Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses..., 2021, Kvale et al

[Andy]

Full title: Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study

Abstract

Background:An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses.

Objective:We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up.

Methods:The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes.

Results:Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021.

Conclusions:If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions.

Open access, https://www.researchprotocols.org/2021/10/e32216

 

[Sean]

Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up....

...we have developed a comprehensive transdiagnostic rehabilitation for chronic illnesses, characterized by a systematic focus on how to initiate and maintain change.

The intention of these microchoices is to break inflexible patterns of symptom regulation by “doing something different” whenever tempted to be guided by the symptoms.

What happens if the patient doesn't 'comply' with these new health dictates?

This approach enables the patient to systematically increase flexibility and their levels of functioning when symptoms and health challenges are present. In addition, a focus on deliberate behavior instead of symptoms implies that change is within reach and possible to control.

Translation: If our therapy doesn't work for you, it is your fault.

The intervention will be delivered to patients with highly diverse primary symptoms,

The expansion of the empire continues... and always will.

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Primary Outcome Measures

Acceptability

The acceptability of the treatment will be measured by the following variables: (1) The proportion of patients accepting to participate in the treatment among those fulfilling the inclusion criteria and offered participation; (2) The proportion of patients offered participation who start treatment; and (3) The proportion of patients completing the treatment program (on-site).

CSQ

The CSQ-8 is an 8-item questionnaire that measures patient satisfaction with health services, where the items are rated from 1 (very low satisfaction) to 4 (very high satisfaction) [26]. The total score ranges from 8 to 32, with higher scores indicating higher degrees of satisfaction. The CSQ-8 has good psychometric properties, with high internal consistency (Cronbach α=.93) and high interitem correlation [27].

BIPQ

The BIPQ is a 9-item questionnaire designed to assess cognitive and emotional representations of illness [28]. Questions are graded from 1 to 10. The last item deals with the perceived cause of illness, in which respondents list the perceived 3 most important causal factors in their illness. For this questionnaire, the general word “illness” can be replaced by the name of a particular illness. The word “treatment” in the treatment control item can be replaced by a particular treatment such as “surgery” or “physiotherapy.” The scale has good psychometric properties according to a recent review [29].

WSAS

The WSAS is a short questionnaire measuring the impact of the illness on aspects of work and social activities [30]. The scale consists of five items rated from 0 (not at all) to 8 (very severe), and a higher score indicates higher impairment (maximum score is 40). The scale is regarded as reliable and valid, with good psychometric properties.

Apart from Acceptability, which is of limited value, this is the standard self-report scam.

It really is becoming drearily predictable.

 

[Sean]

It isn't even randomised.

What a farce.

 

[Peter T]

Here is a novel idea, how about demonstrating with objective outcome measures that you have any interventions that would with individual patient groups by themselves before suggesting they work for combined trans diagnostic patient groups?

Though people with long term illnesses may have some common intervention interests, I would argue these commonalities relate to obtaining appropriate ongoing practical support and dealing with societal prejudices.

Many years ago I worked with groups of adults with diverse long term communication disabilities, largely within social service provision. The outcomes from these groups that participants saw most positive were things like developing a vocabulary to assert their rights to equal access to communication, and their gaining input to staff training and access to service planning/advisory panels. [Unfortunately opportunities that disappeared with subsequent budget cuts.]

 

[Kalliope]

One of the authors is 2. leader of Recovery Norge and main author Gerd Kvale co-authored a study with psychiatrist Bjarte Stubhaug on CBT/mindfulness as curative treatment for ME.

Gerd Kvale became a star when she developed a 4-day intervention against OCD a few years ago. She got featured in Time Magazine for this.

My impression is that this has been super-hyped and A LOT of money has been spent to build an expensive, brand-new center for this treatment in Norway, where they've expanded the treatment for other diagnoses as back pain, anxiety, depression, diabetes, Long Covid, breathing difficulties. As far as I know they've just decided it works and started treating other patient groups before documenting properly that the intervention actually is helpful for other diagnoses as well. I guess that's what they're trying to do now, so I assume the results of this study will likely be very promising.

Here is their website
https://helseihardanger.no

There used to be a section about fatigue as well as one of the things they treat, but that has been removed now.

 

[NelliePledge]

‘Focus on health promoting micro changes instead of symptoms’ my backside

 

[Mithriel]

Methods:The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up.

Does it never occur to these people that people with chronic diseases are already doing all these things already to cope with diseases that have no medical input or support. They talk to each other on forums, read articles, keep mindfulness journals, change their diet, try any small thing which would give them a tiny improvement.

The best way to reduce costs would be to cure disease, the next best thing would be medicine or procedures to relieve symptoms, not to ignore them which is a good way to make them worse.

The way to manage diabetes is to reduce the amount of sugar in the blood, not useful for anxiety and depression.

A hammer desperately looking for nails.

 

[rvallee]

On second thought, let's also throw in the kitchen sink. No, wait, many, many kitchen sinks. Yes, that should work.

The quality of research in clinical psychology is seriously going down, it's getting even less rigorous than famous failed experiments like the Stanford prison and Milgram's. And the general vibe in the field is that things are improving. Amazing.

 

[Sean]

Does it never occur to these people that people with chronic diseases are already doing all these things already to cope with diseases that have no medical input or support.

They have to assert that we are pathetic incompetent wretches who fall apart at the first whiff of difficulties in life, and maybe even malingerers and frauds as well. Otherwise their 'model' doesn't work from the start.

 

[hinterland]

Full title: Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study

Sorry, I don't think I can even get past the title! When they start throwing around the word 'interdisciplinary' you know you're in trouble. They don't know what to do with you. Perhaps less responsibility for the individual physician and more discipline for the patient will help?! That's what it sounds like to my ears. Just chivvy the patient along...

"When a lot of remedies are suggested for a disease, that means it can't be cured." Anton Chekhov