Efficacy of cognitive behavioral therapy targeting severe fatigue following COVID-19: results of a randomized controlled trial 2023, Kuut, Knoop et al

[Arvo]

That makes it a bit more complicated, I think. The conflict of interest would be more apparent if it were an independent business than if it's part of their responsibilities as university employees. Hm.

Maybe, but it's still a big problem IMO. Dutch health care has been deliberately commercialised, so if hospital A "specialises" in a specific treatment for a medical or psychiatric problem and earns money via insurance company reimbursement for that treatment, then I think it's unethical if the researchers of that same hospital (edited to add: that also make a living providing that specific treatment) are the main ones studying the efficacy of the treatment, especially when they are already announcing that they will provide the treatment on a big scale if proven effective, and will develop a related therapist training course that I expect to be monetized as well.

I don't know what the deal is with AMC or VUmc (they are university affiliated), but several dutch hospitals can be owned by shareholders and ran as a business that needs to make profit (and one that can go bankrupt and close down).

And the NKCV is different: it seems to be part of the care provided by the AMC psych department, but as an independent institute it's not part of the AMC psych department itself. It'd be interesting to know how financial reimbursement from health insurance companies are distributed among NKCV (that profiles itself as an independent treatment center) and the AMC psychiatry department (that refers patients to the NKCV).

 

[Arvo]

I'm fairly certain that this wasn't on the NKCV front page a couple of days ago when I checked it.

It certainly wasn't on the archived version of June the 4th.

A new banner was added. It says:

"Attention

The care activities of the NKCV have since January 2022 been continued by the Amsterdam UMC within the NKCV outpatient clinic. The foundation has been discontinued since May this year, the information on this site is correct, however, it still contains references to the foundation and will soon be adjusted."

Edited to add: the "read more"button links to a map and address of the location at VUmc.

 

[Mark Vink]

Full text below

Thank you for your response to that bad article.

If your response is still not open access, then it might be worth considering to contact the journal and stress to them that the original article is open access and as a consequence all responses to that article should be open access without you having to pay for that.

 

[Joan Crawford]

Thank you for your response to that bad article.

If your response is still not open access, then it might be worth considering to contact the journal and stress to them that the original article is open access and as a consequence all responses to that article should be open access without you having to pay for that.

Thanks for that top tip @Mark Vink I shall do that.

 

[Lucibee]

Ty;

Kuut: “Scores on the fatigue severity subscale of the Checklist Individual Strength (CIS), range 8 to 56, with higher scores indicating more severe fatigue; a score of ≥ 35 indicates severe fatigue“

Your PNG: “Subsequently the four subscales are calculated by summing the respective items subscale 1: Subjective feeling of fatigue items 1, 4, 6, 9, 12, 14, 16, 20.”

Yes - it should be 56 (not 52).

 

[dave30th]

Yes - it should be 56 (not 52).

Oops! I just corrected my post. I made this error--I thought I copied the number from somewhere, but now I can't find from where. Maybe it was just my own mistake.

 

[Andy]

Trial By Error: Dutch Team Offers “Dog-Ate-My-Data” Excuses for Not Reporting Null Objective Findings

https://virology.ws/2023/07/11/tria...es-for-not-reporting-null-objective-findings/

 

[Grigor]

It's an excellent take down. Thank you very much David!

 

[Trish]

That's a brilliant article, @dave30th on top form. Those researchers are making complete fools of themselves over this.

 

[dave30th]

Those researchers are making complete fools of themselves over this.

They make it so easy to ridicule their position, given the preposterous arguments they raise. Physical activity isn't related to fatigue in any way? Really???

 

[Charles B.]

They make it so easy to ridicule their position, given the preposterous arguments they raise. Physical activity isn't related to fatigue in any way? Really???

If activity levels aren’t relevant, then why is increasing activity the central aim of these interventions, and why did you include actigraphy as an outcome in *your* own trials??

These people depend on unaffiliated third parties not having the time or desire to actually grapple with the logic in these arguments.

 

[Joan Crawford]

If activity levels aren’t relevant, then why is increasing activity the central aim of these interventions, and why did you include actigraphy as an outcome in *your* own trials??

These people depend on unaffiliated third parties not having the time or desire to actually grapple with the logic in these arguments.

Spot on

 

[Mark Vink]

They make it so easy to ridicule their position, given the preposterous arguments they raise. Physical activity isn't related to fatigue in any way? Really???

Guess who concluded that there is an inverse relationship between fatigue and physical functioning?

Yes, you guessed it right, amongst others, professor Hans Knoop…

 

[rvallee]

Trial By Error: Dutch Team Offers “Dog-Ate-My-Data” Excuses for Not Reporting Null Objective Findings

https://virology.ws/2023/07/11/tria...es-for-not-reporting-null-objective-findings/

They're actually arguing that objective activity data is more subject to bias than subjective questionnaires putting indirect questions into an arbitrary score that, in their admission, never match objective data. Even by the standards of politics this would be absurd. There is simply no context where this doesn't get people laughed out of every room.

And the "intervention" is called Fit after COVID, with the explicit aim of increasing physical activity. So I guess that there is supposed to be no relation between physical fitness and... physical activity? Wut?

And, somehow, this is what's taken seriously and pointing this is out is dismissed as an activist crusade.

Holy crap. This is beyond absurd. The whole discipline has lost the damn plot.

 

[Mark Vink]

They're actually arguing that objective activity data is more subject to bias than subjective questionnaires putting indirect questions into an arbitrary score that, in their admission, never match objective data. Even by the standards of politics this would be absurd. There is simply no context where this doesn't get people laughed out of every room.

And the "intervention" is called Fit after COVID, with the explicit aim of increasing physical activity. So I guess that there is supposed to be no relation between physical fitness and... physical activity? Wut?

And, somehow, this is what's taken seriously and pointing this is out is dismissed as an activist crusade.

Holy crap. This is beyond absurd. The whole discipline has lost the damn plot.

didn’t you know that in the world of delusional psychology, you can increase your fitness without increasing your activity?

 

[rvallee]

didn’t you know that in the world of delusional psychology, you can increase your fitness without increasing your activity?

If only this was restricted to delusional psychology. Almost everyone in medicine we show this to doesn't mind any of it. It's all perfectly good, conforms with their expectations. This is not contained to some fringe corner of medicine, it is establishment dogma not to question any of it. Even people never exposed to this end up with the same conclusions.

Look. At. This. Shit:

This leadership has drawn the attention of Admiral Rachel Levine, the U.S. assistant secretary for health, who will visit CU Anschutz in July to learn more about our researchers’ findings about long COVID’s myriad symptoms and multi-organ impact.

People who have long COVID that's primarily impacting their brain may have different things that are causing that. There may be an ongoing virus in their spinal fluid that's impacting their brain and we might treat that differently with maybe an antiviral or an anti-inflammation medicine...

People who have exercise fatigue or difficulty with exercise, we might need to treat them with other medications, or other treatments like exercise. People who have a lot of fatigue sometimes might need cognitive training or different types of mental health interventions."

https://news.cuanschutz.edu/news-st...dentify-long-covid-cu-anschutz-takes-the-lead



This is insane. There is zero reasoning here. It's negative reasoning, it makes no sense at all. And it is unquestionable dogma.

 

[Charles B.]

If only this was restricted to delusional psychology. Almost everyone in medicine we show this to doesn't mind any of it. It's all perfectly good, conforms with their expectations. This is not contained to some fringe corner of medicine, it is establishment dogma not to question any of it. Even people never exposed to this end up with the same conclusions.

Look. At. This. Shit:



https://news.cuanschutz.edu/news-st...dentify-long-covid-cu-anschutz-takes-the-lead



This is insane. There is zero reasoning here. It's negative reasoning, it makes no sense at all. And it is unquestionable dogma.

Exhaustion is mental illness because we’ve made that determination and are totally intransigent. It has to be something that only befalls an inferior “other.” That way, I can be sure it won’t befall me

 

[Sean]

If activity levels aren’t relevant, then why is increasing activity the central aim of these interventions,...

Exactly.

On this we can all agree with the great Sir Simon and his trusty sidekick, Prof Chalder, when they said (bolding mine):

"...in the later stages of treatment patients are encouraged to increase their activity (which must ultimately be the aim of any treatment)"

Wessely, David, Butler, & Chalder – 1990

 

[Grigor]

Knoop and Wiborg about increasing activity:

"Two Dutch commentators, Hans Knoop and Jan Wiborg, from the Knowledge Center for Chronic Fatigue (Radboudumc) assume that an increase in physical activity acts as 'a catalyst to bring about changes in cognitions about activity and symptoms in patients with CFS'. According to them, research should focus on how the mindset of patients can be changed even faster and more effectively in that regard, they argue."

https://www.medischcontact.nl/nieuw...herapie-cvs-werkt-beter-zonder-bewegingsangst

 

[Arvo]

They're actually arguing that objective activity data is more subject to bias than subjective questionnaires putting indirect questions into an arbitrary score that, in their admission, never match objective data

Well yeah, dontchaknow "medical research is increasingly moving away from objective outcomes", and btw, "why are patient organizations so obsessed with objective measures? Objective measures are also subjective." So.

Wryness aside, as others have noted here, the argument that "there is no correlation between the objective and subjective outcome parameters" is bizarre. (And if that's so then why not ditch the subjective one and switch to the outcome that can show actual, real life change, as you can't infer that from the subjective outcome?)

(Also, the whole point of the CBT was that patients would ignore what they feel subjectively, so they would expand actual real life activity? But that's the UK version, I must admit I haven't fully dived into whatever DIY Frankenstein CBT Bleijenberg and Knoop have stitched together, beyond that it relies heavily on patronising, altering patient's perception of what "recovery" means and making heavy use of telling patients that "CBT works!" as that has a positive effect on outcome.)

And the "intervention" is called Fit after COVID, with the explicit aim of increasing physical activity. So I guess that there is supposed to be no relation between physical fitness and... physical activity? Wut?

Fit, adj. "healthy and strong, especially as a result of exercise"
Fitness, noun. "the condition of being physically strong and healthy" (Cambridge dictionary)

Fit [eng: fit]: "fris; krachtig en gezond. Kiplekker." [feeling well; strong/potent/full of energy and healthy. Fit as a fiddle.] (Van Dale dutch dictionary, english translation mijnwoordenboek.nl)

Hmmm... I don't know what this team's own description of the word "fit" is, but something tells me it might be related to how they explain "recovery".