Een analyse van vijf spraakmakende studies van Nederlands Kenniscentrum Chronische Vermoeidheid
naar het effect van CGT+ (cognitieve gedragstherapie én stapsgewijze uitbreiding van activiteiten)
laat zien dat de studies van het Nederlands Kenniscentrum Chronische Vermoeidheid (NKCV) gekenmerkt worden door zeer ernstige methodologische tekortkomingen,
zoals het niet rapporteren van data en het hanteren van zeer uiteenlopende criteria voor 'herstel'.
Maar zelfs als we die methodologische tekortkomingen zouden accepteren,
blijft er van de claim dat CGT+ effectief is voor CVS weinig tot niets over.
Het effect van CGT+ in een groep mensen met ME werd (nog) nimmer onderzocht/gerapporteerd.
Toch zal de Gezondheidheidsraad ongetwijfeld in haar binnenkort te verschijnen adviesrapport
CBT+, in strijd met de feiten aangedragen door de 'experts' zelf, als 'bewezen effectief' aanbevelen...
Wetenschappelijk bewijs? Me hoela. 'ME'/CVS is een puur politieke/financiele kwestie.
Voor een Nederlandstalige toelichting op de studie, klik op onderstaande afbeelding:
Voor een Nederlandstalige toelichting op de studie, klik op onderstaande afbeelding:
An analysis of Dutch hallmark studies confirms the outcome of the PACE trial:
cognitive behaviour therapy with a graded activity protocol
is not effective for chronic fatigue syndrome and Myalgic Encephalomyelitis.
Gen Med Open. 2017. 1(3): 1-12. doi: 10.15761/GMO.1000117.
Twisk FNM, Corsius LAMM.
Abstract
Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS)
are considered to be enigmatic diseases.
Several studies propose that
the combination of cognitive behaviour therapy with a graded activity protocol (CBT+),
justified by a so-called (bio)psychosocial (explanatory) model,
is an effective treatment option for CFS (ME).
Objective
A critical review of five Dutch hallmark studies that allegedly support this claim.
Methods
An analysis of the five CBT+ studies with special attention to
the patients studied,
the criteria (subjective and objective measures and cut-off scores)
used to select participants and to define improvement and recovery,
the consistency of the definitions of caseness (being diagnosed as a CFS patient at entry)
versus the definitions of improvement and recovery after CBT+, and
the objective effects.
Results
The studies investigated suffer from various methodological flaws.
Apart from these methodological shortcomings,
the claim that CBT+ is an effective treatment option for CFS
is not substantiated by the data reported.
Some studies investigated CFS patients,
other studies investigated CF patients, labelled as CFS patients, or
combinations of CFS and CF patients.
No study investigated the effect of CBT+
in a group of patients meeting the (original) diagnostic criteria for ME.
The effects of CBT+ on subjective measures, for example fatigue and disability,
if present, are insufficient to achieve normal values.
Impressive recovery and improvement rates
are based on very loose criteria for subjective measures.
Cut-off scores for subjective measures used to define improvement and recovery in studies
show overlap with cut-off scores for CFS caseness in one or more of the other studies.
More importantly, looking at the objective measures,
the proof of clinical improvement after CBT+ is lacking.
Conclusion
Solid evidence of effectiveness of CBT+ for CFS, let alone ME,
is lacking in the five hallmark studies.
The lack of objective improvement indicates CBT+ is ineffective.
This conclusion confirms the outcome of the large-scale PACE-trial in the UK.
Keywords:
Myalgic Encephalomyelitis, chronic fatigue syndrome, cognitive behaviour therapy,
graded exercise therapy, measures, effectiveness
http://www.oatext.com/pdf/GMO-1-117.pdf
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