Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with... 2022 Arienti

Full title: Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition

INTRODUCTION: Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct “evidence on” rehabilitation interventions for people with post-COVID-19 condition (PCC), we can search and synthesize the indirect “evidence relevant to” coming from interventions effective for the symptoms of PCC in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in their Guidelines. With this overview of reviews with mapping, we aimed to synthesize in a map the Cochrane evidence relevant to rehabilitation for fatigue, post-exertional malaise and orthostatic intolerance due to PCC.

EVIDENCE ACQUISITION: We searched the last five years’ Cochrane Systematic Review (CSRs) using the terms “fatigue,” “orthostatic intolerance,” “rehabilitation” and their synonyms in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence.

EVIDENCE SYNTHESIS: Out of 1397 CSRs published between 2016 and 2021, we included 32 for fatigue and 4 for exercise intolerance. They provided data from 13 health conditions, with cancer (11 studies), chronic obstructive pulmonary disease (7 studies), fibromyalgia (4 studies), and cystic fibrosis (3 studies) being the most studied. Effective interventions for fatigue included exercise training and physical activities, telerehabilitation and multicomponent and educational interventions. Effective interventions for exercise intolerance included combined aerobic/anaerobic training and integrated disease rehabilitation management. The overall quality of evidence was low to very low and moderate in very few cases. We did not identify CSRs that specifically addressed post-exertional malaise or orthostatic intolerance.

CONCLUSIONS: These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.

Open access, https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y9999N00A22120602

 

who's going to break it to them...

 

This is pretty bad. You can't analyze research in a dozen different diseases and apply it to long Covid by just compiling it.

 

quick search on the Cochrane library:
50 Trials matching post-exertional in Title Abstract Keyword
32 Trials matching post-exertional malaise in Title Abstract Keyword

208 Trials matching "orthostatic intolerance" in Title Abstract Keyword

 

It's amazing that "helpful hypotheses" can be generated for clinical practice and future research from low evidence studies. And, treatments be "effective" but "low evidence".

(Double take, shake head again....)

 

Aside from everything about fatigue being so generic and awful none of it applies, exercise intolerance is not the same thing as PEM. They can't even be bothered to understand the meaning of the words they are using. The process is as smart as a fully text-based research, all it does is match keywords, regardless of their context or meaning.

Considering everything that's happened at Cochrane, this is pathetic. Especially as it does include the Larun review, where it is awfully discussed but still it is addressed. Only problem is it's addressed by denial, which Cochrane is heavily guilty of.

Look at the GRADE values. The Larun review is rated very low, low, and moderate. Somehow. The same study. One rated moderate is for "women with breast cancer after adjuvant therapy", although it's rated multiple times so the analysis is a complete mess. Wow actually this same review makes up dozens of entries alone and it doesn't even apply. Another cancer-related fatigue, for which it isn't even clear if the cancer or the treatment, or both, is at cause. "Home-based multidimensional survivorship program"? WTH? Again more cancer. Cancer cancer cancer everywhere, none of those apply. All types of cancer: colorectal, lung, breast. How did they not exclude those? Just so it could pad the review?

Chronic kidney disease. Chronic respiratory disease. Cystic fibrosis. This is genuinely less serious than the average work done in a legislative committee, outside of fringe weirdos pushing a conspiracy theory or a corrupt agenda. This whole paradigm is a joke. Completely different things for different purposes, all mixed in together. Absolute GIGO.

All of this is either not applicable, they don't even understand what the words mean, or is of such low quality it shouldn't be used, and this includes some work by Cochrane. So, basically on brand for Cochrane. Their motto should be: only quantity, no quality.

 

There are conditions that make people intolerant of, or at least at risk for, high intensity exertion but who otherwise are fine, they can otherwise live a mostly normal life.

PEM is not the same thing as that, and that conflation is highly problematic, as we can see with the continued obsession that Long Covid is about exercise intolerance, all of which is to push the deconditioning nonsense.

 

This is actually hard to explain. Did they just straight up not search for it? Or are they pretending they aren't there? I don't get it, there are matches for this, even using a dumb plain text search. To be fair, most of those are really bad, but then so are the ones they selected.

And the worst is that I don't think it even matters, no one would even care if it was pointed out. This is how unserious Cochrane is.

 

Merged thread

Full title: Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition

INTRODUCTION: Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct “evidence on” rehabilitation interventions for people with post-COVID-19 condition (PCC), we can search and synthesize the indirect “evidence relevant to” coming from interventions effective for the symptoms of PCC in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in their Guidelines. With this overview of reviews with mapping, we aimed to synthesize in a map the Cochrane evidence relevant to rehabilitation for fatigue, post-exertional malaise and orthostatic intolerance due to PCC.

EVIDENCE ACQUISITION: We searched the last five years’ Cochrane Systematic Review (CSRs) using the terms “fatigue,” “orthostatic intolerance,” “rehabilitation” and their synonyms in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence.

EVIDENCE SYNTHESIS: Out of 1397 CSRs published between 2016 and 2021, we included 32 for fatigue and 4 for exercise intolerance. They provided data from 13 health conditions, with cancer (11 studies), chronic obstructive pulmonary disease (7 studies), fibromyalgia (4 studies), and cystic fibrosis (3 studies) being the most studied. Effective interventions for fatigue included exercise training and physical activities, telerehabilitation and multicomponent and educational interventions. Effective interventions for exercise intolerance included combined aerobic/anaerobic training and integrated disease rehabilitation management. The overall quality of evidence was low to very low and moderate in very few cases. We did not identify CSRs that specifically addressed post-exertional malaise or orthostatic intolerance.

CONCLUSIONS: These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.

Open access, https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y9999N00A22120602

 

Again with the complete lack of common sense and reasoning, and the absolutely absurd reality that medicine is A-OK with using awful evidence. This is the real underlying issue: it's not just that they use flawed evidence, it's that it's systemic, they are OK with using terrible evidence. It's failure of basic reasoning: there literally isn't any at all.

Although what an embarrassment that such a terrible review can be produced when the alleged IAG process began in February 2020, closing in on 3 years and with absolutely nothing to show for it, allowing the flawed review marked as deprecated to, somehow, be used.

This should be used in the issue of the NICE guidelines where the PACE authors are pretending they took PEM into consideration. Obviously they did not, there is simply no way to pretend otherwise.

This is truly Cochrane's brand: the evidence is awful, misleading even, and we are so proud of recommending it.

This is not even a valid basis to work with. This is phoning in phoning it in, zero effort, zero attempt at even being relevant. This is just branding and marketing.

 

I read through all the language wondering whether it was a parody of how stupid people could be. I mean every single line is a corker you'd be shocked at an intern for doing, even just for a writers' job where they don't need knowledge of the subject.

It is like someone confusing hot flushes as something that can be helpfully explained by looking up heat stroke in someone with let's say COPD and CF and thinking you've done a helpful masterstroke.

Lazy g**s - we couldn't be bothered to do anything properly other than the weasel words we use to cover up said laziness of 'didn't want to look up the right condition, but this lot get a bit tired too and there are thousands of papers under that broad approx term, so we've half sort of ticked a bit of almost one box that sounds almost similar to what we claim we are covering'

Dangerous if people allowed to write this with a straight face are allowed any kind of medical license because it sounds like they don't take the responsibility of that seriously. Maybe the issue is the bunch who are allowed to spend their time doing this nonsense also shirk being on the front line picking up the pieces of genuine illness anymore and definitely make anyone they see pretend they are OK after whatever they've done before they struggle off to collapse.

If these people saw these individuals before the ones 'they have to be careful with' (in their mind) because someone cares and knows they should know better have been separated out to cover their backs by not ever letting them risk forcing an untreated diabetes, COPD or CF patient through whatever nonsense they might be observant of very different things at very different points with different attitudes at the time, because someone would be wondering why they didn't 'pick up on the signs' and act responsibly to be alive to the risks of such things.

On this occasion 'accidentally' pretending PEM - which means they'll cause potentially irreparable harm by pushing people too far past threshold - 'has no literature to warn them of this' and instead picking up the literature that tells them they get a gold star for 'pushing someone past their limits'...... I've no words tbh