Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition, Nerli et al, 2024 - with comment from T. Chalder

Agreed.

 

I tend to think they believe in it. I assume if the clients get sicker, it's because they weren't working the program correctly.

 

They acknowledge limitations of the study in the paper:

The attention given to patients in the intervention group was not matched with that of the CAU group; still, most patients in the CAU group received medical care that can affect patient-reported outcome measures,31,57 conceivably reducing the impact of not including a sham intervention in the control group. Although no statistical evidence indicates nonrandom missingness, the possibility cannot be ruled out, particularly given the noticeable differences in missing data proportions between the intervention and CAU groups. Objective measures of physical and social function (eg, steps per day and work attendance) were not included but could have yielded valuable information;

I think the limitations are very important and a reason not to splash it all over Xitter i.e Garner, saying how wonderful it is. Although the authors are aware that any contact with medical personnel can improve patient reported symptoms.

Firstly the Care as Usual group is very different treatment/care/whatever than the Treatment Group (Brief Interventions with CATS). The Treatment Group got several sessions with a therapist (the content I don't agree with but there may be some useful components - i.e trying to engage in pleasurable activities on improving mood) but scientifically, there can be a significant effect of just having sessions with a therapist, independent of the content.

(This has been shown many times in many studies in the psych literature, slightly different as we are talking about a medication rather than a specific therapy but to prove this point about contact with health professionals from my own clinical experience: Many repeated studies have found people who are on Clozapine (an atypical antipsychotic - moderately to highly effective in treatment resistant psychosis - but with some very serious side effects (drops the white cells in the body, so high risk of infection and death because the client can't communicate their symptoms due to thought disorder, or their physical illness is put down as delusional by medical and psychiatric workers. These clients require monthly blood tests and monthly review by a psychiatrist (usually their own, who enquires about life and family etc), the psych nurse often brings them in to clinic and does a mental status examination by chatting about their life, any problems etc and they see a phlebotomist and often other clients getting their blood on the day prior to the clozapine clinic run at their community mental health team. So studies have shown that clozapine is not more effective than any other antipsychotic, it was the monthly social contact/support and the frequency of seeing their psychiatric nurse and psychiatrist that most likely means clozapine is a more effective than antipsychotics that don't need such close review. Their nurse and psychiatrist could counsel and support them in any practical problems and recognise when any unavoidable or excessive stress was impacting on their mental health and adjust dose accordingly for a short time if appropriate and do some basic supportive therapy. This meant they had less relapses into acute psychosis, admissions, better quality of life etc)

In this study, they have not been clear how frequent the contacts were with staff at the clinic - the so called "medical care". They say this reduces the impact of not having a sham intervention for the control group. I really don't understand why they just didn't come up with a sham intervention group. This would make the result more robust. They do note they need bigger studies.

Secondly, of course, they are also aware that subjective measures are not as good as objective measures but they could have very easily done this eg recorded work attendance, asked if the patient had a Fitbit etc.