The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With CFS:, 2022, Xie et al

Th recognition that GET and CBT might not be effective treatments is good, although I'm not sure where the schizophrenia fits in.

That's Friedberg F. ME/CFS: Primer for clinical practitioners. (2014). Available online at: www.iacfsme.org. (accessed July 2014). That primer should be withdrawn, it is full of a lot of unevidenced statements.

I'd be surprised.

I've got to say, so far the research protocol is very good. The allocation of participants to the treatments was randomised by an independent statistician. The participants all had to come in for a session once a week, and then had to practice at home. They had to post videos of them doing their home practice each day. The treatment involves abdominal massage - they even had pressure-sensing gloves so the they could get the right amount of pressure.

 

That's pretty intensive CBT.

Primary outcome - MFI-20 - fatigue
Secondary outcomes -

• Overall efficacy evaluation - probably as good as any subjective measure - 4 levels - basically complete cure, nearly a cure, a significant improvement, and minimal or no change, also incorporating the MFI-20 changes.
• PSQI - sleep quality
• HADS - anxiety and depression - these researchers don't seem to have realised that HADS doesn't work in ME/CFS
• Peripheral blood markers - although the title is in the plural, the only one mentioned is NPY, they claim it is an objective biomarker of sleep, anxiety and depression in CFS. I don't think it's as clear cut as that.

Any adverse events were reported and evaluated by a medical committee. If they judged that it was an adverse event, the cost of treatment and financial compensation would be paid to the claimant. Yes, the participants were paying to be involved in this study. (There were 6 adverse events, only two were felt to be related to the qigong, none to the CBT.)

They report only one dropout (CBT group), from a shoulder fracture.

RESULTS

Qigong wins! (as was expected by the researchers). No cures by either treatment, but CBT couldn't even produce a single markedly effective result. To be fair, the daily CBT lectures were probably pretty boring, and I'd be annoyed if I had paid for them.

But, in terms of the primary outcome (MFI-20) and the PSQI and HADS, there was no significant difference between the two treatments. These are subjective outcomes, measured straight after the treatment, so don't really mean anything.

I don't know what to make of the NPY. It didn't really change in the Qigong group (126 to 124), but it went up in the CBT group (142 to 201). There's no unit given anywhere in this qigong/cbt study, so that makes it hard to compare the results with other studies.

I've talked about NPY in this study
Plasma Neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome, 2010, Fletcher et al which didn't really find differences in NPY levels in CFS compared to controls and GWI, although they claimed it was higher in the CFS group. The qigong authors quote that study as showing that levels are higher in CFS, but I don't think the study shows that at all.

NPY is involved in lots of things so it's too simplistic to suggest it means anything specifically about anxiety levels. Some references say that repeated stress and a bad diet increases NPY levels, while others suggest that higher levels are associated with a resilience to stress.


CONCLUSION: Subjective outcomes in an unblinded trial, measured only at the end of treatment - that trial set up could prove anything worked, and so it did. It seems that stomach massage works just as well, if not better than CBT. It's not really clear what the only objective measure, NPY was measuring.

 

Indeed.

But, if you believe ME/CFS is psychosomatic, then I guess it doesn't matter all that much what the treatment is. You go through the motions of treating the patient and, provided the treatment is convincing enough, the patient reports feeling better, and so, the job is done.

One thing I note that was missed from the reporting was the results of the diaries that the participants were supposed to fill out every day about how they feel about the treatment. I would like to see those. It's hard to imagine the participants feeling thrilled to dial in for their daily CBT 30 mins after weeks of that. It would be interesting to know how many of the participants moved to the option of 'reviewing the CBT powerpoint slides in their own time' rather than listening to the CBT therapist, and how many in the qigong arm continue to practice qigong at home now.

 

That they need to start learning how to be qigong masters, because the practice produces outcomes that are as good as CBT and it sounds more fun, with its pressure sensing glove and all?