How Many Awful Papers Can Trudie Chalder Produce?

https://trialbyerror.org/2026/04/16/how-many-awful-papers-can-trudie-chalder-produce/

Professor Chalder Downgrades Definition of “Recovery”

https://trialbyerror.org/2026/04/03/professor-chalder-downgrades-definition-of-recovery/

Trudie Chalder Is Co-Author on Another Bad Exercise Paper

By David Tuller, DrPH

It is a truth universally acknowledged (or at least universally acknowledged by smart researchers), that if the list of authors on an article includes Trudie Chalder, King’s College London’s mathematically and factually challenged professor of cognitive behavior therapy, then the article in question should most assuredly be expected to be short on, or utterly devoid of, intelligence and logical reasoning.

This is certainly the case with a recent publication in European Respiratory Journal titled “Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation.” Professor Chalder is one of more than three dozen co-authors, so it is unclear how much she can be held responsible for the article’s poor quality and unwarranted claims. Nonetheless, this new trial continues what appears to be her impressive streak of being involved with scholarship that can accurately be described as rubbish.

The new trial, conducted at the University of Leicester and Northumbria University, was funded by the Medical Research Council and the National Institute for Health Research. The design was not terrible. Specifically, unlike some other Long Covid rehabilitation studies, this one excluded participants with post-exertional malaise (PEM). That’s a good move, given that the presence of PEM is a contra-indication for an exercise-based rehab program.

So this was a study of Long Covid patients who do not meet criteria for an ME/CFS diagnosis—a key point.

The real problem here is that the reporting of the results stinks.

In the study, 181 participants who were experiencing prolonged symptoms after a Covid-related hospital stay were randomized to either an eight-week face-to-face exercise rehabilitation program, an eight-week remote exercise rehabilitation program, or care as usual. The primary outcome was the change in the Incremental Shuttle Walking Test (ISWT). Among the many secondary outcomes were questionnaires measuring health quality of life and symptom burden.

The conclusion: “Exercise-based rehabilitation improved short-term exercise capacity in Post-COVID syndrome following an acute hospitalization.”

First, let’s note that the conclusion does not explicitly state that the study is not about “post-COVID syndrome” overall but only about non-ME/CFS “post-COVID syndrome.” That’s a major limitation of the findings that should have been emphasized prominently throughout, given the significant numbers of Long Covid patients who do experience PEM and qualify for ME/CFS diagnoses. Health care providers will read the conclusions and assume they can be extrapolated to all Long Covid patients. That is clearly not the case.

Beyond that unacceptable oversight, let’s review the data in a bit more detail and see if that claim holds up.

The face-to-face intervention group had a drop-out rate of 29% and the remote intervention group had a drop-out rate of 39%. These drop-out rates are quite high. Remarkably, the article includes no substantive discussion of this. It is hard to argue persuasively that an intervention is successful or effective when so many participants apparently decided not to continue with it, for whatever reasons. Did they find it unhelpful? Too difficult? Harmful? We don’t actually know.

The article also overlooks the fact that the participants were, on average, almost as unhealthy after the eight-week intervention as they were beforehand. After the intervention, the average increase in the IWST for the face-to-face and remote groups was, respectively, 52 meters and 34 meters more than the increase in the care as usual group. But the average meters walked remained way, way below the levels of healthy people in the same age range.

The average age of participants in the trial was 59. A 2013 study called “Age-specific normal values for the incremental shuttle walk test in a healthy British population” found that the average distance walked during the ISWT by those in their 40s, 50s, 60s, and over 70 were, respectively, 824 meters, 788 meters, 699 meters, and 633 meters. By comparison, those in the face-to-face group increased from 285 to 312 meters, and those in the remote group from 353 to 388 meters.

It should have been obvious to any intelligent or even minimally competent researcher with that an exploration of both of these issues–the high drop-out rate and the continued poor health of the participants–was essential to put the purportedly “positive” findings in context. There is simply not that much positive to report about interventions that left participants severely disabled and that substantial numbers were unable or unwilling to complete.

Oh, and on top of that, there were null results for the trial’s seven quality-of-life and symptom burden questionnaires: EuroQol five-dimension five-level questionnaire (EQ5D), Patient Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7) 7-item scale, Dyspnoea-12, the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT), the DePaul Symptom Questionnaire, and the Montreal Cognitive Assessment (MoCA). In other words, whatever incremental improvements might have occurred, participants did not report any overall benefits in the trial’s many subjective measures of well-being.

And to mention one other odd point…According to a 2019 study cited by the authors, the “minimal clinically important difference” (MCID) for the ISWT is 35 meters. In other words, while the results for the face-to-face intervention surpassed that threshold, the results for the remote intervention did not quite reach it. Yet here’s the opening of the discussion section:

“In this fully powered randomised controlled trial, we demonstrated that both face-to-face and remote exercise-based rehabilitation significantly improve exercise capacity compared to usual care alone in those previously hospitalised with COVID-19. These between group improvements exceed the established MCID (35m), highlighting improvements of clinical relevance in those with post-COVID syndrome.”

This last statement is simply not true in relation to the remote intervention, at least when it comes to the final, adjusted, intention-to-treat analysis. It is either a mistake or a deliberate effort to fudge the facts. I assume the latter, because it is very obvious that 35 is a bigger number than 34. With more than three dozen people on the manuscript, it is hard to believe that no one noticed this discrepancy. Either way, this indisputable error requires a correction. (To be clear, a correction won’t make the rest of the paper any better.)

In fact, the authors might have pointed out that there are multiple studies of the MCID of the ISWT, such as a 2008 analysis that found it to be 47.5 meters, and one from 2015 concluding that it was 70 meters. Even thought they chose to cite the MCID most favorable to their argument and ignore the others, they still presented false information to bolster their case.

So here’s the bottom line: Despite some marginal improvements among those who actually were able to or decided to complete the interventions, the trial documented that exercise-based rehabilitation failed dramatically to restore participants’ health. Moreover, participants felt no better subjectively on any measures than beforehand. Given those telling details, along with the fact that significant numbers of participants abandoned the trial’s intervention arms, the boast that these rehabilitation programs “improved short-term exercise capacity” is hard to take seriously.

**********

Disclosure: My academic position at the University of California, Berkeley, is largely supported by donations to the university via the campus crowdfunding platform from people with ME/CFS, Long Covid, and related disorders.

(View the original post at virology.ws)

#MCID #TrudieChalder

By David Tuller, DrPH

October is a crowdfunding month at University of California, Berkeley. If you’d like to support my work, you can make a donation to the university (tax-deductible for US taxpayers) here.

Last week, Guardian columnist George Monbiot wrote another scathing column about the failure of the UK health care system to address the plight of people diagnosed with ME/CFS. (Monbiot’s previous column on the issue appeared in March; our interview about it is here.) The new column was pegged to the case of 27-year-old Maeve Boothby O’Neill, whose death in 2021 from complications of severe disease has received extensive media coverage in the UK (if not, unfortunately, in the US). But Monbiot also described at length the sorry history of London’s Science Media Centre, a PR agency masquerading as a purportedly neutral arbiter of research, in disseminating fraudulent research in this domain.

To be clear, I use “fraudulent” in the sense of “deliberately deceptive.” I have never claimed that the PACE investigators or their fellow travelers have engaged in the crime of “fraud.” I’m not a lawyer, so that’s not my area of expertise. Rather, I have argued that their research strategies are designed to generate false reports of success and mislead the medical and patient communities. These studies are the research equivalent of a Potemkin village–constructed to look impressive but, in reality, offering nothing of substance, or less than nothing, behind the glittering façade.

In response to Monbiot’s column, the lead PACE investigators (Professors Trudie Chalder, Michael Sharpe, and Peter White) have once again emerged from their cave with a letter defending their honor and promoting their bogus notions. Yet time and science have left these self-important grandees in the dust. They remind me of those ancient Japanese soldiers on obscure islands who didn’t know that World War II was over. Like rotten meat, their theories stink, and the investigators themselves passed their sell-by date long ago. If the PACE trial hadn’t been so awful and caused so much damage and human suffering, their plight would just be sad and pathetic.

Here’s the headline to their letter: “A dualistic view of illness doesn’t help those with ME/CFS.” In other words, this unholy trinity is regurgitating the same tired accusation they have trotted out over and over again–that anyone who challenges their shoddy work has bought into whatever it is they are calling “dualism.”

Their routine bleating about “dualism” is a deflection. Per the descriptions of the interventions–cognitive behavior therapy and graded exercise therapy–the PACE trial was based on the premise that “deconditioning” and “unhelpful beliefs” alone were responsible for perpetuating the devastating physical symptoms characterizing ME/CFS. Refusing to acknowledge that physical symptoms might be caused by pathophysiological dysfunctions sure sounds like dualism to me. Pot, kettle, anyone?

I’m a public health guy, not a biologist or clinician. Early in public health training, students learn about what are called “the social determinants of health.” It goes without saying that someone’s physical and social environment dramatically impacts their health status. But to extrapolate this self-evident concept and insist that a devastating illness can be attributed solely to “deconditioning” and “unhelpful beliefs” about illness—as the PACE authors have claimed for decades—is absurd.

The three professors dutifully note that Boothby O’Neill’s death was “tragic and should have been avoided.” But avoided how? Do they think she chose to starve herself to death—even as she was begging for hospital personnel to provide artificial feeding options? Do they believe she would be alive today if only she’d pursued a course of CBT or GET? Do they think these interventions are likely to save the other young women currently suffering at the hands of the National Health Service?They offer no suggestions on what treatment she should have received. Instead, they blame Monbiot for drawing “generalizations” that they claim are “outdated.”

Given that post-exertional malaise is a defining characteristic of ME/CFS, pushing people to ramp up their activity level despite a resurgence of symptoms is contra-indicated. Nonetheless, these “experts” refuse to acknowledge the harm their approach has caused to untold numbers of patients over the last 30 years. It must be hard to be told, later in your career, that the science to which you’ve devoted so many years is not only incompetent but has also made many patients worse. From that perspective, their reluctance to accept reality is understandable. But it is also unconscionable. In any event, their unwillingness to take responsibility for their errors and the indisputable flaws in their research doesn’t change the facts.

They write that “no relevant paper has been withdrawn and many systematic reviews and meta-analyses have found the approaches to be beneficial.” That statement presumes that the authors of these systematic reviews and editors of the relevant journals are honest brokers conducting honest research. That is not the case. Everyone involved is part of an insular cabal whose members praise and peer-review each others’ work and publish in journals with editorial boards populated by their cronies. This body of research is not science. It’s propaganda.

https://trialbyerror.org/2024/10/24/pace-authors-respond-to-monbiot-column-with-tired-arguments/

#Guardian #MichaelSharpe #monbiot #PACE #PeterWhite #TrudieChalder