Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review

Vink, Mark; Vink-Niese, Alexandra

doi:10.1177/2055102919840614

Cited by 17 publications

(13 citation statements)

References 107 publications

(312 reference statements)

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“…Rehabilitation clinics are offering CBT for these patients based on the claims that these therapies are effective for ME/CFS—a post-infectious illness which can develop after many different infections—as no study into the efficacy of CBT for post-COVID-19 fatigue syndrome has been published. Over the last couple of years, a number of re-analyses of these ME/CFS studies have been published which show that CBT does not lead to objective improvement in heterogeneous groups of ME/CFS patients with different infections triggering their ME/CFS, nor does it restore the ability to work [ 17 , 18 ]. The group of patients with post-COVID-19 fatigue syndrome, on the other hand, is homogeneous.…”

Section: Discussionmentioning

confidence: 99%

“…However, the participant samples in those studies are very heterogeneous, not only because in only around 70% of participants the disease was triggered by an infection, but also because participants developed it after many different infections [ 6 ]. Additionally, a number of re-analyses found that in those studies, CBT did not lead to objective improvement, nor did it restore the ability to work [ 17 , 18 ]. However, in the case of post-COVID-19 fatigue syndrome and long COVID, the sample is not heterogeneous but homogeneous.…”

Section: Introductionmentioning

confidence: 99%

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Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome

Vink¹,

Vink-Niese

2020

Healthcare

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An increasing number of young and previously fit and healthy people who did not require hospitalisation continue to have symptoms months after mild cases of COVID-19. Rehabilitation clinics are already offering cognitive behavioural therapy (CBT) as an effective treatment for long COVID and post-COVID-19 fatigue syndrome based on the claims that it is effective for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—the most common post-infectious syndrome—as no study into the efficacy of CBT for post-COVID-19 fatigue syndrome has been published. Re-analyses of these studies, however, showed that CBT did not lead to objective improvements in heterogeneous groups of ME/CFS patients, nor did it restore the ability to work. The group of patients with long COVID and post-COVID-19 fatigue syndrome, on the other hand, is homogeneous. We therefore analysed the Dutch Qure study, as it studied the efficacy of CBT in a homogeneous group of patients who developed Q-fever fatigue syndrome—which affects up to 30% of patients—after the largest reported outbreak of Q-fever, to see if CBT might potentially be an effective treatment for long-haulers after COVID-19 infection. Our reanalysis found that the Qure study suffered from many serious methodological problems, which included relying on one subjective primary outcome in a study without a control group for the non-blinded CBT treatment group, using a post hoc definition of improvement, waiting 2 years before publishing their objective actometer results and ignoring the null effect of said results. Moreover, only 10% of participants achieved a clinically meaningful subjective improvement in fatigue as a result of CBT according to the study’s own figures. Consequently, CBT has no subjective clinically meaningful effect in nine out of every ten patients that are treated with it. Additionally, the subjective improvement in fatigue was not matched by an improvement in disability, even though the disability was fatigue related according to the researchers. On top of this, CBT did not lead to an objective improvement in physical performance. Therefore, it cannot be said that CBT is an effective treatment for Q-fever fatigue syndrome either. It seems therefore unlikely that CBT will reduce disability or lead to objective improvement in long COVID or in post-COVID-19 fatigue syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome

Vink¹,

Vink-Niese

2020

Healthcare

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“…Accordingly, it is often argued that studies based on a wide diagnostic definition of CFS (i.e., a definition that requires a minimum of accompanying symptoms), such as the Oxford criteria [ 11 ], are at risk of introducing substantial heterogeneity in the patient sample which in turn may obscure results that pertain to a specific subgroup only. Specifically, it is frequently maintained that the use of a wide diagnostic definition in clinical trials tend to select a large portion of patients suffering from mental distress who may benefit from psychological/behavioural interventions, whereas such interventions are claimed to be unhelpful (or even harmful) for the potential subgroup of patients suffering from another (such as inflammatory) disease mechanism [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Are there subgroups of chronic fatigue syndrome? An exploratory cluster analysis of biological markers

2021

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Background Chronic fatigue syndrome (CFS) is defined according to subjective symptoms only, and several conflicting case definition exist. Previous research has discovered certain biological alterations. The aim of the present study was to explore possible subgroups based on biological markers within a widely defined cohort of adolescent CFS patients and investigate to what extent eventual subgroups are associated with other variables. Methods The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) has previously performed detailed investigation of immunological, autonomic, neuroendocrine, cognitive and sensory processing functions in an adolescent group of CFS patients recruited according to wide diagnostic criteria. In the present study, hierarchical cluster analyses (Ward’s method) were performed using representative variables from all these domains. Associations between clusters and constitutional factors (including candidate genetic markers), diagnostic criteria, subjective symptoms and prognosis were explored by standard statistical methods. Results A total of 116 patients (26.7% males, mean age 15.4 years) were included. The final cluster analyses revealed six clusters labelled pain tolerant & good cognitions, restored HPA dynamics, orthostatic intolerance, low-grade inflammation, pain intolerant & poor cognitions, and high vagal (parasympathetic) activity, respectively. There was substantial overlap between clusters. The pain intolerant & poor cognitions-cluster was associated with low functional abilities and quality of life, and adherence to the Canada 2003 diagnostic criteria for CFS. No other statistically significant cluster associations were discovered. Conclusion Within a widely defined cohort of adolescent CFS patients, clusters could be delineated, but no distinct subgroups could be identified. Associations between clusters and constitutional factors, subjective symptoms and prognosis were scarce. These results question the clinical usefulness of searching for CFS subgroups, as well as the validity of the most “narrow” CFS diagnostic criteria. Trial registration: Clinical Trials NCT01040429

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“…Due to the non-organic pathophysiology, CFS is associated with suboptimal health status [21] and the present treatment of CFS is given based on limited or even contradictory evidence from clinical studies [22][23][24]. CFS is named fatigue syndrome in TCM theory and Yang-qi de ciency is regarded as the main reason.…”

Section: Discussionmentioning

confidence: 99%

Dose-Effect of Long-Snake-Like Moxibustion for Chronic Fatigue Syndrome: Study Protocol for a Randomized Controlled Trial

Ma¹,

Gong²,

Zheng³

et al. 2021

Preprint

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Background Chronic fatigue syndrome (CFS) is a disease with high incidence rate and great impact on life, but it lacks for specific pharmacological treatment and diagnostic indicators. In the theory of traditional Chinese medicine (TCM), fatigue is the result of Yang deficiency. Long-snake-like moxibustion, as one of a special moxa therapy, has been applied in Yang deficiency patients for thousands of years in China and it is used widely to relieve fatigue symptoms for its strong function of Yang warming. However, the does-effect relationship is unclear in the moxibustion research. Hence, we design this trial to assess the duration-effect of long-snake-like moxibustion through combining measurements of the subjective patient-reported scales with objective medical infrared imaging technology─Thermal Texture Maps (TTM). Methods This is a single-center, randomized controlled trial. Thirty healthy women and sixty female CFS patients will be recruited to receive the first TTM scanning, then CFS patients will be allocated to 60-minute long-snake-like moxibustion (Group A) and 30-minute long-snake-like moxibustion (Group B) equally. These two groups will receive corresponding treatment once a day, three sessions per week every other day for consecutive 4 weeks. The second TTM scanning will be employed for CFS patients after the end of treatment. The primary outcome will be the score improvement of the Fatigue scale-14 (FS-14). Secondary outcomes include the change of the Self-rating depression scale (SDS),the Self-rating anxiety scale (SAS), and the Symptoms Scale of spleen-kidney Yang deficiency. Discussion The trial will provide evidence for the choice of treatment duration for long-snake-like moxibustion in treating CFS. The results will contribute to explore the dose-effect relationship of moxibustion, and optimize the efficacy of moxibustion therapy. Trial registration: Chinese Clinical Trail Registry (No. ChiCTR2000041000), on 16th December, 2020, http://www.chictr.org.cn/showproj.aspx?proj=62488

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Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review

Cited by 17 publications

References 107 publications

Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome

Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome

Are there subgroups of chronic fatigue syndrome? An exploratory cluster analysis of biological markers

Dose-Effect of Long-Snake-Like Moxibustion for Chronic Fatigue Syndrome: Study Protocol for a Randomized Controlled Trial

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