Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders 2018 Gelauff, Stone, Rosmalen et al

Abstract

While fatigue is found to be an impairing symptom in functional motor disorders (FMD) in clinical practice, scientific evidence is lacking. We investigated fatigue severity and subtypes in FMD compared to organic neurological disease. Furthermore, the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated.

Data from 181 patients participating in the self-help on the internet for functional motor disorders, randomised Trial were included. Data from 217 neurological controls with neuromuscular disorders (NMD) originated from a historical cohort. Fatigue was measured using the checklist individual strength (CIS). Motor symptom severity, depression and anxiety were correlated to fatigue. For multivariable regression analyses, physical functioning and pain were additionally taken into account. Severe fatigue was, respectively, present in 78 and 53% of FMD and NMD patients (p < 0.001). FMD patients scored higher than NMD patients on all fatigue subdomains (p < 0.001). In the FMD group, fatigue subdomains were correlated to depression, anxiety and partly to motor symptom severity. Quality of life was negatively associated with fatigue [OR 0.93 (0.90–0.96), p < 0.001] and depression [OR 0.87 (0.81–0.93), p < 0.001], but not self-rated motor symptom severity. Self-rated health was negatively associated with fatigue [OR 0.92 (0.88–0.96), p < 0.001] and pain [OR 0.98 (0.97–0.99), p < 0.001].

Fatigue was found to be a prevalent problem in FMD, more so than in organic neurological disease. It significantly affected quality of life and self-rated health, while other factors such as motor symptom severity did not. Fatigue should be taken into account in clinical practice and treatment trials.

Paywall, https://link.springer.com/article/10.1007/s00415-018-8915-7

 

Well, obviously. There is no scientific understanding of fatigue, how it works or how to assess it objectively. It's just as true in any disease, is not particular to the neglected spaces of medicine. But the entire discipline is committed to wasting everything they do on nonsense like this instead of doing actual science that relates to the real world. Ironically, they recognize that the BPS model isn't scientific. They know it isn't. So by what right does this have any power over people's lives? Power higher even than the law, even basic human rights.

Theoretical physics isn't any useful until it's confirmed by experimental physics. It's the real world that matters, what people are living, not some junk narratives invented by narcissists.

The lack of validity with real life and common sense is infuriating. So much more progress could be made without the massive separation between patients and physicians, it's as wide as any caste system.

 

There is the issue - still avoiding the wake-up call/come to Jesus moment.

There are the cliches of change either being incremental or revolution, but what do you call a subject area that keeps calling 'new' reviews of 'old and faulty' that fail to take the opportunity (which is what a review really should be about) to unpick where those studies went wrong and veered well off being constructively valid.

I think the term 'meta' is used in other areas when you are no longer reviewing the 'thing' you claim to be of interest but the reviewers, and the environment they created to describe it.

We've got a proven case in ME/CFS with BPS of this whole side having separated from reality and fact of the condition itself then reviewing whether someone is saying something consistent with the inaccurate description that describes this other thing. And the activity of that whole world seems to be focused on self-cloning of more papers with the same flaws and just iterations and attacking the very process that is supposed to be checking it links back to the subject-at-hand ie is valid, actually is measuring - or even talking about - what it claims to.

It just seems horrifically wasted money/resource etc for such limited reviews scope-wise to be being punched out in such numbers repeating the same issues. These scales pretending they measure an entity really do need to be tackled and other aspects feigning justification for all these things

I'm a bit shocked by it all because if, as a comparison, you look at the literature and critical debates that take place in modelling and measuring concepts like 'service quality' models in business what is expected in any review is of such a different level to all of this.

This paper seemed to be comparing patients who they will treat in neurology (and so call them neuromotor) and who doesn't fall into their defined niche of 'organ structure in the brain we know about and is big enough we see and acknowledge only' (and so call that functional). And excluding the fact that the first set is treated properly, has been gotten to the bottom of, and has the correct adjustments and treatment with how they treat 'the rest'. And they are trying to claim what I see as likely consequences of their 'how they treat the rest' is 'the condition'.

A real experiment here would be blinding all people who went into a neurology department for 6mnths and treating them all like they have 'functional', doing the testing as above, then somewhere else that is independent doing the diagnostics to separate who was in which group - let's see 'how much is accounted for by their treatment/situation'?