PACE study results – ‘Daily Telegraph’, 18 February 2011

February 18, 2011

From The Daily Telegraph, 18 February 2011 (story by Martin Beckford).

The biggest study yet into possible ways to reduce the symptoms of Chronic Fatigue Syndrome – the little-understood condition that affects 250,000 people in Britain – claims to have identified the most effective combination of procedures and shown it is safe.

It says that Cognitive Behaviour Therapy (CBT), in which patients discuss their fear and avoidance of physical activity, combined with Graded Exercise Therapy, which helps sufferers gradually increase the amount of activity such as walking they can manage, is more effective and less harmful than previously thought.

In a study of 640 people with the long-term condition, which leaves sufferers extremely tired and often with memory problems and muscle pain, those who were given the two treatments together were found to be more capable of physical activity a year later despite lacking confidence in the plan before it started. They also received Specialist Medical Care, including advice and self-help techniques.

By contrast, those who were given just the advice, or the advice combined with a popular treatment called Adaptive Pacing Therapy – in which sufferers keep a diary and adapt their lives to the limited energy they have – did not see their activity levels improve as much.

The Government-funded trial, published in The Lancet, was carried out by researchers led by Prof Peter White at Barts and The London School of Medicine.

Dr Brian John Angus, Clinical Tutor in Medicine and Honorary Consultant Physician, University of Oxford, said: “This study is the largest ever done in CFS/ME and as such is critically important. The study should reassure patients that there is an evidence-based treatment that can help them to get better and there is no need to worry about harm from the treatment.”
Prof Willie Hamilton, a GP in Exeter, added: “At least half of patients improved with CBT or GET. The study also allays fears that CBT or GET may be harmful.

“This study matters: it matters a lot. CFS/ME is common, and causes a lot of suffering. Up until now we have known only that CBT and GET work for some people. We didn't know if pacing worked. This caused a real dilemma – especially for those in primary care. We didn't know whether to recommend pacing, or to refer for CBT or GET. Worse still, not all GPs have access to CBT or GET, so ended up suggesting pacing almost by default. This study should solve that dilemma.”

1 thought on “PACE study results – ‘Daily Telegraph’, 18 February 2011”

  1. 1/ the cohort did not include ME patients (with a neuro-immune disease) as it was chosen using the Oxford Definition which excludes patients with neurological symptoms.

    “We selected participants in accordance with Oxford criteria for chronic fatigue syndrome.11 These criteria require fatigue to be the main symptom, accompanied by significant disability, in the absence of an exclusionary medical or psychiatric diagnosis (psychosis, bipolar disorder, substance misuse, an organic brain disorder, or an eating disorder)”

    2/ The patients were chosen from those attending CFS Clinics – pwME generally refuse to go to, or drop out early from said clinics, as they offer nothing helpful for someone with an organic disease.

    3/ the benefits shown were measured subjectively, when there was an objective measure available, which was used earlier in the study. Why did the study design not include measurement of activity via a pedometer or actometer?

    4/ Standard medical care with a consultant will not include anything that we have actually found helpful for ME, as the NICE guidelines preclude B12 therapy, diet supplementation, anti-biotic therapy, etc,. So I’m not surprised that lot did not improve much.

    5/ Lies, damn lies, and statistics: one of the first things to look out for is the scale. Here, it is expanded by dint of starting the vertical axis at 18, with that field reduced by over 50%. This dramatasizes the movement in the results. The best improvement is actually in the order of 6-8%. £5 million is a lot of cash to spend to get a subjective improvement of that order.

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