Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID... 2024 Salzmann et al

Full title: Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID neurological inpatient rehabilitation

Highlights

• Post-COVID-19 condition is asscociated with long-term health issues.
  
  
• A biopsychosocial approach seems necessary to enhance treatment of post-COVID.
  
  
• We examined the impact of expectations on post-COVID neurological rehab outcomes.
  
  
• Side-effect expectations predicted illness-related disability and patients‘fitness.
  
  
• Managing patient expectations is crucial for optimal rehab outcomes.

Abstract

Introduction
The COVID-19 pandemic, caused by SARS-CoV-2, has led to long-term health issues known as post-COVID-19 condition, including fatigue and cognitive disruptions. Despite its recognition as a public health concern, the efficacy of therapeutic interventions, especially in neurological rehabilitation, remains unclear. This study examines how treatment expectations are associated with psychological and physical outcomes in post-COVID-19 condition neurological rehabilitation.

Methods
In an observational cohort study 61 patients with confirmed post-COVID-19 condition were included. Baseline (T0) data on treatment and side effect expectations were collected, before participants underwent a 4–6 week multidisciplinary rehabilitation program. Primary outcome was illness-related disability (Pain Disability Index). Secondary outcomes included depressive symptoms (PHQ-9), anxiety levels (GAD-7), functional status (PCFS), fatigue (CFS), and physical fitness (6MWT). Regression models analyzed the associations of baseline expectations with outcomes at the end of rehabilitation (T1) and three months post-rehabilitation (T2).

Results
After adjusting for multiple testing, higher baseline side-effect expectations were associated with greater illness-related disability (β = 0.42, p = 0.007), reduced physical fitness (β = − 0.24, p = 0.04), and more somatic symptoms (β = 0.33, p = 0.006) at follow-up (T2). Positive treatment expectations were associated with poorer functional status (β = 0.35, p = 0.011) at T2.

Conclusion
This study highlights the associations of side-effect expectations with post-COVID-19 condition rehabilitation outcomes. Higher side-effect expectations were associated to poorer outcomes, indicating a nocebo effect. Surprisingly, positive expectations were linked to worse outcomes, possibly due to unrealistic optimism. Managing patient expectations realistically and addressing side-effect concerns seems crucial for optimizing rehabilitation outcomes.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399924003143

 

I don't see them suggest that maybe the reason the patients with higher side effect expectations did worse was because they know their bodies. All the interventions require some degree of physical and/or mental exertion. If they have experienced PEM in the past, surely they'll be more likely to both expect the interventions to cause them some degree of harm, as well as be correct.

They did say this about more "realistic" expectations, though I'm not quite sure what they are suggesting:

Not really sure what to make of the other association:

 

Good grief this is dumb. Zero attempt at making sense of the world out there. They're completely dominated by their own thoughts.

 

The authors of this paper simply don't understand the nature of long Covid or chronic illness in general. People expect certain outcomes from therapy because they know their bodies.

 

Uggggh

I wonder how well they checked for whether there was maybe a bigger confounding factor that was causal to both expectations and outcome

I find this new propaganda so scary as it’s stopping the disabled from expressing their limits . It really is hysterical women / wimpy disabled people not pushing hard enough so keeping themselves disabled crap this expectation effect nonsense trope

And as @forestglip points out there was a negative correlation where the most enthusiastic ended up with the worst function

and they tried to twist that!

here’s why it makes no sense

you should only use functional measures to see if it works

expectation isn’t why this fails!

not suggest the opposite conclusion - I’m gobsmacked at the cheek

Clearly their sales pitch was not accurate ie fibbed about what it could do outcome wise

maybe the message is that they need to stop claiming that and any funding they get based on it until they improve what they do to be something that does work functionally and long term by doing proper research ??

 

If it wasn't for a small sample size then this is one of those papers to add to one of those threads for 'debunking the orthodoxy'

because it proves that whatever expectation they had that wasn't what made the difference

ie they proved their 'null'?

Worse, as well as expectations having nothing to do with it, the message is that their treatment doesn't help, so they should be using that as useful information to either report that and let someone else take over who is a different dept with soemthing to offer and pass on those results so they don't try the same things - not suggesting they need to try some third way on the spiel and mind-bending they wrap the treatment up in

then suggested in their own recommendations that what they needed to work on was expectations. Which to me

 

This is inane. Again with the Goldilocks mentality. Only we the very clever therapists can get this fixed with RightThink (apologies Orwell).

 

It's not the patients that need rehabilitation.

 

The journal being the Journal of Psychosomatic Research. The advisory board of the journal includes such 'champions' of good science as Per Fink, Judith Rosmalen, Michael Sharpe, and Jon Stone....

 

This is so disturbing. There's such an obvious answer to the accusatory title and for that to be ignored.

 

"Positive treatment expectations were associated with poorer functional status (β = 0.35, p = 0.011) at T2."

Doesn't this completely undermine their arguments?

 

"Managing patient expectations is crucial for optimal rehab outcomes."

What about the expectations of the clinicians and researchers? Where for goodness sake is the reflection on what the heck they have actually set out to do, and what data they received.

If twiddling about with pt outcomes by managing these is all you've got in the clinic then, please stop, go home and pass the patients on to someone with a grasp of reality, science and some hope of making objective improvements in patients' functioning.

Stop blaming the patients for poor outcomes that they don't like. Sick. Disturbing

 

Chilling. But this obliviousness is the reaction I got telling a doctor how much sicker GET made me. He shrugged it off and recommend...more GET.

These people honestly live in their own fantasy world and the scientific community is enabling them. A whole discipline full of naked emperors strutting about talking nonsense to each other.

 

So. Rehabilitation didn't work. Therefore they need more rehabilitation. And it still didn't work. Therefore they need even more rehabilitation.

You could get smarter reasoning out of brain damage. Not out of people who suffered brain damage but the actual damaged brain itself.

Any random group of willing teenagers would do better than this. Literally any random group. They don't even need lots of resources. They just need to care and not be mindlessly biased. There is clearly something wrong with medical training that you so consistently get worse outcomes out of experts than from a random process.

Hell, there is no way that any current ranked LLM wouldn't do better than this in every single way. Statistically, LLMs have outperformed this at least for a year. So before this study even started, it was already far dumber than even several open source LLMs out there.

Fantasy universe indeed. With zero overlap with actual reality.