Dr Charles Shepherd, Hon. Medical Adviser, ME Association.
Yesterday, Cochrane issued a statement and published an amended version of their previous and controversial review of ‘Exercise therapy for chronic fatigue syndrome’ (see below).
The mission at Cochrane is to, “promote evidence-informed health decision-making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence. Our work is internationally recognized as the benchmark for high-quality information about the effectiveness of health care.”
Therefore, it is important that any published reviews are accurate, and the original review of exercise studies in ME/CFS was not.
We are still assessing this latest amendment and will work with colleagues at the CFS/ME Research Collaborative (CMRC) and Forward ME to consider ways in which we can work better with organisations like Cochrane in the future, ensure the evidence-base is more accurately reflected and that it leads to a better understanding of ME/CFS by health professionals.
Cochrane Statement
Today, Cochrane publishes an amended version of the Review, ‘Exercise therapy for chronic fatigue syndrome.’
In the last nine months, this Cochrane Review has been modified by the review’s authors and evaluated by independent peer reviewers and editors.
It now places more emphasis on the limited applicability of the evidence to definitions of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) used in the included studies, the long-term effects of exercise on symptoms of fatigue, and acknowledges the limitations of the evidence about harms that may occur.
Cochrane’s Editor-in-Chief, Dr Karla Soares-Weiser, commented on the publication of the review:
“Cochrane recognizes the importance of providing the best available evidence on interventions for ME/CFS to enable patients and clinicians across the world to make well-informed decisions about treatment.
“This amended review is still based on a research question and a set of methods from 2002, and reflects evidence from studies that applied definitions of ME/CFS from the 1990s.
“Having heard different views expressed about the evidence base for this condition, we acknowledge that the publication of this amended review will not resolve all the ongoing questions about this globally important health topic.
“We have decided, therefore, that a new approach to the publication of evidence in this area is needed; and, today we are committing to the production of a full update of this Cochrane Review, beginning with a comprehensive review of the protocol, which will be developed in consultation with an independent advisory group that we intend to convene.
“This group will involve partners from patient-advocacy groups from different parts of the world who will help us to embed a patient-focused, contemporary perspective on the review question, methods and findings.”
She added, “By forging better relationships with patients, as well as the groups that represent them and the clinicians who seek to treat them, we can improve the way in which future Cochrane Reviews in this area address important questions and meet patients’ and clinicians’ needs.
“I can confirm that work will begin on this new review at the beginning of 2020 and that we will keep patient groups regularly informed of progress during the subsequent months.”
The review’s conclusions:
“Exercise therapy probably has a positive effect on fatigue in adults with CFS compared to usual care or passive therapies. The evidence regarding adverse effects is uncertain.
“Due to limited evidence it is difficult to draw conclusions about the comparative effectiveness of CBT, adaptive pacing or other interventions.
“All studies were conducted with outpatients diagnosed with 1994 criteria of the Centers for Disease Control and Prevention or the Oxford criteria, or both. Patients diagnosed using other criteria may experience different effects.”
- Read the Review in full
- Find out more about the Cochrane Library
- Comment from members of Science 4 ME Forums
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https://www.meassociation.org.uk/2019/10/amended-cochrane-review-exercise-therapy-for-chronic-fatigue-syndrome-03-october-2019/
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