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Protocol: Persistent physical symptoms reduction intervention: a system change and evaluation (PRINCE), 2015 onwards, Chalder, Moss-Morris, et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Sly Saint, Feb 1, 2019.

  1. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    See now that would be a more interesting trial : PBT (playing boardgames therapy) versus CBT.

    Although I have no doubt that, given the way they do these trials, they could 'prove' that almost anything results in improvement.
     
  2. chrisb

    chrisb Senior Member (Voting Rights)

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    Should they not just call it PT? That includes both Panacea Therapy and Physical Training.
     
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  3. Robert 1973

    Robert 1973 Senior Member (Voting Rights)

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    Can someone please explain to me how this is classified as an RCT? A + B v A isn’t my understanding of a controlled trial.
     
  4. MEMarge

    MEMarge Senior Member (Voting Rights)

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    I would love to be able to join a dance class, play squash, go skiing or even walk for 5 mins without pain.
    However I fear that replacement spines are further away than effective ME treatments!!

    I'm not complaining re my lot. Following major spinal fusion and then decompression ops when I was 18 I was able to continue a full and active life till my spine started collapsing again aged 35. My daughter however has had her life effectively on hold since age 16, ie for the last 8 years.
    Until she got ME she was doing weekly trampolining and ballet alongside fulltime at school, with the usual social life for her age!!!
     
  5. wdb

    wdb Senior Member (Voting Rights)

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    Edzard Ernst wrote a good piece on A+B vs A, unfortunately I think that 'no treatment' is still considered a control so technically it is an RCT (A+treatment vs A+nothing). It's a constant frustration to me that all RCTs are often considered similarly strong evidence when un-blinded no-treatment control subjective RCTs are in fact complete worthless junk.
     
  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Aha, not so fast!
    A controlled trial is not just a trial with controls. It is a trial with appropriate, or adequate, controls.

    In a similar vein a fastened seat belt is not just a seat belt with fasteners.

    Unfortunately, that 'controlled' implies 'adequately controlled' is never mentioned, unless someone considers the controls inadequate. In which case the comment is 'this trial is not adequately controlled'. So it is easy for people who follow 'procedures' or recipes or whatever you call them to miss the meaning of 'controlled'. I suspect a lot of 'expert statisticians' fall into that category.

    It has to mean adequately controlled because one can think of any number of trials with comparators, like standard care, that are very clearly not performing the function of a controlled trial. They do not allow you to discount irrelevant contextual influences.

    Whether Ernst really understands this sort of thing or not I would not know.
     
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  7. wdb

    wdb Senior Member (Voting Rights)

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    Where is that definition from, I certainly agree that is what it ought to mean ?
    NICE for example just give this definition
     
  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Yes but NICE is run by recipe-followers. It has no academic credibility. Throughout my career NICE was consider risible in the department of medicine. They always got things wrong because they followed rules that made no sense.

    A controlled trial is just one instance of a controlled experiment - which is something that scientists have been involved with for centuries. A controlled experiment is one with credible, adequate or appropriate controls.
     
  9. alktipping

    alktipping Senior Member (Voting Rights)

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    when standard health care = abandonment to your own devices doesn't that negate all of pace and many other trials that use standard health treatments as a comparison especially in a medical profession where budgeting gets prioritised first second and last. I have read a lot of papers on Medscape over the last year where the priority is cost rather than benefit to patient. the medical insurance companies have a lot to answer for when it comes to how patients are treated or abused . edited to ad this may only be the case on Medscape as I do not have access to other med publishers .
     
    Last edited: Feb 4, 2019
  10. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    I agree, it is a perversion of the term.

    A Randomised control trial requires a (patient) blinded control arm.
     
  11. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I don't think there is a recipe. A controlled trial is one with adequate controls - and as in all science what counts as adequate is dependent on the detailed contextual factors of every experiment. Every situation is different, just as in ordinary life. If you want to know if the are iron stains on the shirts are from the washing machine you need different controls from when you want to know why the tulips did not flower this year. No two trials are the same.
     
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  12. Cheshire

    Cheshire Moderator Staff Member

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  13. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Merged thread

    This is from her lecture in March 2019
    reading between the lines this transdiagnostic approach seems to me to be a further step towards a Per Fink style BDS and presumably they can then 'sell' it to IAPT as a more economical treatment as it purports to deal with multiple 'disorders'/symptoms.
     
    Last edited: Mar 18, 2019
  14. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    https://www.uea.ac.uk/documents/246046/11919343/LTCMUS Pathfinder Evaluation Phase 1.pdf/bccbe428-ba4d-44ff-b2f8-09cb43cdb62b

    IAPT LTC/MUS Pathfinder Evaluation Project
    Phase 1
    Final report

    University of Surrey, November 2013 (Revised April 2014)
    University of Surrey Evaluation Team


    "As a component of some Pathfinder projects, training was provided for GPs and physical health clinicians. The projects began during organisational upheaval in primary care, as general practices were preparing for the clinical commissioning groups introduced by the Health & Social Care Act 2012. Only twelve from over 30 general practices approached by Devon Pathfinder responded to the offer of training for practitioners in detecting and referring people with MUS. In Berkshire twenty GPs were trained in managing MUS in primary care by Per Fink..."

    I think this was in 2010; he was invited to the UK to train Berkshire GPs in the TERM Model.
     
    Last edited: Mar 18, 2019
  15. Mithriel

    Mithriel Senior Member (Voting Rights)

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    "We know that between all of these so-called medically unexplained symptoms that there is a huge overlap between them. They have shared pain, distress, disability, all sorts of different things to varying degrees"

    These symptoms are common to all chronic illnesses and many acute ones. They simply ignore all the symptoms that differentiate them. They also take a term like PEM and make it general. If you ask anyone, healthy or ill, if they feel worse after exercise the vast majority will say they do. Ask if they feel fine after exercise but collapse three days later most will have never thought that possible.
     
  16. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    https://clinicaltrials.gov/ct2/show/study/NCT02426788

    I think the results of this RCT are going to be presented at 9th World Congress of Behavioural and Cognitive therapies (Berlin July 17th-20th 2019)

    see:
    https://wcbct2019.org/Downloads/abstract-book-1.pdf

     
  17. Daisymay

    Daisymay Senior Member (Voting Rights)

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  18. rvallee

    rvallee Senior Member (Voting Rights)

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    That's the difference between a cruise ship, the HMS PACE, and an exploration vessel: it has a predetermined destination and in fact the whole of the journey is built around arriving at the destination at a time set far in advance.

    The outcomes used are so random, as if they just threw darts at a board, then took shots and shouted random questionnaires. Might as well measure how quickly can someone solve a rubik's cube for all that it's relevant.

    Once again the question: how is anyone OK with being so careless with their funds? If at least they were self-funded it would only be half as bad. After all, if their BS worked they should have no problem finding private funders.
     
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  19. Sean

    Sean Moderator Staff Member

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    Awful lot of assuming going on with these clowns.
     
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  20. rvallee

    rvallee Senior Member (Voting Rights)

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    By what illogic is a 100% psychological model transdiagnostic? There is not a single aspect to their model that is not wholly psychosomatic. It even reduces it further by strictly limiting to imaginary thoughts and beliefs, which make up a tiny segment of psychology.

    Especially when it literally stands in opposition to an actual transdiagnostic understanding involving multiple organ systems and disciplines.

    It's like their whole "holistic" nonsense, claiming they consider the whole individual when actually it reduces everything to one dimension of one aspect through an extremely narrow interpretation. And ironically does not even consider the psychological aspects since they reject everything we tell them so they don't even acknowledge the very aspect they wrongly claim to focus on. Ultimately it is all about their psychology and their own thoughts and beliefs.
     
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