First trans-diagnostic experiences with novel micro-choice based group rehabilitation for low back pain, long COVID, type 2 DM, 2024, Kvale+

SNT Gatchaman

SNT Gatchaman

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First trans-diagnostic experiences with a novel micro-choice based concentrated group rehabilitation for patients with low back pain, long COVID, and type 2 diabetes: a pilot study
Kvale, Gerd; Søfteland, Eirik; Jürgensen, Marte; Wilhelmsen-Langeland, Ane; Haugstvedt, Anne; Hystad, Sigurd William; Ødegaard-Olsen, Øystein Theodor; Aarli, Bernt Bøgvald; Rykken, Sidsel; Frisk, Bente

The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted.

In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes. Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up.

The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3–4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up.

Of the 241 included participants (57% women, mean age 48 years, range 19–84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001.

Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial.

ClinicalTrials.gov NCT05234281

Link | PDF (BMC Medicine)
 
More unblinded, subjective outcome nonsense, and as usual the term "trans-diagnostic" indicates that findings are spurious.

Not a good start with the abstract: "The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses."

Apparently all these complex and expensive chronic illnesses can be hand-waved away with group therapy: very cheap, very good.

Across disorders, medical advice for chronic health challenges typically encompasses recommendations to gradually increase the activity level, while at the same time not overdo it. As the main concern for the patient is to prevent the condition from worsening, there is a high risk of developing defensive coping strategies that might contribute to conserve or, in some instances, even exacerbate the problem.
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One of the main features is a shift in focus, from targeting symptoms to targeting and monitoring seemingly mundane everyday micro-choices that facilitate increased levels of functioning. The intention of these microchoices is to break unhelpful patterns of symptom regulation by “doing something different” whenever tempted to be guided by the symptoms or habits, with the goal of increasing flexibility and functioning.
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The intervention has been delivered to patients with a disparate selection of complex health challenges, namely chronic low back pain, long COVID, type 2 diabetes, and mixed anxiety and depression.
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This novel approach to delivering concentrated evidence-based rehabilitation to highly challenging groups of patients suffering from a broad range of complex, chronic disorders was associated with high satisfaction with the extent of the treatment, in spite of our approach being substantially shorter than traditional 3–4-week rehabilitation interventions. Similarly, across disorders, patients were highly satisfied with the amount of help, indicating that their needs were met.
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A good example of how questionnaires will be filled in showing a positive change, because a professional spent time "helping" the patient.

Several aspects of the intervention – detailed in the protocol paper – break with the typical mode of rehabilitation: e.g., (1) distinct phases, including a separate pretreatment preparation for change, (2) the concentrated format (3–4 consecutive days), (3) a shift in focus from symptoms to actions (indicating that change is within reach, installing hope in the patients), (4) focusing on the myriad everyday opportunities for “doing something different” than what the habits or symptoms suggest, i.e., the micro-choices, (5) starting to practice breaking unhelpful patterns of symptom regulation in a safe context together with health care professionals, giving the opportunity to correct and modify unhelpful behavior patterns when they occur, and (6) continue practicing in the patients’ every-day life.
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(Is this the Lightning Process?)

It is also highly interesting to note that a large and significant change was achieved already 1 week after the intervention, which might be surprising given the chronicity of the health challenges. Our results are in line with the already published results for the same intervention in mixed anxiety/depression, and also for previous experiences with this format in obsessive-compulsive disorder, panic disorder, and chronic fatigue syndrome.
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All of which should tell you that you're not measuring what you think you're measuring.

This could indicate that the micro-choice focused concentrated rehabilitation approach has a potential for substantial generic and transdiagnostic effects. Moving forward, we speculate that a shift from a diagnosis-based intervention to focusing on the handling of the most dominating symptoms (i.e., pain/fatigue) could be useful. Further long-term studies are needed to shed light on this.
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I have no doubt that more studies will be forthcoming.
 
oh dear. This approach has been discussed in several threads and is already on offer in Norway.

Here's a media article from 2023 about this "novel" approach. Towards the end of the article they mention a study that will be published soon and has followed up patients for a year, which I assume is the study to this thread.

Science Norway: Can Long Covid be treated in three days?

quote:

The researchers call them micro-choices. They are the small and seemingly insignificant choices we make in everyday life that often happen automatically, and that we make to regulate anxiety and discomfort. Kvale and her colleagues try to make patients aware of exactly when these moments happen and the choices they are making.

“For some people, this means focusing on the choices they make early in the day, which can contribute to them being tired,” says Kvale.

Others might find it more relevant to look directly at the choices they make regarding rest.

“There are lots of ways to rest. Just doing something else – like increasing one’s activity level – can be a good rest for some people,” she says.
 
The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses.

Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up.

Which tells you all you need know about the legitimacy of this study – both its intended audience and its methodology.

The real question about this kind of study is how do they keep getting away with it?
 
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Good grief I hope an LLM wrote this title because it's just chock-full of meaningless buzzwords and it would be less embarrassing.

I'm just baffled by the two first paragraphs, which have nothing to do with one another, in fact pretty much contradict each other. Again it sounds like an LLM wrote this, and frankly probably did. It's true that effective treatments are needed, but they are not trying to do that, instead they're just doing the same old failed nonsense. Also, spoiler: health care is already broken. In part because of pseudoscience like this.

Also how can something be both novel and evidence-based? This ideology is seriously just straight up offensive on philosophical grounds alone, it doesn't just make no pretense to make sense, it challenges common sense and reason in ways that should make people angry.

This nonsense seems to be called "The Bergen 4-day treatment", and appears to be their creation, and the reference for ME/CFS is this paper: A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up, so really just the same old repackaged CBT stuff, as is tradition.
 
And just continues the old scam model of "does random variation of CBT" "improve X/Y/Z" in "group A/B/C/.../Z" using "useless rating questionnaire". It's a combinational scam, there are just endless permutations that they can go through. In fact this same group is doing exactly this. All of which add up to exactly as much difference, or even distinction, as wearing different hats while doing the same thing.

This is seriously the biggest scam in the history of medicine. It makes Theranos look downright honest and good-natured.
 
And some of the authors are affiliated with the institution that is the new host for Cochrane Norway. Wonder if that will mean anything (though not that the old host, FHI/National Institute of Public Health, didn't have a very positive view of CBT...)
 
rvallee said:
This nonsense seems to be called "The Bergen 4-day treatment", and appears to be their creation, and the reference for ME/CFS is this paper: A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up, so really just the same old repackaged CBT stuff, as is tradition.
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I don't think it is the Bergen 4 Day Treatment, that should contain intensive exposure therapy (although if we are believed to be afraid of any type of exertion/sensory load etc. then I guess anything can be called exposure therapy...?). But it is the same people, and it is the same mindset behind it.
 
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