3 Conclusion
This short analysis shows that there are many issues with the meta-analysis by Kolala et al. (1) and the studies in it. The meta-analysis was set up to examine whether non-protocol-based CBT was effective for ME/CFS in studies that did not use the Oxford criteria. Nevertheless, two of the included studies used these criteria, and none of the included studies examined non-protocol-based CBT. Moreover, PEM, the main characteristic of the disease, was not required for diagnosis in any of the included studies.
Kolala et al. concluded that CBT was not effective, but then used two post-hoc analyses to state that individual face-to-face CBT was effective for fatigue and that self-directed CBT was effective for physical functioning. However, even after those treatments, patients remained severely ill and severely disabled. Also, quality of life, which was one of the two objectives according to the registration of the meta-analysis, did not improve. Different forms of CBT did not lead to objective improvement, and an extensive review of the literature found that CBT has a negative instead of a positive effect on work and illness benefit status (30).
Only one study was deemed to be high risk of bias by Kolala et al. (1). Nevertheless, all studies were non-blinded studies that relied on subjective primary outcomes. Ten of the 12 studies used passive control groups, and a systematic review by Fordham et al. (25) found that the effect size of CBT is trivial if studies use an active control group instead of a passive control group. Adherence to treatment was bad, dropout was high, and studies used selective reporting of objective outcomes. Consequently, the risk of bias in the included studies was high.
In conclusion, our analysis confirms the conclusion by NICE (3) that the quality of CBT studies is (very) low and that CBT, irrespective of the form that is used, is not an effective treatment for ME/CFS.
New:
Well done yet again to Mark Vink @huisarts-vink.bsky.social who is bedbound with ME)
"Commentary: Cognitive behavioural therapy for the treatment of chronic fatigue syndrome in adults: a short analysis of the meta-analysis"
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