Saturday, February 26, 2011

Recent CBT, GET, PACE study published in Lancet

Recent CBT, GET, PACE study published in Lancet

Last week, a study on chronic fatigue syndrome was published.  It has resulted in a lot of comments, controversy and media attention. We would like to bring it to your attention because the headlines in the media do not tell the whole story and we urge you to interpret them carefully. For example, the study did not conclude, as, for example, the CBC stated (18 Feb): "Taking it easy is not the best treatment for chronic fatigue syndrome, rather exercise and behavior therapy are, a large study finds." 

The objective of the study was to compare specialist medical care alone, to specialist medical care with adaptive pacing therapy, to specialist medical care alone with cognitive behavioral therapy, to specialist medical care alone with graded exercise therapy.  The study was well conducted using a large sample.  All patients met the Oxford criteria for chronic fatigue syndrome and were recruited from six secondary-care clinics in the UK. Specialist medical care included advice about chronic fatigue syndrome, including avoidance of activity extremes, and rest and self-help strategies. 

The authors concluded that cognitive behavioral therapy and graded exercise can safely be added to standard medical care to moderately improve outcomes for chronic fatigue syndrome. Important to note, and similar to what the authors pointed out, a positive effect of cognitive therapy does not translate to the fact that these illnesses are psychological in nature.   
To understand what "moderate gains" actually means requires a careful review of the grading systems developed for this study - but on the surface it appears as if these were quite minor improvements in some symptoms. 

Furthermore, the positive effects of Adaptive Pacing should not be discounted.  Adaptive Pacing was developed for this study so it is not yet clear how that lines up with what most of us in Ontario consider PACING. Its is also unclear how a person with ME - especially as defined under Canadian Consensus i.e. including Post Exertion Malaise - would volunteer to participate in a study involving regular exercise, unless they were already quite skilled at pacing their energy. There is a need for clarification and more research.


MEAO will continue to monitor the study and the reaction to it and will provide a more detailed analysis in an upcoming Reaching Out.  In the meantime, if you have questions or concerns, please contact us at [email protected]

Editor's note: If you have opinions on CBC's coverage, its possible to send them on-line feedback.
Lydia E.  Neilson, M.S.M. , Founder
Chief Executive Officer
512 - 33 Banner Road
Nepean, ON K2H 8V7 Canada
Tel. 613.829.6667
Fax 613.829.8518


SEPTEMBER 22 - 25, 2011


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