Association or causation?

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clareb35
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by clareb35 on Sat Aug 17, 2013 12:29 pm

Association or causation?

Dr Miller wrote:
The principle of GET is based on the fact that the people who make the best recovery from CFS/ME steer a compromise between over and under activity. People who fare badly either tend to drive themselves too hard and "crash" as is well described by several contributors or they go to the other extreme and take to their beds to await recovery. Neither of these approaches is helpful and both delay recovery.
People who fare badly either tend to drive themselves too hard and "crash" as is well described by several contributors or they go to the other extreme and take to their beds to await recovery.

Dear Dr Miller
Please can you give us the references for the research studies that demonstrate that these behaviours delay recovery? And are you able to confirm that the selection criteria were robust (i.e. that it wasn't a mixed bag of patients suffering from a variety of conditions of which fatigue was one symptom)?

Secondly, can you describe what factors have been controlled for in these research studies? As is drummed into researchers from day one, association is not causation. So, for example, the patients who "take to their beds" and do not recover might be those who were more severely affected in the first place. (As an aside, I find the phrase "take to their beds" rather offensive - would it ever be used about patients with cancer, MND or even gastroenteritis?)

Thirdly, if these research studies show that it is in fact causation and not just association, that implies that there are positive changes to physiological mechanisms that can be activated by doing the right amount of activity. Please can you say a bit more about those mechanisms? For example, what was adversely affected in those who drove themselves too hard and 'crashed', but would have been improved had they done somewhat less?

I ask because I am very keen to understand what I need to do to recover and if there are robust scientific studies out there that can help me to take an evidence-informed approach to my self-management of this frustrating condition, I would like to read them. Thank you.