Graded Exercise Therapy for Patients with Chronic Fatigue Syndrome in Secondary care: a benchmarking study, 2021, Smakowski, Chalder et al

Abstract

Objective
We investigated the effectiveness of Graded Exercise Therapy (GET) delivered to patients with Chronic Fatigue Syndrome (CFS/ME) in a routine, specialist clinic by measuring patient-reported outcome data collected prospectively over several timepoints alongside therapy. Benchmarking analyses were used to compare our results with those found in randomized control trials (RCTs).

Method
Data was collected from patients, with a diagnosis of CFS/ME, who had been referred to a specialist clinical service in South London. Measures included Chalder fatigue questionnaire, physical functioning subscale of the short-form health questionnaire and the work and social adjustment scale. Change on each measure was calculated over time using linear mixed-model analyses. Within group effect sizes were calculated and compared with previous RCT’s.

Results
Fatigue scores were significantly reduced by session 4 (-5.18, 95%CIs -7.90, -2.45) and at follow-up (-4.73, 95%CIs -7.60, -1.85). Work and social adjustment and physical functioning progressively improved over the course of therapy, reaching significance at discharge and maintained at follow-up (WSAS -4.97, 95%CIs -7.97, -1.97; SF-36 10.75, 95%CIs 2.19, 19.31).

Conclusions
GET is an effective treatment for CFS/ME within clinical practice. However, effect sizes were smaller in routine clinical practice than RCT’s suggesting that avenues for augmentation need to be considered.

Abstract only, https://kclpure.kcl.ac.uk/portal/en...re(fbd405e8-ae37-4690-9e75-54b3052690f4).html

 

https://twitter.com/user/status/1410039797062721539

 

Is this frantic press of ever poorer quality BPS papers a desperate attempt to overwhelm service commissioners before the publication of the final NICE guidelines, even though they must know it is too late to influence the guidelines themselves; is it part of their bid to colonise Long Covid; or are they trying to convince themselves and their acolytes that there is still some scientific basis for their beliefs, despite increasingly losing the arguments over the validity of research methodologies relying solely on experimental slight of hand and manipulation of bias within subjective outcomes?

Though I have little faith in the British medical and scientific establishment not to be swayed by the eminence of the handful of venerated professors still in attendance at the altar of GET and CBT, hopefully this endless repetition of the same flawed methodologies will eventually serve to undermine their proselytising.

 

Interestingly, though Crawley in Bristol/Bath seems to be switching to research involving children with ongoing problems following their intervention, reported as successful with 95% of patients (if I remember the figures correctly), Chalder in London still seems to have enough patients to research on first time round.

Does this mean that Crawley is beginning to realise that on objective measures the UK specialist services are failing to achieve the cure rates they believed to be possible, but Chalder is not? Or is Crawley [beginning] to hedge her bets, where as Chalder is just doubling down on the same old same old?

 

this was a huge problem in the CBT study she published last fall with Sir Simon.

 

Yes, indeed.

 

Now published open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1949049

 

Yet again conflating ME with chronic fatigue and inflating the numbers. There's no way that many people in the UK have real ME. Typical BPS tactic.

Yet more useless scales which don't measure PEM or even require it in the CDC 94 criteria. Open label study with no objective outcome measures.

 

I wonder whether the stalling of the NICE guidelines is due to the fact that this (kinda, sorta) ‘new knowledge’ was going to be published and would make NICE changing their minds on GET after all

 

This is pretty bad. And again Chalder is making claims that these findings demonstrate "effectiveness" while claiming that the study design does not allow for causal explanations. To claim something is "effective" is making a causal claim. She has documented an association between people who receive GET and a proportion of those who report that they feel better. That is not demonstrating "effectiveness." it is demonstrating a chronological association which might mean something or might not. To her, it seems every association is an opportunity to claim causality.

 

Trial By Error: More Science-as-Promotion from the GET Campaigners

"Perhaps Professor Chalder and her colleagues believe that the volume of studies confers some sort of credibility on the content. That strategy might work in some cases, but not when the research is as misleading as the GET propaganda Professor Chalder and colleagues published in July in the journal Disability and Rehabilitation. (This publication comes after, among other instances, Professor Chalder’s misleading CBT paper last fall in the Journal of the Royal Society of Medicine, to which Professor Brian Hughes and I published a rejoinder; and Professor White’s misleading GET paper in the Journal of Psychosomatic Research, which was corrected to make it clear that the study had null results.)"

https://www.virology.ws/2021/09/14/...cience-as-promotion-from-the-get-campaigners/

 

I do sometimes wonder if they really have the scientific nous to distinguish between the two. As if to them it is "so obvious" the relationship must be causal ... they just get mental dropouts of those rather important bits of scientific reasoning along the way. It's bordering on weird.

 

I have thought the same thing. They might elide between the two without realizing it, because it is self-evident to them that the treatments are "effective."

 

Moved post

David Tuller Sept 14 2021

https://www.virology.ws/2021/09/14/...cience-as-promotion-from-the-get-campaigners/