FITNET’s Internet-Based Cognitive Behavioural Therapy Is Ineffective and May Impede Natural Recovery in Adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. A Review
Abstract
:1. Introduction
2. Summary of the FITNET Trial
3. Issues with Trial Design
3.1. The Protocol
3.2. Patient Selection
3.3. Using Primary Outcomes Assessed via Questionnaires
3.4. The Actometer Results
4. Issues with the Conclusions
4.1. Long-Term Follow Up (LTFU)
4.2. Crossing Over
4.3. Maternal Concern
5. Issues with the Definition of Recovery
5.1. Naturally Occurring Recovery
5.2. The Definition of Recovery
5.3. School/Work Attendance
6. Issues with the NHS FITNET Trial
6.1. Background Information
6.2. Protocol Design, Diagnosis and the Control Group
6.3. Illness Fluctuations
6.4. Activity Management
6.5. The Boom and Bust Theory
7. Discussion
8. Strengths and Weaknesses of the FITNET Trial
- *
- a protocol that was published years after the trial started plus a badly designed control group;
- *
- patient selection issues such as more than 70% of those in the treatment group not having an infectious onset;
- *
- not excluding participants with a comorbid psychiatric disorder or those who during the trial were found not to have CFS but a psychiatric disorder instead;
- *
- a post hoc definition of recovery that included the severely fatigued/ill, yet labelling it as a strength of the study;
- *
- not publishing the actometer results, thus causing reporting bias;
- *
- not taking into account the naturally occurring recovery rates in adolescents with CFS as documented by many studies;
- *
- ignoring its own primary goal (recovery rates at LTFU) as well as the null effect at LTFU.
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
BMJ | British Medical Journal |
CBT | Cognitive Behavioural Therapy |
CFS | Chronic Fatigue Syndrome |
FITNET | Fatigue In Teenagers on the interNET |
GET | Graded Exercise Therapy |
LTFU | Long Term Follow Up |
ME | Myalgic Encephalomyelitis |
ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome |
NICE | National Institute for Health and Care Excellence |
PEM | Post Exertional Malaise |
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Reference | Recovered | Improved | Mean LTFU |
---|---|---|---|
Marshall et al. 1991 [42] | - | 76% definite improvement | 2.2 years |
Feder et al. 1994 [39] | 65% | 29% | 3.8 years |
Bell 1995 [36] | up to 47% | 27–46% | 26.7 months |
Joyce et al. 1997 [34] | 54% to 94% | - | 18 to 38 months |
Krilov et al. 1998 [37] | 43% (“cured”) | 52% | 1–3 years |
Rangel et al. 2000 [40] | 67% | - | 3.8 years |
Bell et al. 2001 [38] | 37.1% | 42.9% greatly improved (well but not resolved) | 13 years |
Patel et al. 2003 [35] | 80.6% recovered/improved | - | 2.5–3 years |
Gill et al. 2004 [43] | 25% showed near to complete improvement | 31% showed partial improvement | 4.57 years |
Norris et al. 2017 [41] | 75% | - | 2–3 years |
Rødevand 2017 [44] | most recover | - | 3 years |
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Ghatineh, S.; Vink, M. FITNET’s Internet-Based Cognitive Behavioural Therapy Is Ineffective and May Impede Natural Recovery in Adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. A Review. Behav. Sci. 2017, 7, 52. https://doi.org/10.3390/bs7030052
Ghatineh S, Vink M. FITNET’s Internet-Based Cognitive Behavioural Therapy Is Ineffective and May Impede Natural Recovery in Adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. A Review. Behavioral Sciences. 2017; 7(3):52. https://doi.org/10.3390/bs7030052
Chicago/Turabian StyleGhatineh, Simin, and Mark Vink. 2017. "FITNET’s Internet-Based Cognitive Behavioural Therapy Is Ineffective and May Impede Natural Recovery in Adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. A Review" Behavioral Sciences 7, no. 3: 52. https://doi.org/10.3390/bs7030052