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Graded Exercise Therapy Doesn't Restore The Ability To Work In ME/CFS – Rethinking Of A Cochrane Review

Sunday 28 June 2020


From Work (via IOS Press):



Graded exercise therapy doesn’t restore the ability to work in ME/CFS. Rethinking of a Cochrane review

Article type: Research Article
Authors: Vink, Marka; * | Vink-Niese, Frisob
Affiliations: [a] Family and Insurance Physician, Amsterdam, The Netherlands | [b] Independent Researcher, Germany
Correspondence: [*] Address for correspondence: Mark Vink, Family and Insurance Physician, Amsterdam, The Netherlands. E-mail:


BACKGROUND: Cochrane recently amended its exercise review for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in response to an official complaint.

OBJECTIVE: To determine if the amended review has addressed the concerns raised about the previous review and if exercise is an effective treatment that restores the ability to work in ME/CFS.

METHOD: The authors reviewed the amended Cochrane exercise review and the eight trials in it by paying particular interest to the objective outcomes. We also summarised the recently published review of work rehabilitation and medical retirement for ME/CFS.

RESULTS: The Cochrane review concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. However, the review did not consider the unreliability of subjective outcomes in non-blinded trials, the objective outcomes which showed that GET is not effective, or the serious flaws of the studies included in the review. These flaws included badly matched control groups, relying on an unreliable fatigue instrument as primary outcome, outcome switching, p-hacking, ignoring evidence of harms, etc. The review did also not take into account that GET does not restore the ability to work.

CONCLUSION: GET not only fails to objectively improve function significantly or to restore the ability to work, but it’s also detrimental to the health of≥50% of patients, according to a multitude of patient surveys. Consequently, it should not be recommended.

Keywords: Bias, occupational health, patient safety, return to work, work rehabilitation

DOI: 10.3233/WOR-203174

Journal: Work, vol. Pre-press, no. Pre-press, pp. 1-26, 2020
Received 12 November 2019
Accepted 14 January 2020
Published: 14 June 2020


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