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How have selection bias and disease misclassification undermined the validity of myalgic encephalomyelitis/chronic fatigue syndrome studies?

  [ 2 votes ]   [ 1 Comment ]
By Luis Nacul et al. • www.ProHealth.com • March 18, 2017


Note: You can read the full article here.

By Luis Nacul et al.

Abstract
 
Myalgic encephalomyelitis/chronic fatigue syndrome has been a controversial diagnosis, resulting in tensions between patients and professionals providing them with care. A major constraint limiting progress has been the lack of a ‘gold standard’ for diagnosis; with a number of imperfect clinical and research criteria used, each defining different, though overlapping, groups of people with myalgic encephalomyelitis or chronic fatigue syndrome. We review basic epidemiological concepts to illustrate how the use of more specific and restrictive case definitions could improve research validity and drive progress in the field by reducing selection bias caused by diagnostic misclassification.

Source: Luis Nacul, Eliana M Lacerda, Caroline C Kingdon, Hayley Curran, Erinna W Bowman. How have selection bias and disease misclassification undermined the validity of myalgic encephalomyelitis/chronic fatigue syndrome studies? Journal of Health Psychology 1–5. March 1, 2017.




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Article Comments Post a Comment

This is a very important topic
Posted by: dfwmom
Mar 23, 2017

In many studies of ME / CFS, the benefits of various treatments or therapies are slim at best. If even one or two participants was mis-classified for participation in the study as having CFS/ME when they do not, then the statistical benefits of a given treatment could be mis-represented and the conclusions would then be incorrect.

One area where this is most likely to happen is in the area of exercise as a treatment. It is documented that persons with CFS/ME have a decline in performance on the second day after exercise, so the condition of persons with CFS/ME is likely to decline if subjected to regular exercise. Exercise can be beneficial to those who do not have CFS/ME. If a person without CFS/ME is inadvertently included in a study where exercise is examined as a treatment for CFS/ME, this could inflate benefits for exercise as a treatment, and produce the incorrect conclusion that exercise is an effective treatment, when, in fact, it is not.

This is not just a matter of a statistical error. When doctors use such conclusions to justify exercise as a therapeutic approach to CFS/ME, when exercise is likely to actually result in a deterioriation in the condition of a CFS/ME patient, such an misclassification can encourage dangerously inappropriate treatment that can be harmful to a patient.
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