An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms, 2025, Arroll et al

Sasha said:
I'd avoid saying, '5 of the 11 followed up patients fully recovered' because we don't know that they did - only that the authors say that the participants say that they did, which is two removes from actual fact.
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I think changing "fully recovered" to "reported that they fully recovered" would be okay.

Sasha said:
I don't know if you can reference what I gather is the Lightning Process's instruction to participants to say that they've recovered or hugely improved even if they haven't.
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I think that'd be useful, but I don't know enough about LP to know if I'm saying things about it accurately. Hopefully someone else can add something about that.

Sasha said:
I couldn't tell, from a quick glimpse at the study, whether the practitioner put every single participant they'd ever had forward for 'audit' or whether they'd have been free to select the ones who'd had the best outcomes
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This makes it sound like it was only a portion of those who completed the LP:
The sample size was determined by the number of participants the interviewer could do during her student vacation.
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Nightsong said:
I wonder how many patients were excluded from undergoing the LP because of these factors? And the other salient phrase is "completing treatment" - how many dropped out of the "treatment"?
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Less that a year into ME from Covid, I got turned down by an LP practitioner because I was working on my mental health with a therapist.

I’ve also heard of many that are turned down because they aren’t willing to believe in LP. There’s a famous case of an ME patient in Norway that was dropped from Landmark’s study because she posted negative opinions about LP on social media. They stalked her and excluded her.
 
forestglip said:
This makes it sound like it was only a portion of those who completed the LP:
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But it was unclear to me (on a really skimpy reading) whether the practitioner had put forward all of their clients for the interviewer to select from. Maybe they had 100 clients and only chose the best 20? But as I said, I haven't read it properly, sorry! Bit short on time.
 
I added a paragraph and slightly changed the last paragraph (bolded):
The abstract, discussion, and conclusion do not mention that almost half of the patients (8/20) who did the lightning process (LP) did not participate in this study's survey. It is plausible that those who did not improve would be less likely to want to participate in a followup.

5 of the 12 followed up patients reported that they fully recovered, while 11/12 "reported being back to 85% of normal". These participants had had symptoms for a median of 9.5 months before starting the LP, and were followed up 8.5 months after the LP (which took 3 half days to complete). These results are not surprising considering natural improvement is common within the first few years of long COVID.

In a study which followed 2197 long COVID patients up to two years after symptom onset [1], only 4% of participants had symptoms which did not show signs of improving. ~6.4% of participants fully recovered.

The paper does not include details about what proportion of people did not complete the LP. It also does not say what proportion of those who completed the LP were contacted for followup or what method was used to select those who were followed up.

Considering the small sample size in Arroll et al, the low followup rate, the unspecified dropout rate for LP, and the potential selection bias of those most likely to improve participating in the LP, it is plausible that the observed improvement and recovery in this study is due to natural improvement.

[1] Servier, C., Porcher, R., Pane, I., Ravaud, P., & Tran, V. T. (2023). Trajectories of the evolution of post-COVID-19 condition, up to two years after symptoms onset. _International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases_, _133_, 67–74. https://doi.org/10.1016/j.ijid.2023.05.007
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Parker has written about it:

Criteria for being offered ongoing care after assessment differ between LP and SMC approaches; LP assessment focuses on psychological readiness to engage with the training and its concepts, while SMC assessment focuses on diagnosis. LP clients are encouraged to engage with LP materials (audio/book) before completing an online form and pre-course telephone call which includes assessment of their psychological readiness to engage, belief that change is possible using the LP and belief in capability to recover. For example, questions see Parker p. 122 [Citation10]. Telephone coaching is provided to support clients to become psychologically ready to proceed to the course at the facilitator’s discretion.

https://www.tandfonline.com/doi/full/10.1080/21641846.2021.1935373
 
Sasha said:
But it was unclear to me (on a really skimpy reading) whether the practitioner had put forward all of their clients for the interviewer to select from. Maybe they had 100 clients and only chose the best 20? But as I said, I haven't read it properly, sorry! Bit short on time.
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It's possible, but I don't think it says one way or the other.
 
Utsikt said:
Parker has written about it:

Criteria for being offered ongoing care after assessment differ between LP and SMC approaches; LP assessment focuses on psychological readiness to engage with the training and its concepts, while SMC assessment focuses on diagnosis. LP clients are encouraged to engage with LP materials (audio/book) before completing an online form and pre-course telephone call which includes assessment of their psychological readiness to engage, belief that change is possible using the LP and belief in capability to recover. For example, questions see Parker p. 122 [Citation10]. Telephone coaching is provided to support clients to become psychologically ready to proceed to the course at the facilitator’s discretion.

https://www.tandfonline.com/doi/full/10.1080/21641846.2021.1935373
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So basically, they are handpicking those that already believe it will work. And making them pay an enormous sum which will induce sunk cost fallacy.
Then doing their voodo magic.
Then asking the people if it worked.
Bearing in mind some of the voodo magic instructions include pretending it worked even if it didn’t.
Then suprise, the handpicked people told to say it worked say it worked!
The fact this is published in journals is astonishing.
 
Relevant bits about the participants:
The LP practitioner agreed to participate in an independent audit of patients completing treatment and obtained permission to provide the study team with names, email addresses and mobile phone numbers. Our interviewer followed up with participants who were not initially contactable to avoid responder bias.

Of 20 patients completing the LP, 12 (60%) were contactable; all agreed to be interviewed and the time elapsed since completing the LP was a median of 8.5 months with a range of 2 to 12 months.
 
It might be worth pointing out the bolded sentence in the conclusion. Especially in context of the bolded sentence that came just before it.

They also dismiss reports of harm elsewhere as issues with the interpersonal skills of the practitioner. But the most telling part is that they say that this is ‘in their experience’, yet they claim that this is an ‘independent review’. How can it be independent if they have enough ‘experience’ with LP to say anything about the source of claims of harm?

From the paper:

The NICE concern about harm was based on a qualitative study (of nine patients and three parents) where most participants found considerable benefit, and two participants complained about the attitude of the staff administering the LP.[6] Our experience with such complaints is that there can be confusion regarding the viewpoint of an occasional therapist with limited interpersonal skills with the LP intervention. Our study also of twelve participants found no harms. In the Bristol trial, no harm was reported; the participants in our audit also reported no harm. Long COVID symptoms are prevalent, disabling, and costly, and there is a need to develop evidence-based treatment options. It is impossible to generalize our study findings to a broader group of patients because of the small sample size and restricted demographic variation. Nonetheless, it is encouraging that many patients can get so quickly.

Conclusion
All participants experienced debilitating fatigue. All participants made significant improvements; some had cures after performing the LP and did not experience any harm and was congruent with the Oslo Consortium Statement.[2] This is the first study to report outcomes for patients with long covid with the lightning process. Primary care clinicians can be assured that this is likely to be a safe and effective intervention. Randomized trials are indicated.
 
Utsikt said:
It might be worth pointing out the bolded sentence in the conclusion. Especially in context of the bolded sentence that came just before it.

They also dismiss reports of harm elsewhere as issues with the interpersonal skills of the practitioner. But the most telling part is that they say that this is ‘in their experience’, yet they claim that this is an ‘independent review’. How can it be independent if they have enough ‘experience’ with LP to say anything about the source of claims of harm?

From the paper:

The NICE concern about harm was based on a qualitative study (of nine patients and three parents) where most participants found considerable benefit, and two participants complained about the attitude of the staff administering the LP.[6] Our experience with such complaints is that there can be confusion regarding the viewpoint of an occasional therapist with limited interpersonal skills with the LP intervention. Our study also of twelve participants found no harms. In the Bristol trial, no harm was reported; the participants in our audit also reported no harm. Long COVID symptoms are prevalent, disabling, and costly, and there is a need to develop evidence-based treatment options. It is impossible to generalize our study findings to a broader group of patients because of the small sample size and restricted demographic variation. Nonetheless, it is encouraging that many patients can get so quickly.

Conclusion
All participants experienced debilitating fatigue. All participants made significant improvements; some had cures after performing the LP and did not experience any harm and was congruent with the Oslo Consortium Statement.[2] This is the first study to report outcomes for patients with long covid with the lightning process. Primary care clinicians can be assured that this is likely to be a safe and effective intervention. Randomized trials are indicated.
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Good points. The contrast between those two sentences is especially jarring.
 
Utsikt said:
They also say this in the abstract:

This study suggests that the lightning process is a promising and safe intervention for symptoms of long COVID. Primary care clinicians can refer patients for treatment with a high chance of benefit without fear of harm.
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Maybe I'll add this paragraph:
Furthermore, there is a contradiction about the generalizability of this evidence for clinical care. The paper makes these definitive statements: "Primary care clinicians can be assured that this is likely to be a safe and effective intervention." and "Primary care clinicians can refer patients for treatment with a high chance of benefit without fear of harm." Yet the paper also states that "It is impossible to generalize our study findings to a broader group of patients because of the small sample size and restricted demographic variation."
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forestglip said:
Maybe I'll add this paragraph:
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Maybe this is more precise? It also says where the statements are.

Furthermore, the authors make multiple statements about the evidence for clinical care that directly contradict their statement on the generalizability of this evidence. These definitive statements can be found in the abstract and the conclusion:
(…)
Yet the paper also …
 
Utsikt said:
Maybe this is more precise? It also says where the statements are.

Furthermore, the authors make multiple statements about the evidence for clinical care that directly contradict their statement on the generalizability of this evidence. These definitive statements can be found in the abstract and the conclusion:
(…)
Yet the paper also …
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Yes, I think that's better, thanks.
 
Utsikt said:
@forestglip you might also want to add that they don’t mention that an audit can’t be used to determine the efficacy of a treatment. If they try to determine the efficacy, why isn’t it subject to ethics clearance etc.? It seems like they want to have their cake and eat it too.
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I only want to include things I can personally defend, and I'm not familiar enough with those concepts to do so.

Utsikt said:
@forestglip the limited sample size and demographics aren’t the main issues in terms of generalizability
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That paragraph is just showing that they are recommending LP despite their own disclaimer that their evidence can not be used to recommend it. I include some other limitations in the other paragraphs.
 
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