AHRQ Evidence Review


The 2014 the Agency for Healthcare Research and Quality (AHRQ) in the USA published an evidence review, which reported that treatment with cognitive behavioural therapy (CBT) and graded exercise therapy (GET)  improved fatigue, function, global improvements, and employment in ME/CFS patients. This conclusion was based on a combined analysis of studies using a range of definitions of ME and CFS, including the very broad Oxford definition which can include patients with other diseases.

In the interim, the 2015 NIH Pathways to Prevention report suggested that the Oxford definition should be retired, stating that it could “impair progress and cause harm”, while some ME organizations and patients’ advocates called on AHRQ to perform a reanalysis of its data, separating out the results of studies using the Oxford definition, and separating studies using CBT from other forms of counselling.

The new analysis has now been published as an Addendum to the original report (read more). As widely expected, separation out of studies using the Oxford definition led the AHRQ to downgrade its recommendations about the usefulness of CBT and GET. When Oxford studies were excluded, it found that there was “insufficient evidence of the effectiveness of GET on any outcome”, and that there was insufficient evidence of effectiveness of CBT on function, employment and global improvement and a low strength of evidence of improved fatigue.

As the Addendum concludes, “Our sensitivity analysis would result in a downgrading of our strength of evidence on several outcomes which can be attributed to the decrease in power, dominance of one large trial, or lack of trials using criteria other than the Oxford case definition for inclusion. Blatantly missing from this body of literature are trials evaluating effectiveness of interventions in the treatment of individuals meeting case definitions for ME or ME/CFS.”

In a valuable essay, Jennie Spotila and Mary Dimmock have discussed the background and implications of this reanalysis (read more), and they conclude, “There is no evidence that CBT and GET are effective treatments for us, and therefore, these treatments can no longer be recommended. If CDC and others persist in recommending treatments for which there is no evidence of effectiveness in ME/CFS patients, it will not only perpetuate confusion but also put patients at risk. Such an unscientific recommendation goes against the principles of evidence-based medicine and is not accepted in other diseases.”

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