Factors associated with work status in chronic fatigue syndrome (2019) S A M Stevelink, N T Fear, M Hotopf, T Chalder

I was sure I'd seen this posted here, but now cannot see it.

They say "The early involvement of occupational health practitioners is recommended to maximize the chances of maintaining employment." - Not seen any good evidence for any intervention intended to improve employment outcomes for CFS though.

This is published in journal from the Society of Occupational Medicine - I wonder if it's a precursor to more spin from Ira Madan, who has a long history of promoting CBT/GET on the basis of very weak evidence?

Edit:
Paywall, https://academic.oup.com/occmed/advance-article-abstract/doi/10.1093/occmed/kqz108/5543260
Sci hub, https://sci-hub.se/10.1093/occmed/kqz108

 

The data, in the abstract at least, does not speak to this either way.

 

This study appears to make light of "cfs" again. As if the only factor keeping people with this illness from working is co-morbid depression.

Aside from "cfs", it would be interesting to see the percentage of the employed who have depression.

 

Paywall, https://academic.oup.com/occmed/advance-article-abstract/doi/10.1093/occmed/kqz108/5543260
Sci hub, https://sci-hub.se/10.1093/occmed/kqz108

 

This

 

This study is actually advertising.

 

It's preparing for more privatised spin offs from NHS in lieu of direct provision.

How many private companies currently provide CBT therapy, who has a financial stake in them, and where do they operate?

The fact that you don't need robust evidence has done nothing to halt the IAPT roll out. The pie has infinite slices.

 

55% were currently working but if I understand correctly, this includes patients who worked part-time, did casual work or are a student. Nonetheless the average of 30 hours a week seems quite high.

There was no significant difference in anxiety between those who worked and those who did not, so I assume this isn't a major factor determining whether patients continue to work or not. There was also no difference in somatic attributions between the groups, while the difference in physical functioning (60 versus 30) was huge. So it seems that what determines whether CFS patients continue to work or not is not patients thinking they have a somatic illness or anxiety, but how ill they actually are.

 

"We assessed cross-sectional data from patients attending a UK specialist CFS treatment service between 1 January 2007 and 31 December 2014."
majority of ME patients (moderate to severe) would not be able to attend so it's hardly a representative sample.

 

Don't think so. I usually respond if I think there's something really misleading in the results, that might confuse readers. Don't think this is the case with this short paper. On the other hand, it's rather frustrating that the authors do not discuss the hypotheses they have tested.

Why did they ask patients whether they saw their symptoms as physical, psychological or combination of both? They probably thought this was an important factor determining outcomes. But now that the results indicate it's irrelevant to work status, they barely mention it in the discussion section. They also highlight the high numbers of anxiety in this patient sample, by which they seem to say that this is important. But there was no difference in anxiety between the working and not-working group.

I suspect that if somatic attributions and anxiety, which both feature prominently in their cognitive behavioural model, had shown significant differences between the groups, that the authors would have highlighted this and how important it is to incorporate this in the treatment etc.

 

They could argue that the physical functioning scores reflect perception of physical functioning and that this perception causes poor health and poor work status.

All their theories are based on causally interpreting such correlations through a psychogenic lens, so why not here too?

 

Maximus do the work capability assessment tests for ESA...

 

I will be included in this assessment. Attended a CFS/ME Clinic from Jan 2014- discharged early Jan 2015

‘Self reported current employment status’ - well my Clinician was involved in at least 3 letters to and fro with a local Occupational Health Consultant, who was acting on behalf of my employer.

Due to strict HR rules within the civil service, I had mandatory reviews all through the Sickness Absence period, both with my manager(s) [supported by my Union rep] and with independent medical staff, first with a G.P. and then three meetings with the above Occ Health Consultant from the local hospital (employed by the Occ Health business employed by the civil service).

The very first hurdle I would have had to overcome, was to actually get to work (50-60 min journey there by car in rush hour, 30-35 min journey home).

Despite OH assistance, all the way through the procedure, they did not enable me to return to work, not even to phased return.

Try someone who had been hospitalised by Sepsis, followed by an CFS/ME diagnosis (who had already had PVFS 12 years earlier).

I admitted to being very anxious about my health, my job (which I loved and had received recent ‘outstanding’ reports), our financial situation, two teenagers and a greyhound, OH bearing the burden, our mortgage, moving to half pay, then no pay. As @Trish said, no wonder I was anxious - I was not depressed - but, even if I had been, it would not have been surprising.

When first diagnosed (even having had PVFS), you still do not realise the strain you put your body through to get to clinic.

Not until Tribunal put me into Support Group ESA July 2015 (Sepsis August 2013) did I even realise that the whole sickness procedure, attending clinic and coping with U.K. benefits system had been severely affecting my M.E. My slight improvements began in 2016.

At one point, I contacted “Access to Work” as I understood that you could get funding to ease your journey if you were considered disabled or on a phased return to work. In 2014, they offered to pay for a taxi from home to the local railway station. I would then have had to commute by train (short 10 min journey), then walk to office (2mins). The stress of attempting to co-ordinating a taxi, train, walk option would have been worse than driving myself!


The moral of this tale is I had OH ‘support’.
Despite initial concerns, the doctors I saw were actually good, kind and helpful.
I had no exercises/counselling or household aids provided (which may, or may not, have helped)
The CFS/ME Clinic actually wrote decent explanatory letters (later used as evidence for benefits).
I was dismissed from work.
I still have M.E.