Fatigue in patients with chronic disease: results from the population-based Lifelines Cohort Study, 2021, Goërtz, Knoop et al

Abstract

(1) To evaluate the prevalence of severe and chronic fatigue in subjects with and without chronic disease; (2) to assess to which extent multi-morbidity contributes to severe and chronic fatigue; and (3) to identify predisposing and associated factors for severe and chronic fatigue and whether these are disease-specific, trans-diagnostic, or generic. The Dutch Lifelines cohort was used, including 78,363 subjects with (n = 31,039, 53 ± 12 years, 33% male) and without (n = 47,324, 48 ± 12 years, 46% male) ≥ 1 of 23 chronic diseases. Fatigue was assessed with the Checklist Individual Strength-Fatigue.

Compared to participants without a chronic disease, a higher proportion of participants with ≥ 1 chronic disease were severely (23% versus 15%, p < 0.001) and chronically (17% versus 10%, p < 0.001) fatigued. The odds of having severe fatigue (OR [95% CI]) increased from 1.6 [1.5–1.7] with one chronic disease to 5.5 [4.5–6.7] with four chronic diseases; for chronic fatigue from 1.5 [1.5–1.6] to 4.9 [3.9–6.1].

Multiple trans-diagnostic predisposing and associated factors of fatigue were found, explaining 26% of variance in fatigue in chronic disease. Severe and chronic fatigue are highly prevalent in chronic diseases. Multi-morbidity increases the odds of having severe and chronic fatigue. Several trans-diagnostic factors were associated with fatigue, providing a rationale for a trans-diagnostic approach.

Open access, https://www.nature.com/articles/s41598-021-00337-z

 

From the paper, my bolding:

Moving away from a disease-specific to a trans-diagnostic, or even generic focus on fatigue may help to accelerate the development of interventions for fatigue to improve daily functioning of patients with a chronic disease. That is, findings from fatigue research in one chronic disease can be generalized to other chronic diseases. Moreover, a trans-diagnostic approach also supports the complexity of multi-morbid chronic disease management, as disease-centered treatments will not fully address the comprehensive needs of patients with multiple chronic diseases. To date, the effectiveness of cognitive behavioral therapy and exercise therapy in reducing fatigue has been demonstrated in specific chronic diseases such as RA, T1DM, MS, COPD, and end-stage renal disease63,64,65,66,67,68. These interventions target factors such as physical activity which has been found to be a trans-diagnostic factor for fatigue and may, therefore, be effective for multiple chronic diseases (i.e. trans-diagnostic disease management).

 

Yes, this is the direction Knoop is heading in for a while now: just chucking everything on a great big heap under a CBT empire for everything.

I really wish some good investigative journalism would be set loose on it (connections, sponsors etc.), but that doesn't really happen much in The Netherlands anymore (and there are so much issues that the one that do do it somewhat already have an overflowing plate).

 

Absolutely nothing of value was gained from this study, so a true psychosocial study. I have no idea why it makes sense to them to single out literally the most common symptom of illness and obsess over it. Other than wanting to supply the "solution" to it, which is of course what this is about.

Yes, the most common symptom in all of medicine is commonly found with chronic diseases. Very useful study, folks. We never could have figured that out before, other than the fact that it's common knowledge.

"Why fund scientific research when you can instead waste it on junk like this?", is how I imagine the funding process for this went.

 

Thirty odd years ago, Wessely and co decided that fatigue was the same in all illnesses, that there was a scale of a bit of fatigue to a lot of fatigue but it was all the same thing with the same underlying process. That is why research money for ME was given to a group looking at primary biliary cirrhosis for instance.

All those years of research has offered no insight so why Knoop looking at it now?

 

So what is the desired end here? To erase all, or most disease differentiation? Rename everything Fatigue? Maybe Fatigue, with ranks to at least provide some difference between all the fatigue states.

To provide the same treatment for all diseases, that is GET/CBT?

One disease I can think of that exercise doesn't fix is hypothyroidism.

ETA: Well, there are lots of diseases that aren't fixed with just exercise and/or counseling!

 

Perhaps he is "really" an undercover etymologist and is intent upon studying the various meanings of the word "fatigue".

 

These researchers need to taste their own medicine and see how that works for them. How about they receive pooled blood from several chronic illnesses and see how long it takes for them to retract their paper?

 

In the patient magazine for RA republished in the MS one, there was a very informative article about fatigue that resonated with the people I know with MS but not me.

It said that a large part of the fatigue they experience is due to the sheer effort it takes to do anything with a damaged body. I saw this with my friend who had cerebral palsy. She often had to go to bed after shopping, things like that, because it took her so much effort to move.

While there is a component to fatigue which is probably be due to the actual illness, possibly the immune activation in RA and MS, if they are really serious about finding a treatment reinstalling home helps and decent care availability would give a big return.

(Not to mention that the money would pass into the local economy by paying a lot of home helps the peanuts they earn compared to the likes of Wessely but that is probably political so remove if that is so )

 

I think Rosmalen, Knoop and Vercoulen are really convinced that psychosocial factors play a big role in fatigue seen in chronic illnesses. That the underlying disease itself is not the main driver. There's some truth to that but I'm afraid they're leaning too much towards the psychosocial side.

 

In the sense that disability support, sick leave and other important features related to dealing with chronic illness are psychosocial, then sure, why not? I don't know why they would be classified as psychosocial but whatever. Otherwise I have no idea what those supposed psychosocial ideas have anything to do with any of this. I have seen the explanations and none of them make any sense at all.

 

When I read psychosocial factors, I always think of the issues or situations where psychotherapists can blame the chronically ill person for being sick. Such things as poverty, unhappy/problem family background etc. Not issues such as @rvallee noted like, social safety nets for disabilities. Which I completely agree with @rvallee are social issues.

 

I think ultimately it's that they only think of causes, never consequences. BPS ideologues explicitly take the consequences and assign them as causes, if they can, or ignore them entirely. So all the things that can only be consequences, not causes, simply don't make it in their minds. It's not that they're not important, it's that since they can't be causes, they simply don't consider those at all, it runs counter to the dogma and the dogma is everything.

 

I think here again, more circular issues. For example, poverty can certainly cause anxiety. But, faced with an anxious client, the idea that poverty may be an important factor or cause may not be considered. The client or patient is just processed through a CBT program in order to learn how to deal with their anxiety. In this ideology, it's the patient's fault. Not the fault of systems, government, stigma, racism, sexism etc.