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Irish Medical Times letter to the editor
Sunday 21 March 2010
Fatigue research needed
Santhouse et al claim cognitive behavioural therapy (CBT) and graded exercise therapy (GET) ‘have been shown to work’ in CFS. What the literature actually shows is that while such therapies can have an effect, this is not the same thing as ‘working’: a meta-analysis calculated the average ‘Cohen’s d’ effect size across various CBT and GET studies to be 0.48, which would generally be described as a small-moderate effect size (Malouff, 2008).
A recent review of three Dutch CBT studies found that, while patients reported lowered fatigue, their activity levels did not improve and remained low, calling into question claims that CBT is an effective rehabilitative strategy (Wiborg, 2010).
Systematic reviews tend to ignore ‘real world’ data. An audit of five Belgian rehabilitation clinics offering CBT and GET found that while improvements were recorded in various subjective outcome measures, there was negligible change in results from the exercise test and the average number of hours in paid employment decreased at the end and at follow-up.
The authors give the impression that nothing can be done if CBT and/or GET are not recommended. However a NIH-funded study in the US (Jason, 2007) found a management programme based on the pacing of activities showed superior results to the arms of the trial involving CBT and GET. High rates of adverse reactions have also been reported with graded exercise programmes (Kindlon and Goudsmit, 2010).
ME/CFS is increasingly recognised as a heterogeneous condition. Hopefully, research will shed more light on the subject.
The letter originally appeared here.
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