Barry
Senior Member (Voting Rights)
If it's PACE cheese it will be full of holesIt is!
We need to mine it immediately![]()

If it's PACE cheese it will be full of holesIt is!
We need to mine it immediately![]()
And stink.If it's PACE cheese it will be full of holes.
That being said, use of teletherapy for patients too unwell to attend clinic is an innovative approach that merits further research.
I have a similar problem whenever I read the word 'the rapist'............did it againReading this response from the authors, I misread "teletherapy" as "telepathy". Knowing who the authors were, it only caused me to half raise one eyebrow.
Probably a typo.Reading this response from the authors, I misread "teletherapy" as "telepathy". Knowing who the authors were, it only caused me to half raise one eyebrow.
If it's PACE cheese it will be full of holes.
Thats no good, i choose to believe its Brie, Feta, Havarti, Mozzarella, Ricotta and ColbyAnd stink.
Sorry if this has been asked already, but did MEA submit their response to GETSET to The Lancet, or did they just not bother because of the conflict between the tiny word limit and Brandolini's Law?
Best to tag @Russell Fleming in that case.That was a genuine question, by the way... (albeit a slightly barbed one!).
The letters
Karen D. Kirke
Graded exercise self-help for chronic fatigue syndrome in GETSET
Joan S Crawford
Graded exercise self-help for chronic fatigue syndrome in GETSET
Robert H Saunders
Graded exercise self-help for chronic fatigue syndrome in GETSET
Frank Twisk
Graded exercise self-help for chronic fatigue syndrome in GETSET
Anne Wood
Graded exercise self-help for chronic fatigue syndrome in GETSET
Lucy V Clark, Francesca Pesola, Janice M Thomas, Mario Vergara-Williamson, Michelle Beynond, Peter D White
Graded exercise self-help for chronic fatigue syndrome in GETSET
They didn't include how much physical activity the participants undertook in the past week as requested by Anna Wood.Anna Wood is concerned about adherence to GES and missing data; both were reported in the paper and neither significantly altered our findings or conclusions.1
The protocol notes that to “measure departure from intended treatment, participants will be asked at follow-up whether they adhered to the booklet and guidance, and how much PA [physical activity] they undertook in the past week.”3 It would be useful if Clark and colleagues could now also publish such data.
It is disappointing that there are again making this point without sharing information about the other subgroup i.e. with the higher baseline scores.We have already acknowledged the small size of the effect on physical functioning (0·20), but our finding that the effect size was greater in those with the worst baseline physical functioning suggests this might represent a ceiling effect.
---Response to: Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial
The SF-36 physical functioning (PF) outcomes for those in the guided graded exercise selfhelp (GES) group who had a baseline SF-36 PF score ≥45 (call them group B) must have been particularly poor in the GETSET trial.1 We are told that those with a baseline score ≤40 (group A) made up approximately 40% of the sample and ended with average score of 56.9. This means the average outcome for group B, the higher functioning group at baseline, was actually lower, at around 54.9. Also, by definition, group A increased by an average of at least 16.9 (56.9-40). However the whole sample only increased by an average of 8.4. This means that an upper bound on the average increase for group B would be only approximately 2.7, in comparison to the increase of 16.9 for group A. This is an extreme scenario and the difference in improvements was most likely higher than 14.2. It would be interesting if Clark and colleagues could give the exact figure so everyone would be aware of the magnitude of the difference in the response.
Clark and colleagues say the poor results may be due to a ceiling effect. More than 90% of healthy working-age people score 90 or more.2 Therefore, the mean score of 54.9 for group B and 55.7 overall suggests that if there is a ceiling in the effectiveness of GES, it is a long way below normal functioning. I do not believe this was made clear to readers.
Tom Kindlon
Competing interests: I work in a voluntary capacity for the Irish ME/CFS Association.
References:
1. Clark LV, Pesola F, Thomas J, Vergara-Williamson M; Beynon M, White PD. Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial. The Lancet. June 22, 2017 doi:10.1016/S0140-6736(16)32589-2
2. Wilshire CE, Kindlon T, Matthees A, McGrath S. Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial. Fatigue. 2017;5:1–4.
MINE, MINE .... ALL MINE!!!It is!
We need to mine it immediately![]()
It is disappointing that there are again making this point without sharing information about the other subgroup i.e. with the higher baseline scores.
Our finding that GES was more useful in those with worse physical functioning is reassuring and has been reported previously,[11] but further exploration is necessary because it might be related to a ceiling effect in those with good physical functioning at baseline. This ceiling effect might also explain the relatively smaller difference in the effect size for physical function, which would reduce the overall difference between study groups.