Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review

Vink, Mark; Vink-Niese, Alexandra

doi:10.1177/2055102918805187

Cited by 23 publications

(28 citation statements)

References 64 publications

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“…It would be impossible to critique all CBT trial evidence within the confines of this article, thus we point readers to reviews of the field (Rimbaut et al, 2016) and systematic reviews (Larun et al, 2016; Price et al, 2008) that appear to show, prima facie, that CBT and GET outperform other treatments for ME/CFS (mostly usual care) with small-to-modest effect sizes. However, this evidence is increasingly contested by re-analysis of data from clinical trials (Geraghty et al, 2017; Wilshire et al, 2018) and meta-reviews (Vink and Vink-Niese, 2018).…”

Section: Problematic Evidence From Clinical Trials and Practicementioning

confidence: 99%

The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

Geraghty

Jason

Sunnquist

et al. 2019

Health Psychology Open

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Chronic fatigue syndrome/myalgic encephalomyelitis is a debilitating illness that greatly impacts the lives of sufferers. A cognitive behavioural model attempts to explain illness onset and continuance with a hypothesis that the illness is perpetuated by patients’ irrational beliefs and avoidance behaviours. This theory underpins the promotion of cognitive behavioural therapy, a treatment that aims to change beliefs and behaviours. This article reports on a detailed review of the cognitive behavioural model. Our review finds that the model lacks high-quality evidential support, conflicts with accounts given by most patients and fails to account for accumulating biological evidence of pathological and physiological abnormalities found in patients. There is little scientific credibility in the claim that psycho-behavioural therapies are a primary treatment for this illness.

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Section: Problematic Evidence From Clinical Trials and Practicementioning

confidence: 99%

The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

Geraghty

Jason

Sunnquist

et al. 2019

Health Psychology Open

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“…39% were working or studying at least part time at trial entry, compared with 47% after treatment. However, as found by the reanalysis of the Cochrane exercise review for ME/CFS [159], there were a number of issues with this study. Participants in the exercise group had sessions of five to fifteen minutes, increasing to a maximum of thirty minutes, at least five days a week.…”

Section: Smc (No Treatment)mentioning

confidence: 90%

Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies

Vink¹,

Vink-Niese

2019

Diagnostics

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome leads to severe functional impairment and work disability in a considerable number of patients. The majority of patients who manage to continue or return to work, work part-time instead of full time in a physically less demanding job. The prognosis in terms of returning to work is poor if patients have been on long-term sick leave for more than two to three years. Being older and more ill when falling ill are associated with a worse employment outcome. Cognitive behavioural therapy and graded exercise therapy do not restore the ability to work. Consequently, many patients will eventually be medically retired depending on the requirements of the retirement policy, the progress that has been made since they have fallen ill in combination with the severity of their impairments compared to the sort of work they do or are offered to do. However, there is one thing that occupational health physicians and other doctors can do to try and prevent chronic and severe incapacity in the absence of effective treatments. Patients who are given a period of enforced rest from the onset, have the best prognosis. Moreover, those who work or go back to work should not be forced to do more than they can to try and prevent relapses, long-term sick leave and medical retirement.

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“…Regarding the reporting of harmful study events, it is challenging to conclude on how proportionate the occurrence of harmful/unwanted events is to the observed effects. Information on the occurrence of adverse/unwanted events is essential, as research conducted by Kindlon (2011) and Vink and Vink-Niese (2018) showed that over the past 20 years patients have consistently reported either no or adverse effects from these interventions. However, not reporting adverse events is typical for this field as psychotherapy trials generally report infrequently on adverse outcomes (Duggan et al, 2014; Jonsson et al 2014; Vaughan et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review

Ahmed¹,

Mewes²,

Vrijhoef

2019

J Health Psychol

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Cognitive behavioural therapy and graded exercise therapy have been promoted as effective treatments for patients with myalgic encephalomyelitis/chronic fatigue syndrome. However, criticism on the scientific rigour of these studies has been raised. This review assessed the methodological quality of studies on the effectiveness of cognitive behavioural therapy and graded exercise therapy. The methodological quality of the 18 included studies was found to be relatively low, as bias was prominently found, affecting the main outcome measures of the studies (fatigue, physical functioning and functional impairment/status). Future research should focus on including more objective outcome measures in a well-defined patient population.

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Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review

Cited by 23 publications

References 64 publications

The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model

Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies

Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review

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