Supervised, individualised exercise reduces fatigue and improves strength and quality of life more than unsupervised home exercise.., 2022, Shah et al

Andy

Andy

Retired committee member
Full title: Supervised, individualised exercise reduces fatigue and improves strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome: a randomised trial

Abstract

Question
In people in the chronic phase of Guillain-Barré syndrome (GBS), how much more does a supervised, individualised exercise program improve functional independence with activities of daily living than a home-based exercise program? How do the two exercise programs compare regarding their effects on muscle strength, fatigue, pain and quality of life?

Design
Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of outcome assessors.

Participants
Sixteen adults with stable residual disability ≥ 6 months after the onset of GBS.

Intervention
Participants in the experimental group were allocated to 60-minute sessions of physiotherapist-supervised strengthening, endurance and breathing exercises, gait training and pain management, two to three sessions/week for 12 weeks. The control group was prescribed a home program of 30-minute sessions of maintenance exercises and education in self-management, two to three sessions/week for 12 weeks.

Outcome measures
Functional independence in activities of daily living on the 100-point Barthel Index (primary outcome), muscle strength on the 60-point Medical Research Council scale, fatigue on the 0-to-63 Fatigue Severity Scale, a visual analogue scale of pain severity, and quality of life, measured at baseline and months 6 and 12.

Results
At month 6, the median between-group difference was 5 (95% CI 0 to 20) for functional independence, 8 (95% CI 4 to 18) for strength, –13 (95% CI –28 to –1) for fatigue, and 12 (95% CI 3 to 13) for the environment domain of quality of life. Estimated effects at month 12 had a similar magnitude, but most of the CIs had greater uncertainty.

Conclusion
Supervised, individualised exercise reduced fatigue and improved strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome.

Open access, https://www.sciencedirect.com/science/article/pii/S1836955322000157
 
Effect appears trivial and confidence intervals make the claim very suspect, especially by getting worse at the 2nd end point. There are thousands of unaccountable factors with this much fuzziness. Academia seriously needs to crack down on what is an unmistakable pattern of wildly inflating the importance of any individual study, it's getting as bad as clickbait.

It's like learning the exact wrong lesson about a lie going around the world many times before the truth puts on its boots and using it as an express method of communication.
 
Unblinded. ✔
Subjective outcome measures only. ✔
Weak to zero statistical effect size. ✔
Unjustified conclusion given the quality of the evidence. ✔

Conclusion
Supervised, individualised exercise reduced fatigue and improved strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome.
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I see this error a lot in health-psychology. The assumption is that reported symptoms and experienced symptoms are the same thing, when they are not.

There is also a large difference in mean age between the home-based and hospital based groups, likely a result of the very low sample size and potential confounder.

Lastly, note:

Although the hospital registry contained some patients who had had GBS for > 6 years, recruitment was focused on those who were within 6 years of onset
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So what are they trying to say here? That exercise is good for fatigue is taking for granted but they are desperate to say that supervised exercise is better which can only be to keep professionals employed.

Even if supervised exercise is marginally better, if it continues to work, and there is no reason to assume progress suddenly stops with continued exercise of it does help fatigue, then the group exercising without supervision will get to the same level even if it takes longer but at a much reduced cost.

I am considering it from the point of view from someone who believes in exercise studies.
 
The supervised group did 60 minutes of physiotherapist-supervised activity, yet the home group only did 30 minutes of activity?? Couldn't one conclude that the supervised group had better results because they did twice as much physical activity that resulted
in a better outcome??
 
TigerLilea said:
The supervised group did 60 minutes of physiotherapist-supervised activity, yet the home group only did 30 minutes of activity?? Couldn't one conclude that the supervised group had better results because they did twice as much physical activity that resulted
in a better outcome??
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Don't get all technical and analytical --- it's not like this is science!
 
I'm not sure trying to decipher anything from this works any better than reading entrails. It's pretty clear that this trial formula yields completely unreliable results where the interpretation does at least 99% of the work. It's just fuzzy maths corralling guesstimates into the expected shape and only reporting when you can squint some vague resemblance of a product.

In science it's critical to remove all confounding factors and make sure you are actually testing one element with all other things being equal. Not bothering with that makes all efforts pointless. Not surprisingly, doing this on a mass scale only leads to mass pointlessness.

Might as well trust Volkswagen about their emissions testing claims. I mean if you can't trust the good folks who build cars to self-certify that they are indeed "great", who can you trust? Of course their fuel economy is matched by solid pollution-reduction technology. What, you don't trust the good folks selling you a car with their claims about that car?

Speaking of which, the judgment made against VW is a good template for how to deal with the whole eminence-based medicine debacle: make the fines actionable towards fixing the problem. Take money away from people who caused a problem and put it to productive use. Now that's accountability.
 
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