Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life:... 2024 Pick, Chalder, Hotopf et al

Full title: Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study

Highlights

• Subjective functional neurological symptoms (FNS) were monitored for 7-days.
• Ecological momentary assessment tracked FNS and other subjective experiences.
• Wearables assessed objective physiological signals, including autonomic markers.
• Our novel remote monitoring protocol was feasible, acceptable and valid.
• Daily events and negative affect were robust temporal predictors of FNS severity.

Abstract

Functional neurological symptom disorder (FNSD) is a neuropsychiatric diagnosis referring to symptoms resembling those of neurological disorders, occurring without causal neuropathology. FNSD has a complex biopsychosocial aetiology but its mechanisms are poorly understood. Remote monitoring technologies (RMT) could provide critical insights into functional neurological symptoms (FNS) in real-world contexts.

We examined the feasibility and acceptability of a novel RMT protocol, to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Physiological variables were measured using wearable Fitbit 5 devices. Multilevel modelling examined variables associated with FNS variability. Average EMA completion rates were good in both groups (≥80%).

At week-level, the FNS group reported significantly greater subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect were the most prominent time-lagged predictors of within-day moment-to-moment FNS severity.

RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Interventions targeting affective reactivity and regulation might be beneficial in this group. Larger-scale, longer-term RMT studies are needed in this population.

Open access, https://www.sciencedirect.com/science/article/pii/S0165178124005328

 

Damn. That's nearly as many authors as participants (ignoring controls) for a pretend feasibility study. As if it's not feasible to do something easy. But of course you quickly notice that this isn't a feasibility study. They do a lot of analysis of 'events' and stuff.

It's clear that this has become a new normal: frame all your studies as 'pilot' or 'feasibility' and so on (or even 'case series' I guess), to excuse the complete lack of rigor, but do a lot of the normal stuff of a full study. This way they can make claims while excusing any gap or flaw under "it's just a pilot/feasibility study", but it's still valid and is stuff they've been commonly doing for years anyway.

Very useful study. They concluded that sick people reporting disabling symptoms have disabling symptoms, which happen in something we can call time, or at least at time points we can call 'events', if one wants to make it sound more profound than it is. Which is not at all, what with the linear passage of time being a universal factor in all things and so on.

Well, they didn't conclude this so much as observe this. Somewhat. Definitely something where real-time monitoring, which is a really unusual way to describe wearables, is a thing. At least that much can be said: it is a thing.

With 17 participants over 7 days, 82% is actually very low. It's just 7 days. Most people who diet stick to it for at least 7 days, and diets are notorious for being abandoned quickly. They can't even get 17 people to apply their stuff for 7 days. But they call it good so it doesn't matter. Makes sense when you don't think about it.

Of course this is entirely useless pseudoscience but, hey, it's good for their career. Somehow. Now that's the puzzling part, a true multifactorial complex biopsychosocial problem no one will ever elucidate.