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Robert Courtney
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==Withdrawal of graded exercise therapy as a treatment == Mr Courtney's scientific analysis of the evidence for the use of [[graded exercise therapy]] (GET) in patients with [[ME/CFS]], and of the flawed biopsychosocial model as a justification for GET, was in agreement with that of a number of other researchers and clinicians, and was vindicated by the 2016 release of the full patient outcome data for the controversial [[PACE trial]], which showed the 12 weeks of exercise therapy resulted in no statistically significant improvement in walking distance or employment for CFS patients.<ref name="rapidresponse2015">{{Cite journal | date = Jan 15, 2015 | url = http://www.bmj.com/content/350/bmj.h227/rr-20 | title = The BMJ - Response: “The cognitive-behavioural model of illness for chronic fatigue syndrome and myalgic encephalomyelitis is not supported by the outcomes of the PACE trial” by Robert Courtney, in response to "Tackling fears about exercise is important for ME treatment, analysis indicates" | first = Robert | last = Courtney|journal=[[The BMJ]]}}</ref><ref name="Wilshire, 2018" /> In the [[United States]], a 2016 scientific review by the AHRQ led to the CDC withdrawing the recommendation of GET and CBT for ME/CFS patients in 2017.<ref name="Smith2016">{{cite journal | vauthors = Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M | title = Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219| journal = Evidence Report/Technology Assessment | pages = 1–433 | date = Dec 2014 | pmid = 30313001 | doi = 10.23970/AHRQEPCERTA219 | url = https://www.ncbi.nlm.nih.gov/books/NBK379582/ | publisher = Agency for Healthcare Research and Quality (US)}}</ref> In 2018, Courtney's lengthy Cochrane complaint, submitted shortly before his death, led to an independent Cochrane review that supported his scientific criticisms,<ref name="CEU">{{Cite web | title = Formal Complaint re ‘Exercise therapy for chronic fatigue syndrome’ | date = Apr 10, 2018 |publisher =[[Cochrane]] | url=https://www.virology.ws/wp-content/uploads/2019/03/Cochrane-Report-on-Courtney-Complaint.pdf}}</ref> and Cochrane's withdrawal of the patient exercise data followed. After Courtney's death in 2018, an open letter signed by over 40 scientists and researchers supported the Cochrane decision to withdraw it on scientific grounds,<ref name="openletter">{{Cite web|url=https://www.virology.ws/2018/10/23/a-statement-in-support-of-cochrane/ | date = Oct 23, 2018 | first = David | last = Tuller | authorlink = David Tuller|website =[[Virology blog]] | title = A statement in support of Cochrane|access-date=|archive-url=|archive-date=|url-status=}}</ref> and the original [[Cochrane]] reviewers then submitted repeated revisions of the systematic review. Cochrane then announced that the outdated review would be replaced with a new one, written by a different team, although this has not yet been published.<ref>{{Cite web|url=https://community.cochrane.org/organizational-info/people/central-executive-team/editorial-methods/projects/stakeholder-engagement-high-profile-reviews-pilot/cochrane-exercise-and | title = Cochrane Exercise and ME/CFS Review Update: May 2021 | last = Bastian | first=Hilda | authorlink=Hilda Bastian | date = May 31, 2021 | website = community.cochrane.org|language=en|archive-url=|archive-date=|url-status=|access-date=2021-11-18}}</ref> Cochrane's systematic review was highly influential in a number of countries, including the [[United Kingdom]], which announced a full update of the CFS/ME guidelines in 2019. The new [[NICE guidelines]], published in 2021, included a secondary analysis of the PACE trial data that he co-authored in its evidence review, abandoned support for the biopsychosocial model, and removed the recommendation for [[graded exercise therapy]], downgraded [[cognitive behavioral therapy]] from a primary treatment, and changed the widely criticized diagnostic criteria.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last=NICE Guideline Development Group | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref>
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