Treatment effects of multimodal inpatient psychotherapy for post-COVID patients: First results from a non-randomized, controlled study, 2026, Koller+

[MSEsperanza]

According to a summary by the Norwegian ME Association, Flottorp recently claimed under oath in a Norwegian court that she was not aware of 1) Crawley’s replication of FITNET with null results, and 2) MAGENTA with null results.

Just stumbled across this while searching something else. (Now forgot why.)

Apologies I have to ask as only able to be on the forum for very short skimming occasionally -- is this discussed somewhere else on the forum? Are you aware of this @dave30th ?

I think that's a [sorry, brain-fogged, difficult to find words ] - - i think that is further very 'loud' evidence for the fact that her publications on ME/CFS, her and her co-authors' critique of the NICE guideline etc. are more than questionable.

We know already that Flottorp et al are good ad twisting facts and cherry-picking alleged evidence but that claim that she didn't know study results essential to the topic seems to me the top of [insert fitting word].

It would be interesting to know how/ whether the NICE gl evidence assessment [that she repeatedly attacked] referred to both studies. Maybe they are even mentioned in the rebuttal by NICE gl committee?

Edit: The studies were published some time after the release of the new NICE guideline, so of course not included in their evidence synthesis. But weren't some of Flottorps co-authors of the attacks against NICE also investigators in FITNET so would have known by then of the results? (Sorry not able to check now)

 

[Evergreen]

What they cite in the protocol paper in favour of the physio/exercise component is revealing:

Our physiotherapeutic treatment concept for post-COVID will take up established physiotherapeutic treatment approaches for fatigue (e.g. for multiple sclerosis) [33, 34] and will include pacing as a central technique in all therapies.

To treat more physical symptoms of PASC, such as breathing problems and fatigue, we will supplement psychotherapeutic interventions with physiotherapy. Research on other chronic diseases, such as multiple sclerosis, has demonstrated the beneficial effects of aerobic exercises on fatigue symptoms [33, 34]. Furthermore, aerobic exercise was shown to be effective and safe as an early intervention after (severe) SARS-CoV-2 infection [35] as well as a treatment to improve PASC-related fatigue and functional capacity [29, 36, 37]. When combined with the concept of pacing - a self-management strategy that involves tailoring physical and cognitive activity to the individual’s energy levels [2]- aerobic exercise can be safely incorporated without risking post-exertional malaise (PEM), a worsening of chronic fatigue symptoms after minimal physical or mental exertion [38]. Various studies have shown that activity pacing positively impacts fatigue severity in chronic diseases [39–41].

33 is on MS/RA/SLE
34 is on MS
38 is on ME/CFS: Stussman (the PEM substudy from the NIH intramural study), but it certainly does not suggest that aerobic exercise can be safely incorporated without risking PEM if activity is tailored to the individual.
39 is on "chronic conditions associated with fatigue complaints"
40 is on "patients with breast cancer undergoing chemotherapy in Ethiopia"
41 is on ME/CFS: Casson's review (it's not what we would call pacing, it includes CBT and GET)

But people with MS seem to respond differently to exercise than people with ME/CFS (Hodges 2017, Andrea White 2012).

A thread where we list studies where the response to exercise in ME/CFS is compared to other fatiguing diseases would be helpful. Perhaps we have one already?

 

[Evergreen]

Regarding adverse effects, the protocol paper says:

We do not believe the trial raises any ethical concerns. We are not aware of any specific risks or disadvantages that may affect patients during the trial, and we do not expect any specific adverse or serious adverse events.
...
Side effects of evidence-based psychotherapies are fortunately quite rare. However, potential adverse effects may include lack of treatment response, the emergence of new symptoms, worsening of existing symptoms, strains in the therapist-patient relationship, challenges or changes in work, family, or other social relationships, stigmatization, and the development of a pathological dependence on the therapist [73–75].

73-75 are all about psychotherapy.

There is no consideration of harm from physiotherapy or exercise.

This attitude explains why adverse effects are not reported, or even mentioned, in the "treatment effects" paper. Or maybe an "adverse effects" paper is in press.

I feel like we should arrange an evacuation flight from Erlangen.

 

[V.R.T.]

Cause harm to participants or to th

Hopefully it will cause a great deal of harm to the authors reputations when the science comes through for us. This is all going to look as utterly indefensible as it really is.

Unfortunately in the meantime it will get pwME and LC sectioned and forced into harmful 'therapies'

 

[Utsikt]

There is literally no possible excuse for somebody claiming any degree of expert status to not know the full history of their field, and in considerable detail.

That is their damn job.

Anything less is reckless wilful ignorance at best, and extreme incompetence, dishonesty, and callousness at worst.

It’s telling that Flottorp presumably is the best witness the welfare administration could come up with.

She also has a history of privately lobbying the ethical committee for approval for Landmark’s LP study. The then deputy of one of the national committees (and a law professor) described it as

– This is at best unprofessional and an isolated failure, she writes.

– It may also be an expression of the fact that there are major challenges in the governance system with attempts at network governance outside the ordinary arenas for debate and governance.

Oh, and she tried to pressure the National Research Centre for Complementary and Alternative Medicine (a national, government-funded research and information centre, assigned by the Norwegian health authorities), when they put out a warning against using LP based on reports of harm.

But that’s enough of a digression. The conclusion is that being unaware of, or ignoring, contradictory evidence seems to be par for the course in this field..

is this discussed somewhere else on the forum?

I can’t remember. I’ve ranted about it a few times

 

[rvallee]

There is literally no possible excuse for somebody claiming any degree of expert status to not know the full history of their field, and in considerable detail.

That is their damn job.

Anything less is reckless wilful ignorance at best, and extreme incompetence, dishonesty, and callousness at worst.

This is especially problematic with clinical opinion being valid evidence in a court of law. If it can be as unreliable as this, this is far worse than even the main issue with most testimony in that people have unreliable memory. It's simply not credible for someone this involved not to know such a basic detail.

At best it reflects incompetence, and that's just as disqualifying as far as evidence in a court of law goes. This actually puts into question the very validity of using clinical opinion as reliable evidence. This is as bad as fabricating evidence. If clinical opinion is to remain valid evidence in court, it has to be completely separated from junk like this, with extreme prejudice. It obviously won't, thus dramatically lowering the validity of clinical opinion as reliable evidence.

 

[Turtle]

"I didn't know" was not an acceptible answer in the Neurenberg(WW II) trials.
Why are we letting researchers off the hook now not knowing about papers in their own field of expertise?

Doctors still use diagnose by exclusion. Nothing else is wrong with an ME/CFS patient so it must be psychological.
Psychologists confirm that diagnose with numerous tests, that are flawed at best, many even highly biased.

Tickling each other under the chin (translaterd dutch saying) and pointing at each other all the time.

Responsibility for the well-being of the patients is not on their minds.

 

[dave30th]

Are you aware of this @dave30th ?

No, I was not.

 

[MSEsperanza]

I can’t remember. I’ve ranted about it a few times

No, I was not.

Found it on the News from Scandinavia thread. Post here.