Response to the editorial by Dr Geraghty

Abstract

This article is written in response to the linked editorial by Dr Geraghty about the adaptive Pacing, graded Activity and Cognitive behaviour therapy; a randomised Evaluation (PACE) trial, which we led, implemented and published. The PACE trial compared four treatments for people diagnosed with chronic fatigue syndrome. All participants in the trial received specialist medical care. The trial found that adding cognitive behaviour therapy or graded exercise therapy to specialist medical care was as safe as, and more effective than, adding adaptive pacing therapy or specialist medical care alone. Dr Geraghty has challenged these findings. In this article, we suggest that Dr Geraghty’s views are based on misunderstandings and misrepresentations of the PACE trial; these are corrected.

Activity Pacing is Associated With Better and Worse Symptoms for Patients With Long-term Conditions

“…Similarly, pacing has been found to be ineffective at reducing fatigue when defined predominantly in terms of reducing activities. 37 Activity adjustment was significantly associated with increased depression. A similar pattern was found when pacing was measured using the POAM-P, the PARQ and the CPCI pacing subscales, but not associated with depression when pain was controlled.…”

“…Used in this way, a multidimensional approach to pacing could challenge previous findings that have questioned the role of pacing in rehabilitation programmes. 12,37 The regression models found that the total amount of variance explained ranged from a substantial R 2 =18.3% to 38.9%. However, it should be noted that the regression models did not include detailed clinical observations (for example, physiological/objective measurements).…”

Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment

“…1 We recognise that articles in the media are not subjected to peer review and that people can be misquoted, but in the case of the PACE trial, many healthcare professionals have echoed these opinions in the medical literature. The message since the first article in The Lancet has been that both cognitive behaviour therapy (CBT) and GET are 'safe and effective ' (BACME, 2011;Sharpe et al, 2017) or at least more effective than specialised medical care and adaptive pacing therapy (APT; White et al, 2011White et al, , 2017.…”

PACE-GATE: An alternative view on a study with a poor trial protocol

“…The 'PACE-gate' editorial by Geraghty and the subsequent response by White et al (Geraghty, 2016;White et al, 2017) made me smile and shake my head at the same time. White et al (2007White et al ( , 2011 deviated substantially from the trial protocol of their randomized controlled study on treatments for chronic fatigue syndrome (CFS).…”

“…These therapies were not curative and should be downgraded to adjunct support-level status. White et al (2017) responded that Geraghty's views are based on 'misunderstandings and misrepresentations', which they would 'correct'.…”