Quality of evidence for therapist-delivered (non-drug) interventions for subjective symptoms in medically undisputed illnesses (draft thread)

[MSEsperanza]

There is a thread that tries to collect adequately controlled clinical trials and reviews on therapist-delivered/ non-drug interventions for illnesses and symptoms that don't have biomarkers yet here.

Thought it could be also helpful to have a meta-thread collecting both well done and badly done clinical trials in this area.

Also thought it could be useful to start with a collection of non-drug trials investigating subjective symptoms in medically undisputed illnesses like MS, Rheumatoid Arthritis etc.

So this thread is for collecting clinical trials and reviews on therapist-delivered interventions for subjective symptoms in medically undisputed illnesses.

I'd suggest that discussions on existing threads should be kept there. Papers and reviews that don't warrant an own thread can be discussed here.

 

[MSEsperanza]

Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis (2021) Harrison et al

https://www.s4me.info/threads/which...work-meta-analysis-2021-harrison-et-al.20394/

(Will add complete citation later)

The authors assessed risk of bias (RoB) with Cochrane's RoB methodology but:

In assessing RoB, performance bias was not considered for the overall quality judgement as lack of blinding of participants and healthcare professional is an inherent limitation in studies of behavioural and exercise interventions
The abstract is also misleading: the results that it mentions are post-treatment, not at follow-up.

Pooled effect sizes post-treatment (top) vs. at 3 to 6-month follow-up (bottom) relative to treatment as usual:

Note: "Estimates of the effect at longer-term follow-up versus TAU where only one study was available are not presented (balance exercise, combined exercise and emotional expression therapy)."

At follow-up, energy conservation had a SMD of -0.31. This is essentially the same as all other interventions that include psychotherapy or physical activity, the most effective (supposedly) of which range from SMD -0.39 to -0.33. This suggests that most of the improvement came from response bias.

As for the quality of the 103 trials that were included, only 33 had a 3-6 month follow-up and 9 had a 7-12 month follow-up.

I suppose this tells us that the answer to the authors' question (the title) is none, but the positive spin in their phrasing ("show the most promise") indicates that the review was not meant to find a negative result. Though it is expected that Moss-Morris displays allegiance bias towards psychotherapy and exercise. A honest conclusion would have been that the quality of the evidence for these interventions is poor, as for ME, and that the evidence does not suggest they are beneficial.

ETA: balance exercise seems more specific to MS than the other general interventions, but I don't see how it could reduce fatigue.

 

[MSEsperanza]

Clinical trials and reviews used by the Institute for Quality and Efficiency in Healthcare (IQWiG) in Germany for their Health Information on fatigue in RA:

(Includes qualitative studies.)

Sources for the section "Living and dealing with fatigue" (in RA)

Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EH, Chalder T et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 2013; (8): CD008322.

Dures E, Kitchen K, Almeida C, Ambler N, Cliss A, Hammond A et al. "They didn't tell us, they made us work it out ourselves": patient perspectives of a cognitive-behavioral program for rheumatoid arthritis fatigue. Arthritis Care Res (Hoboken) 2012; 64(4): 494-501.

Hewlett S, Cockshott Z, Byron M, Kitchen K, Tipler S, Pope D et al. Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum 2005; 53(5): 697-702.

Nikolaus S, Bode C, Taal E, van de Laar MA. New insights into the experience of fatigue among patients with rheumatoid arthritis: a qualitative study. Ann Rheum Dis 2010; 69(5): 895-897.

Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud 2008; 45(7): 995-1002.


Google translate link to the Health Information "Living and dealing with fatigue" (in RA)

https://translate.google.com/translate?sl=auto&tl=en&u=https://www.gesundheitsinformation.de/leben-und-umgang-mit-erschoepfung-fatigue.html#Welche-Behandlungen-k%C3%B6nnen-bei-Fatigue-helfen


Edit: Removed sources on the benefit of exercise for the underlying illness, not fatigue. Will check further content and links later.

 

[MSEsperanza]

Thread on the Cochrane Review on non-pharmacological interventions in RA (2013), co-authored by Chalder and used as evidence for the IQWiG health information mentioned above:

https://www.s4me.info/threads/non-p...atoid-arthritis-cochrane-database-2013.21774/