men and 47 in women, with a standard deviation for each of about 13.5. This was in a sample of convenience of university and health-service employees.

The study that is the subject of the thread reported that the MCQ score pre-treatment was 54 (SD 12). After treatment it was 51 (11). If you look at the questions, there's a section on cognitive confidence, e.g. 'My memory can mislead me at times'. So, it would not be surprising for someone with an illness that involves cognition issues at times to have a total score that is a bit higher.

I haven't spent enough time on this to be sure, and it looks like there are various weightings that can be given to the questions. But it's looking to me as though a very large percentage of the sample population of this study had perfectly normal metacognition scores. To then spend 3.5 weeks training these people to see the world differently and only have the tiny change in reported outcome seems a failure in itself, without us even needing to mention the lack of a change in reported physical quality of life.

 

[Trish]

This study reads more like promotional material for the rehab clinic, not serious science. I assume the study was done by the clinic staff who want to sell their inpatient rehab program to employers or government benefits agencies.