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

dave30th said:
I would guess they're probably publishing a selection of responses and the authors will respond to all of them with their usual stupidities and misrepresentations.
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A rare exception to the adage that it isn't stupid if it works. Here it's definitely both. Because wow does it work 100% of the time, no matter how convoluted the excuses and reasoning are.
 
Trudie Chalder is using ReCOVer to promote CBT for Long COVID at the May ATS Symposium in Washington DC.



Evidence for Fatigue Management in Long COVID (abstractsonline.com)


The wheels are inspired by A new paradigm is needed to explain long COVID - The Lancet Respiratory Medicine, S4ME thread here.
(Only Chalder changed the content and added arrows so it's more noticeable the cogwheels don't work like that, very on brand.)

Claire Willis 2021 is her own editorial with Willis in the Journal of mental health: Full article: Concern for Covid-19 cough, fever and impact on mental health. What about risk of Somatic Symptom Disorder?
 

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Arvo said:
If you are interested in this study, I recommend looking at the FOI files as they contain a ton of information, also in english. It gives a lot of trial content, but e.g. also discusses an awaited upcoming Australian sibling of this trial, and shows signs of problematic COI's and claims.
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Thanks for that post Arvo. The prospect of an Australian version isn't good. The Australian NHMRC contributed funding for the Dutch study - I think they need to be contacted. If we can't head off a replication of the study, we need to at least need to try to get some sound objectives outcomes included.
 
InitialConditions said:
Yesterday, I sent some comments to Hans Knoop and Tanja Kuut on potential issues with the data in Table 3 and presentation of results in Fig 2.

I have asked that they consider addressing these points—which may well be explainable—before the paper is published in final form. Lets see if they do that!

Obviously, there are other issues—such as the trial protocol and philosophy behind the study—that have been raised here. I just focused on some things that don't make sense to me.
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I finally had an email response from the authors (after an email to the editor).


Your comments on our study were sent to us by the editor of CID. We apologize for not responding directly to your mail. Your email ended in our spam box and was missed by us. Below we respond to the 4 remarks. We have send our response also to the editor.

1) The standard errors as reported in table 3 are correct. They seem identical because they are rounded to one decimal place. They are not identical.


2) Indeed, there is an omission in the caption of figure 2. The measure of uncertainty presented is the standard error with its 95% confidence interval, while we only referred in the text to the standard error. The caption of figure 2 should have been:


‘Checklist Individual Strength–fatigue scores and standard errors with their 95% confidence interval from baseline to the posttreatment assessment for the cognitive-behavioral therapy group and the care as usual group.’


3) As mentioned at 1) , the standard errors in the table 3 are rounded to one decimal place. When drawing the figure we used the unrounded standard errors. This can explain the small differences in the length of the error bars. The lengths of all error bars with their 95% CI are correct.


4) The error bars in figure 2 are not centered in the corresponding data points. This is a deliberate choice. If we had centered the bars, the individual error bars at baseline for both groups would not be visible for the reader as they overlap at that time point.
 
Thanks for sharing.

InitialConditions said:
1) The standard errors as reported in table 3 are correct. They seem identical because they are rounded to one decimal place. They are not identical.
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Doesn't change the problem in my view.

The standard errors at the start of the trial were very different compared to follow-up assessments. For example, for the primary outcome, CIS fatigue, it started at 0.7 then it was 1.4 at T1 en 1.7 at T2. So it more than doubled. This is unlikely to be due to a change in sample size because figure 1 says no participants were excluded form the analysis.

If the SE can be go from 0.7 to 1.7, it is a bit peculiar that they are exactly the same at T1 (1.4 and 1.4) and at T2 (1.7 and 1.7) in both groups. And that the same pattern appears in 3 to 4 of their other outcome measures. It's a bit like throwing a dice 8 times and and getting all 6s . It happens, but only about 1 in a million times.
 
A critical response to the CBT #longCOVID trial by Kuut et al. Eventhough they didn't touch on all the details, it looks pretty good. I don't think we've seen a collaboration of MDs voicing their concerns about CBT like this very often in the Netherlands. Is it a first? I think so. It's a clear sign things are changing! Anyways, well done to all the authors!

 
Hutan said:
That is a terrific letter.
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:thumbup: A couple of highlights.

Secondly, the outcomes were solely self-reported, with inherent limitations. Objective outcome measures, such as physical fitness (CPET), exercise behaviour and return to work that could have supported the authors conclusions have not been included. The results of the actometer that were planned in the study protocol are lacking for unreported reasons.

Lastly, the majority of patients participated upon self-referral to a non-blinded intervention, which increases the chances of unconscious or implicit bias to reporting positive treatment effects, overestimating its effectiveness. All in all, this study lacks high-quality evidence using appropriate control groups, ensuring that potential harms as well as benefits of CBT are fully considered.
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it remains uncertain whether CBT helps to improve post-COVID fatigue and which post-COVID patients may benefit. The underlying implicit message that post-COVID is a psychological disease adds to the invalidation of post-COVID patients and their symptoms and may paradoxically lead to increased suffering.
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Good stuff. :thumbup:

We will win when we get enough clinicians and researchers like this taking up the fight we have had to carry for fifty years.

They not only have more credibility and clout, and cannot be so easily dismissed, they also have the health and stamina to do it, and keep doing it.

Patient's lack of that critical resource is the single biggest advantage the psychosomatic ideologues have had against us.
 
The point that jumped out for me was the numbers in each group who also received physiotherapy. (34% vs 68%), and the effect of any exercise regime likely to be prescribed by the physios on PEM. That makes complete nonsense of the so called control group if most of them were being told to exercise.
 
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