Recommendation 8-12. Future studies funded and conducted by the Department of Veterans Affairs to assess treatments for chronic multisymptom illness should adhere to the methodologic and reporting guidelines for clinical trials, including appropriate elements (problem– patient–population, intervention, comparison, and outcome of interest) to frame the research question, extended follow-up, active comparators (such as standard of care therapies), and consistent, standardized, validated instruments for measuring outcomes.
Examples of methodologic and reporting guidelines include those set forth by such organizations as the Agency for Healthcare Research and Quality and the Institute of Medicine and in such other efforts as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Consolidated Standards of Reporting Trials statement.
On the basis of its assessment of the evidence on treatments for CMI, the committee found that several treatments and treatment approaches may be potentially useful for CMI. However, evidence sufficient to support a conclusion on their effectiveness is lacking.
Recommendation 8-13. The Department of Veterans Affairs should fund and conduct studies of interventions that evidence suggests may hold promise for treatment of chronic multisymptom illness. Specific interventions could include biofeedback, acupuncture, St. John’s wort, aerobic exercise, motivational interviewing, and multimodal therapies.
Program Evaluation. As noted above, the committee did not find comprehensive evaluations of VA programs, such as the PACTs, SCAN-ECHO programs, and WRIISCs. Program evaluation—including assessments of structures, processes, and outcomes—is essential if VA is to continually improve its services and research.
Recommendation 8-14. The Department of Veterans Affairs (VA) should apply principles of quality and performance improvement to internally evaluate VA programs and research related to treatments for chronic multisymptom illness (CMI) and overall management of veterans who have CMI. This task can be accomplished using such methods as comparative effectiveness research, translational research, implementation science methods, and health systems research.
IOM (Institute of Medicine). 2010. Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. P. 261.