Follow-up of patients with post covid-19 condition after a multidisciplinary team assessment: a pilot study, 2024, Wigge et al.

[SNT Gatchaman]

Follow-up of patients with post covid-19 condition after a multidisciplinary team assessment: a pilot study
Alexander Wigge; Johanna Philipson; Solveig Hällgren; Helena Filipsson; Britt-Marie Stålnacke

OBJECTIVES
To follow up patients with post-COVID-19 condition (PCC) 6 months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave.

METHODS
A prospective pilot study conducted in a clinical setting of patients (n = 22) with PCC referred from primary healthcare to a specialist clinic for a 2 day-multidisciplinary team assessment followed by a subsequent rehabilitation plan. Data were collected through questionnaires filled in prior to the team assessment and 6 months later.

RESULTS
Fifteen of the initial 22 patients participated in the follow-up. No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful. This differed between the genders, where all the women 100% (n = 8) perceived it as being helpful, compared with 40% (n = 2) of the men (p = 0.012).

CONCLUSIONS
Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing. However, since the participants themselves perceived the intervention as being helpful, the team assessment seems to be of some value. Further studies with larger populations would be of interest.

Link | PDF (Journal of Rehabilitation Medicine - Clinical Communications) [Open Access]

 

[SNT Gatchaman]

The results showed no statistically significant improvements in any of the questionnaires after six months. The majority of the participants perceived the team assessment as being helpful. Since the assessment seemed to be of some value, there is a need for further studies with larger populations.

 

[SNT Gatchaman]

It's inconceivable to them that a multi-disciplinary / BPS / rehabilitation model could be anything but helpful.

While assessing the quality of this study, several factors must be considered. Some strengths are that the multidisciplinary team consisted of experienced clinicians and that several of the questionnaires have been used in previous studies on similar groups of patients. Although a team assessment and rehabilitation should be based on a biopsychosocial approach, the optimal duration and intensity of a rehabilitation intervention for PCC has not been defined.

This study showed no statistically significant improvements in PCC following multidisciplinary team assessment and a rehabilitation plan. Nevertheless, a majority of the participants found the intervention helpful. However, more research on the subject is needed, preferably studies on larger populations, with control groups and compliance controls. In addition, qualitative studies may answer why women scored the assessment as helpful despite the absence of self-scored improvements.

"Guys, guys: we just need to do more research and we'll get the exact amount multi-disciplinary rehabilitation just right, you'll see."

 

[bobbler]

Follow-up of patients with post covid-19 condition after a multidisciplinary team assessment: a pilot study
Alexander Wigge; Johanna Philipson; Solveig Hällgren; Helena Filipsson; Britt-Marie Stålnacke

OBJECTIVES
To follow up patients with post-COVID-19 condition (PCC) 6 months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave.

METHODS
A prospective pilot study conducted in a clinical setting of patients (n = 22) with PCC referred from primary healthcare to a specialist clinic for a 2 day-multidisciplinary team assessment followed by a subsequent rehabilitation plan. Data were collected through questionnaires filled in prior to the team assessment and 6 months later.

RESULTS
Fifteen of the initial 22 patients participated in the follow-up. No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful. This differed between the genders, where all the women 100% (n = 8) perceived it as being helpful, compared with 40% (n = 2) of the men (p = 0.012).

CONCLUSIONS
Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing. However, since the participants themselves perceived the intervention as being helpful, the team assessment seems to be of some value. Further studies with larger populations would be of interest.

Link | PDF (Journal of Rehabilitation Medicine - Clinical Communications) [Open Access]

So fascinating that on the ‘helpful’ question - which could be prone to social pressure ie politeness - there was such a massive difference between genders

If many of the older males I know had been through the crud cfs patients got as ‘care’ and weren’t being coerced with perceived threats (which if they were retired and not likely to feel vulnerable to having ‘hysterical woman notes’ affecting treatment fir other things because it hasn’t happened to them before) they would interpret that question as literal. And give what eg their wife would see as a ‘blunt’ answer.

ie ‘is it good enough?’… ‘no’

so 40% saying it’s not helpful vs 100% of women saying ‘helpful’ adds up merely based on social pressure /etiquette

whereas women are trained they must be polite etc and aren’t thinking immediately it’s a business thing but an interpersonal one too - like no pints would be like not saying ‘thank you’ or please.

it makes me think that all surveys like this should be required to have a statement at the front making clear the implications of these questions / the ‘research question’ they are being interpreted as .

so ‘this will be used in making decisions about what type of clinicians are offered, and what type of symptoms should be focused on’

‘should we be offering something different’

‘is this the best combination of staff’

Is very different to ‘was Valerie helpful today’

or ‘would you rather have this than nothing’

 

[Eleanor]

There was a statistically significant difference between men and women, where a larger proportion of women perceived the intervention as being helpful. This kind of disparity between genders has been shown in multimodal rehabilitation of chronic pain, with larger improvements in women compared with men (28). In a previous quality study by Stenberg et al. (29) of neck and back patients it was shown that gender seemed to affect expectations and experiences of healthcare generally. In their study the men did not doubt that they were entitled to be helped, and took help from healthcare for granted while more women sought help for problems they had experienced for a long time but could no longer control. They expressed the attitude that others might have had a greater need of healthcare and doubted the value of their pain in the eyes of others.
We could only speculate whether this could be a factor that has influenced the results of our study.

I notice in Table IV that all the women who said the intervention was helpful rated the helpfulness as 'small-moderate'. Of the two men who said it was helpful, one rated the helpfulness 'small-moderate' and one 'big'.

 

[bobbler]

I notice in Table IV that all the women who said the intervention was helpful rated the helpfulness as 'small-moderate'. Of the two men who said it was helpful, one rated the helpfulness 'small-moderate' and one 'big'.

The mind boggles as to what KPIs ie accounting type ‘play the game focus’ these things have to have that you wouldn’t want to fish out those individuals for whom there was real and ‘big’ benefit and prove them more on how and why and who

surely it’s better to have a service with a defined and tight patient cohort for whom you make a big difference

vs burying those who would benefit in a load of people being polite but who need someone else offering something more appropriate and less at best superfluous?

 

[bobbler]

So fascinating that on the ‘helpful’ question - which could be prone to social pressure ie politeness - there was such a massive difference between genders

If many of the older males I know had been through the crud cfs patients got as ‘care’ and weren’t being coerced with perceived threats (which if they were retired and not likely to feel vulnerable to having ‘hysterical woman notes’ affecting treatment fir other things because it hasn’t happened to them before) they would interpret that question as literal. And give what eg their wife would see as a ‘blunt’ answer.

ie ‘is it good enough?’… ‘no’

so 40% saying it’s not helpful vs 100% of women saying ‘helpful’ adds up merely based on social pressure /etiquette

whereas women are trained they must be polite etc and aren’t thinking immediately it’s a business thing but an interpersonal one too - like no pints would be like not saying ‘thank you’ or please.

it makes me think that all surveys like this should be required to have a statement at the front making clear the implications of these questions / the ‘research question’ they are being interpreted as .

so ‘this will be used in making decisions about what type of clinicians are offered, and what type of symptoms should be focused on’

‘should we be offering something different’

‘is this the best combination of staff’

Is very different to ‘was Valerie helpful today’

or ‘would you rather have this than nothing’

The only solution I can see to this issue

and I think it’s probably significantly behind why cfs got played

is fir all charities to band together and write to all institutions doing research and all clinics insisting questions of this type are removed

and telling all patients to skip any questions or ‘just say no’ even though it might feel rude. Tho that doesn’t account for if there was any gerrymandering etc of course anywhere.

I’d suggest getting other illness charities involved in it too as this methodology issue spreads (so will slowly affect them and be as big an issue for them as for us). But it gives weight it’s not just the me/cfs people

they could get a few good faces to front it like a tv celeb such as one of the van tulkien and someone who is big on methods reputation wise but less of a celeb to those not reading science etc

unless everyone is doing it and there is a public campaign to stop the rot patients do not have the safety to do it because understandably these aren’t administered properly anonymously and SVERYONE knows not to upset your doctor of hcp who will write notes in you and affect future treatment and access for other things.

but I worry about the MEA PROMS using this phenomenon

 

[Amw66]

PROMS is job substantiation . It s more of this .

 

[NelliePledge]

When we took part in training in my old job we used to be given “evaluation questionnaires” at the end which were commonly referred to as “happy sheets”.

 

[Sean]

So fascinating that on the ‘helpful’ question - which could be prone to social pressure ie politeness - there was such a massive difference between genders

Seems like an important clue about what is actually going on when they ask these kind of soft questions.

all charities to band together and write to all institutions doing research and all clinics insisting questions of this type are removed

and telling all patients to skip any questions or ‘just say no’ even though it might feel rude. Tho that doesn’t account for if there was any gerrymandering etc of course anywhere.

Yep. I have long advocated that patients should organise strikes against substandard research methodology and clinical practice. Refuse to cooperate with, submit to, or participate in it, and not work with known repeat offenders. And make the technical and ethical reasons for it very public.

We are under no obligation to submit to incompetence and mistreatment, and worse, in our healthcare. Let alone be grateful for it.

Patient strikes could also be a good way to draw attention to it all. Make the public want to know why we are doing something so unusual.

 

[rvallee]

No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful.

Biopsychosocial evidence-based medicine in a nutshell. Lots of people find homeopathy helpful. And acupuncture. And reiki. And chiropractic. And Scientology. And so on. This is not how any of this should be done.

Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing

It's literally null. It's not not convincing, it's convincingly ineffective. This treatment model is very expensive, does not scale, will never be able to meet the full demand. And it DOESN'T WORK.

And of course yet again, I don't even remember a single study published on LC rehabilitation that wasn't: it's a tiny prospective study with no controls. They all are. All of them. Literally all. Dozens and dozens of them, all identical. About a treatment model that has been used from day 1 on this patient population. Based on having used for years on us, which was also a failure.

And they want more. Bigger. Not better, rigor is their kryptonite here. Just bigger. Longer. Years of dithering and "may be" and "could be of help to some" and so on while people lose years of their lives and die. Madness. Biopsychosocial madness.

 

[rvallee]

I agree. This type of research should be banned. It's custom built to produce fake results and does nothing but harm.

But they badly want the fake results. They love them so much. Absurd.