Núñez en kollega's hebben in een studie het lange termijn-effekt van CGT/GET bestudeerd.
In tegenstelling tot
wat onze vermoeidheidsexperts van het NKCV vorig jaar beweerden
is CGT/GET werkt potentieel zeer nadelig uit bij een grote groep ME/CVS-patiënten,
hetgeen ook door dr. Maes en ondergetekende in
een uitgebreide review gesteld werd.
Na een jaar is de kwaliteit van het leven van de CGT/GET-deelnemers niet verbeterd.
Daarentegen is de pijn sterker en het fysiek funktioneren
toegenomen in de CBT/GET-groep.
Goh, zouden die patiënten dan toch terecht "zeuren" als het gaat om CGT/GET?
In de CGT/GET-groep waren de beperkingen door "emotionele" problemen vooraf groter.
Die achterstand t.o.v. de kontrolegroep herstelde zich slechts gedeeltelijk door CGT/GET.
Dus de pijn neemt toe, het fysieke funktioneren neemt af, maar je voelt je "psychisch beter".
Na 12 maanden waren de comorbide aandoeningen, zoals fibromyalgie, darmproblemen
("prikkelbare darm-syndroom") en schildklier-dysfunktie, in beide groepen toegenomen.
De auteurs stellen dat hun onderzoeksresultaten de konklusies van
de "kontroversiële" CGT/GET-review van Twisk en Maes onderschrijven....
Dit is de eerste onderzoeksgroep die op basis van een "randomized control trial"
(de basis voor de onterechte evidence bases"-succesclaim van de "biopyschosocialisten")
stelling durft te nemen (misschien toch niet effektief, wellicht zelfs schadelijk).
Als er één schaap over de dam is...
Citaten uit de studie:
Studies have found that HRQL [health-related quality of life]
is markedly more affected in CFS than in other chronic disabling rheumatic diseases.
....
A total of 198 patients were finally diagnosed with CFS according to Fukuda criteria
and were considered for inclusion.
....
CBT contents included
- psycho-educational interventions to explain the multi-factorial character of CFS,
- progressive muscle relaxation procedures (Jacobsen) to identify muscle tension,
- sleep hygiene patterns to enable entry into and maintenance of phase IV sleep,
- detection and control of verbal and non-verbal pain-inducing attitudes,
- cognitive restructuring to modify non-adapted and catastrophic thought patterns,
- information about the relationship between vegetative and anxiety symptoms,
- modification of type A vehavioural patterns,
- improvement in assertiveness,
- patterns to increase attention and memory,
- sensorial focalization for sexual inhibition, and
- disease relapse prevention.
....
All GET sessions were personally supervised by a qualified physiotherapist,
who is a registered nurse with a diploma in physiotherapy, and
more than 20 years’ experience in general physiotherapy for neurological disease and
8 years’ experience in a third-level CFS and fibromyalgia (FM) reference unit.
....
Symptomatic pharmacological treatment was equal in the two groups and
included analgesia (paracetamol 1-3 g/day p.o.),
ibuprofen (600-1800mg/day p.o.)
if subjects reported inflammation (fever, myalgia, enlarged cervical nodes), and
zolpidem 10 mg/ night p.o.
if patients reported significant insomnia.
....
....
At 12 months,
there were significantly lower SF-36 physical function and bodily pain dimension scores
compared to baseline (p=0.004 and p= 0.021, respectively).
...
We also observed
a significant increase in comorbidities in both study groups at 12 months,
in agreement with other reports, suggesting a marked role of comorbidities in CFS disability.
....
The only significant differences at baseline in the SF-36 and HAQ scores
was the SF-36 emotional role score, which was lower (worse) in the intervention group
(28.07±41.69 vs. 47.62±48.77, p=0.042).
....
Although some studies cautiously conclude that
exercise therapy is a promising treatment for CFS,
the results of our study tend to support
the somewhat controversial findings of Twisk and Maes
that the combination of CBT and GET
is ineffective and not evidence-based and
may in fact be harmful in some patients,
a view supported by various surveys carried out by patient advocate groups.
Health-related quality of life in patients with chronic fatigue syndrome
group cognitive behavioural therapy and graded exercise versus usual treatment.
A randomised controlled trial with 1 year of follow-up.
Clin Rheumatol. 2011 Jan 15.
Núñez M, Fernández-Solà J, Nuñez E, Fernández-Huerta JM, Godás-Sieso T, Gomez-Gil E.
Abstract
Chronic fatigue syndrome (CFS)
produces
physical and neurocognitive disability
that significantly affects health-related quality of life (HRQL).
Multidisciplinary treatment
combining graded exercise therapy (GET), cognitive behavioural therapy (CBT) and
pharmacological treatment
has shown only short-term improvements.
To compare the effects on HRQL of
(1) multidisciplinary treatment combining CBT, GET, and pharmacological treatment, and
(2) usual treatment (exercise counselling and pharmacological treatment)
at 12 months of follow-up.
Prospective, randomized controlled trial
with a follow-up of 12 months after the end of treatment.
Patients consecutively diagnosed with CFS (Fukuda criteria)
were randomly assigned to intervention (n=60) or usual treatment (n=60) groups.
HRQL was assessed at baseline and 12 months
by the Medical Outcomes Study Short-Form questionnaire (SF-36).
Secondary outcomes
included functional capacity for activities of daily living
measured by the Stanford Health Assessment Questionnaire (HAQ) and
comorbidities.
At baseline, the two groups were similar,
except for lower SF-36 emotional role scores in the intervention group.
At 12 months,
the intervention did not improve HRQL scores,
with worse SF-36 physical function and bodily pain scores
in the intervention group.
Multidisciplinary treatment was not superior to usual treatment at 12 months
in terms of HRQL.
The possible benefits of
GET as part of multidisciplinary treatment for CFS
should be assessed on an individual patient basis.
PMID: 21234629
http://www.ncbi.nlm.nih.gov/pubmed/21234629
Met dank aan Rob die me attendeerde op deze studie.
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