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«Multidisciplinary treatment combining graded exercise therapy (GET) cognitive behavioural therapy (CBT) and pharmacological treatment has shown only short-term improvements.»
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XMRV Global Action har lagt ut Mark Twists utdypning av studiet:
«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,
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.
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.)i f 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).
… a review of the CBT/GET model in 2009 by Twisk and Maes found that CBT/GET was not only hardly more effective than non-interventions or standard medical care but that many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration.
In addition, the authors suggest that exertion, and thus GET may have a negative impact on many CFS patients due to post-exertional malaise as it may amplify pre-existing physiopathological abnormalities.
This is in line with studies, suggesting the physiopathological basis of this phenomenon may include increased oxidative stress and altered muscle excitability, combined with reduced cytokine and heat-shock protein responses when CFS patients are exposed to incremental strenuous exercise.
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.
Frank Twisk to CO-CURE
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