healthcare: Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome?... - 2020 - Vink et al

Healthcare: Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome by Mark Vink and Alexandra Vink-Niese

Abstract:
An increasing number of young and previously fit and healthy people who did not require hospitalisation continue to have symptoms months after mild cases of COVID-19.

Rehabilitation clinics are already offering cognitive behavioural therapy (CBT) as an effective treatment for long COVID and post-COVID-19 fatigue syndrome based on the claims that it is effective for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—the most common post-infectious syndrome—as no study into the efficacy of CBT for post-COVID-19 fatigue syndrome has been published.

Re-analyses of these studies, however, showed that CBT did not lead to objective improvements in heterogeneous groups of ME/CFS patients, nor did it restore the ability to work.

The group of patients with long COVID and post-COVID-19 fatigue syndrome, on the other hand, is homogeneous. We therefore analysed the Dutch Qure study, as it studied the efficacy of CBT in a homogeneous group of patients who developed Q-fever fatigue syndrome—which affects up to 30% of patients—after the largest reported outbreak of Q-fever, to see if CBT might potentially be an effective treatment for long-haulers after COVID-19 infection.

Our reanalysis found that the Qure study suffered from many serious methodological problems, which included relying on one subjective primary outcome in a study without a control group for the non-blinded CBT treatment group, using a post hoc definition of improvement, waiting 2 years before publishing their objective actometer results and ignoring the null effect of said results.

Moreover, only 10% of participants achieved a clinically meaningful subjective improvement in fatigue as a result of CBT according to the study’s own figures. Consequently, CBT has no subjective clinically meaningful effect in nine out of every ten patients that are treated with it.

Additionally, the subjective improvement in fatigue was not matched by an improvement in disability, even though the disability was fatigue related according to the researchers.

On top of this, CBT did not lead to an objective improvement in physical performance.

Therefore, it cannot be said that CBT is an effective treatment for Q-fever fatigue syndrome either. It seems therefore unlikely that CBT will reduce disability or lead to objective improvement in long COVID or in post-COVID-19 fatigue syndrome.

 

What are the differences between LC and post-COVID-19 fatigue syndrome? Why are they using 2 separate names?

When did they slip "fatigue" in?

 

Long-Covid would encompass any prolonged symptoms something like 4 weeks + after initial infection. Post-COVID-19 fatigue syndrome would be a subset of long-Covid patients who have fatigue as a main symptom and the diagnosis would be given much later. NICE say 12+ weeks for "post-COVID19-syndrome" — they aren't calling it post-COVID-19 fatigue syndrome. It's not clear if the authors of this paper make a distinction between the two.

 

Can I just say it's amazing that these papers even have to exist. We have watched in real time patients getting and remaining ill, and we've seen studies already showing that this is often because the virus is attacking different bodily systems and tissues. Yet CBT is still in the mix.

 

That's my fear -- the ones who only read the headlines will assume CBT is good for Long Covid.

I'd prefer the title was declarative: Unlikely CBT will help Long Covid.

Edit for accuracy.

 

Looking forward to reading this!

 

I think the title is quite an interesting choice, as it is revealing of the expectation bias so many researchers have in the BPS field.

Anyone who judges a study without even reading the abstract can't be taken seriously. The abstract itself gives a summary of the negative findings to the research question, which also works to unmask the expectation bias of the reader - a clever and subtle method of education!

 

https://twitter.com/user/status/1340697028171620357


A closer look at the Qure Study
https://mecfsskeptic.wordpress.com/2020/12/20/a-closer-look-at-the-qure-study/

 

Pure limpidity. Wonder who could have written that?

 

Clearly it was Q from Star Trek.