Commenting on a recently published report of a large-scale evaluation of behavioral interventions for chronic fatigue syndrome (CFS), Fred Friedberg, PhD and Jenna Adamowicz warned against overstating the capacity of any currently available therapy to produce recovery from CFS.
In January 2013, the journal Psychological Medicine published an article in which Peter White reported a recovery rate of 22% to 23% from CFS after treatments given in the PACE trial, a large scale five-year study in England and Scotland which compared the effectiveness of various forms of behavioral treatment for CFS. Dr White and his colleagues reported that the trial demonstrated that “cognitive behavior therapy and graded exercise therapy were more effective treatments for chronic fatigue syndrome than specialist medical care (SMC) alone, when each was added to SMC.”
In their commentary, Dr Friedberg and Ms Adamowicz pointed out that because the term “recovery” was used to refer only to recovery from the current episode, the outcomes would more accurately be described in terms of remission rather than recovery. They noted too that the definition of recovery used in the report does not include the subjects’ perceptions of their health status, particularly if they view themselves as recovered.
They concluded that because a recovery rate below 25% still leaves the majority of patients with significant symptoms and impairments, “the publicity generated by trumpeting recovery outcomes in CFS far exceeds the relatively modest results found for most patients in behavioral treatment research.”
Dr. Friedberg is an Associate Professor and Ms. Adamowicz is a Senior Research Analyst in the Department of Psychiatry at Stony Brook University. Their commentary, titled “Reports of recovery in chronic fatigue syndrome may present less than meets the eye,” was published in the August 2014 issue of Evidence Based Mental Health. It was first published on line on May 21, 2014. The recovery data from the PACE trial were reported in an article by Peter D. White, et al. published in the October 13 edition of Psychological Medicine under the title “Recovery from chronic fatigue syndrome after treatments given in the PACE trial.”
from Fred Friedberg Warns Against Overstating Recovery Results in Studies of Chronic Fatigue Syndrome
Extract:
What is already known on this topic?
The definitions of recovery in chronic fatigue syndrome (CFS) are numerous, as are the amount of intervention and naturalistic studies designed to assess illness recovery. In a recent systematic review of 22 studies, recovery percentages ranged from 0% to 66%. White et al report a recovery rate of 22% to 23% in their active behavioural intervention conditions. This rate corresponds with findings of a previous intervention study in CFS that used similar recovery criteria.
What this paper adds?
- A controlled comparison of three recognised behavioural interventions for CFS incorporating an unusually large sample (thus, greater power) in comparison to previous clinical trials.
- The use of multiple case definitions of CFS with varying criteria to assess clinical recovery. Thus, the percentage of patients who no longer met full illness criteria can be determined with reference to several definitions, rather than just one.
- Operationalised criteria for recovery that include both symptom and functional changes as informed by population data. Such precise criteria make clear how recovery …
Reports of recovery in chronic fatigue syndrome may present less than meets the eye by Dr Fred Friedberg, Jenna Adamowicz in Evid Based Mental Health doi:10.1136/eb-2013-101652
