Agreed.
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Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition, Nerli et al, 2024 - with comment from T. Chalder
- Thread starter Kalliope
- Start date
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.
hibiscuswahine
Senior Member (Voting Rights)
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.
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.
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There is a puff-piece on the study in a news site for health interested today (paywalled) including an enthusiatic "we could save a lot of money by having patients seen in the clinic rather than in long-term rehab stays"
It would be even cheaper to drop the clinical visits too
It would be even cheaper to drop the clinical visits too
Andy
Retired committee member
Brief journal editorial comment, Cognitive Behavioral Therapy Approach May Improve Long COVID Symptoms, Boost Physical Function
Dolphin
Senior Member (Voting Rights)
Merged thread
JAMA is an influential US medical journal
https://jamanetwork.com/journals/jama/fullarticle/2829488
Medical News in Brief
January 17, 2025
Cognitive Behavioral Therapy Approach May Improve Long COVID Symptoms, Boost Physical Function
Samantha Anderer
Article Information
JAMA. Published online January 17, 2025. doi:10.1001/jama.2024.27437
editorial comment
randomized clinical trial published in JAMA Network Open. Patients who had undergone a brief outpatient program incorporating cognitive and behavioral approaches reported greater improvements in physical function after 1 year than those who had undergone rehabilitation care as usual.
invited commentary noted that psychosocial interventions such as cognitive behavioral therapy have been shown to positively change immune system functioning and improve symptoms of somatic conditions. The particular intervention used in the long COVID study was informed by the cognitive activation theory of stress, which suggests that stressful events—such as a virus—trigger bodily symptoms, but that the continuation of the effects can be prolonged by cognitive factors.
Back to top
Article Information
Published Online: January 17, 2025. doi:10.1001/jama.2024.27437
JAMA is an influential US medical journal
https://jamanetwork.com/journals/jama/fullarticle/2829488
Medical News in Brief
January 17, 2025
Cognitive Behavioral Therapy Approach May Improve Long COVID Symptoms, Boost Physical Function
Samantha Anderer
Article Information
JAMA. Published online January 17, 2025. doi:10.1001/jama.2024.27437
editorial comment
randomized clinical trial published in JAMA Network Open. Patients who had undergone a brief outpatient program incorporating cognitive and behavioral approaches reported greater improvements in physical function after 1 year than those who had undergone rehabilitation care as usual.
iStock.com/Prostock-Studio
invited commentary noted that psychosocial interventions such as cognitive behavioral therapy have been shown to positively change immune system functioning and improve symptoms of somatic conditions. The particular intervention used in the long COVID study was informed by the cognitive activation theory of stress, which suggests that stressful events—such as a virus—trigger bodily symptoms, but that the continuation of the effects can be prolonged by cognitive factors.
Back to top
Article Information
Published Online: January 17, 2025. doi:10.1001/jama.2024.27437
Last edited by a moderator:
Kalliope
Senior Member (Voting Rights)
Trial by Error by David Tuller: Norwegian Long Covid Rehab Trial Misrepresents Clinically Insignificant Findings As "Effective"
Quote:
This trial, however unimpressive the findings, has received lots of attention.
Along with the study, JAMA Network Open published an “invited commentary” from Trudie Chalder, King’s College London’s factually and mathematically challenged professor of cognitive behavior therapy. It is full of her usual blah blah, like this bit of PACE-style propaganda: “Over the past few decades, substantial evidence has amassed for the efficacy of CBT for symptoms in the context of somatic conditions, including chronic fatigue syndrome.”
And as often happens with research from these investigators, the news coverage has been glowing and gullible. NRK—the Norwegian Broadcasting Corporation—published a credulous article headlined “New study gives hope.” The headline on a MedPage Today article was “Long COVID Symptoms Improve With Outpatient Intervention.” Of course, neither mentioned that the results on the primary outcome were not clinically significant. I assume this trial’s inflated claims will be included in the next iteration of the recent “living” systematic review of Long Covid interventions, which is itself in need of a major correction.
https://virology.ws/2025/01/30/tria...inically-insignificant-findings-as-effective/
Quote:
This trial, however unimpressive the findings, has received lots of attention.
Along with the study, JAMA Network Open published an “invited commentary” from Trudie Chalder, King’s College London’s factually and mathematically challenged professor of cognitive behavior therapy. It is full of her usual blah blah, like this bit of PACE-style propaganda: “Over the past few decades, substantial evidence has amassed for the efficacy of CBT for symptoms in the context of somatic conditions, including chronic fatigue syndrome.”
And as often happens with research from these investigators, the news coverage has been glowing and gullible. NRK—the Norwegian Broadcasting Corporation—published a credulous article headlined “New study gives hope.” The headline on a MedPage Today article was “Long COVID Symptoms Improve With Outpatient Intervention.” Of course, neither mentioned that the results on the primary outcome were not clinically significant. I assume this trial’s inflated claims will be included in the next iteration of the recent “living” systematic review of Long Covid interventions, which is itself in need of a major correction.
https://virology.ws/2025/01/30/tria...inically-insignificant-findings-as-effective/
Arnie Pye
Senior Member (Voting Rights)
Wasn't it also the case in the UK that many people who died in hospital during the pandemic were assumed to have died of Covid as a primary cause even if they actually died of other things, like cancer, heart attack, stroke, dementia etc.?
Arnie Pye
Senior Member (Voting Rights)
I noticed that comments had been disabled on the video in this twitter link.
Kalliope
Senior Member (Voting Rights)
New article about the study from the Norwegian public broadcaster NRK:
Uenighet om long covid: - Håper ikke det blir stående et bilde av at det er lett å kurere
auto translation: Disagreement about long covid: - I hope there's no impression left that it's easy to cure
Quotes:
Søraas believes that the methods in the study in Stavern should be used on long-term COVID patients.
However, he believes it is important not to blindly rely on one method, even if some patients improved.
...
(Nerli):
– I completely agree that it is important to find the underlying causes of long covid, but in our eyes it is not something either biological or psychological.
...
(Stafseth from the Covid Association):
- It's great that someone get better, but it's unethical to promote a method that makes many people sicker
...
– I think it's a bit of a shame that the leadership of a patient association is not positive, or at least open and curious, about a treatment plan that is effective and safe. I struggle to see that the Covid Association's position on the study is in the interest of all their members, says Nerli.
Uenighet om long covid: - Håper ikke det blir stående et bilde av at det er lett å kurere
auto translation: Disagreement about long covid: - I hope there's no impression left that it's easy to cure
Quotes:
Søraas believes that the methods in the study in Stavern should be used on long-term COVID patients.
However, he believes it is important not to blindly rely on one method, even if some patients improved.
...
(Nerli):
– I completely agree that it is important to find the underlying causes of long covid, but in our eyes it is not something either biological or psychological.
...
(Stafseth from the Covid Association):
- It's great that someone get better, but it's unethical to promote a method that makes many people sicker
...
– I think it's a bit of a shame that the leadership of a patient association is not positive, or at least open and curious, about a treatment plan that is effective and safe. I struggle to see that the Covid Association's position on the study is in the interest of all their members, says Nerli.
hibiscuswahine
Senior Member (Voting Rights)
4-5 hours of brainwashing, a 26% drop out rate and a treatment effect that did not meet clinical significance. So not the success story they are telling the world.
And to ignore the patient organisation saying that pwLC have said this CBT intervention has caused harm and Soraas saying that those reports are not scientific....perhaps he needs to follow up the drop-outs? They probably don't want to have a bar of him or if they reported the harm, he probably wouldn't include their reasons in his study.
And to ignore the patient organisation saying that pwLC have said this CBT intervention has caused harm and Soraas saying that those reports are not scientific....perhaps he needs to follow up the drop-outs? They probably don't want to have a bar of him or if they reported the harm, he probably wouldn't include their reasons in his study.
It is Nerli, not Sørås, who says the reports are not scientific. Though I wish Sørås didn't say this treatment should be provided to LC patients.
Kalliope
Senior Member (Voting Rights)
There are some new comments to the paper.
one by Richard White and one by Mark Vink and Friso Vink-Niese
There's also a response from the authors disagreeing with the critical comments.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828267
one by Richard White and one by Mark Vink and Friso Vink-Niese
There's also a response from the authors disagreeing with the critical comments.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828267
Utsikt
Senior Member (Voting Rights)
As expected, they did not address most of the concerns.