Targeting persistent fatigue ... in adolescents and young adults with a fatigue syndrome or rheumatic condition... 2023 Vroegindeweij et al

Full title: Targeting persistent fatigue with tailored versus generic self-management strategies in adolescents and young adults with a fatigue syndrome or rheumatic condition: A randomized crossover trial

Objectives

To evaluate the use of two self-management intervention strategies for persistent fatigue in adolescents and young adults with a fatigue syndrome or rheumatic condition.

Design
A randomized crossover trial administering tailored lifestyle advice and generic dietary advice, each 12 weeks, with a four-week washout period between.

Methods
Sixty participants (aged 12–29) were included. Tailoring was achieved through the PROfeel method. Dietary guidelines were conceptualized by the Netherlands Nutrition Centre. Questionnaires were used pre–post-interventions to measure primary outcome ‘fatigue severity’ (Checklist Individual Strength-8) and secondary outcomes ‘self-efficacy’ (Self-Efficacy Scale-28) and ‘quality of life’ (QoL) (Paediatric Quality of Life Inventory 4.0). Feasibility and adherence were self-rated on a scale of 1 to 10 (low to high). Linear mixed modelling was used to assess change over time, compare strategy effectiveness and study the impact of intervention order.

Results
Fatigue severity, self-efficacy and QoL regarding ‘physical’ and ‘emotional’ functioning improved significantly over time (all p < .015). The average improvement of the two QoL subscales was clinically relevant, as was the fatigue improvement in 20 out of 46 participants who completed the trial and 5 dropouts. The interventions were equally effective, and intervention order did not impact the improvement level (prange = .242–.984). The self-management strategies received similar feasibility (M = 6.45, SD = 1.91) and adherence (M = 7.67, SD = 1.67) ratings.

Conclusions
As small to clinically relevant improvements were observed, self-management strategies might be particularly useful to bridge waiting time for guided treatments such as Cognitive Behavioural Therapy.

Open access, https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12711

 

blurgh...

 

Quotes from the article:

"In this randomized crossover trial, we used the biopsychosocial model to design tailored lifestyle advice named PROfeel. Realizing that treatments by specialized healthcare providers such as CBT have long wait lists, we decided to implement the advice as a self-management strategy that could potentially be used during waiting time."

[...]

No significant differences between the effectiveness of the tailored PROfeel lifestyle advice and generic dietary advice were found. Intervention order was irrelevant to the observed level of improvement." ​

 

Don't say: "The intervention failed to improve outcomes compared to the control group."

Say: "The interventions were equally effective!"

 

It seems that patients ate worse (more unhealthy) but that did stop the authors from claiming the diet intervention was equally a success.

"the overall diet quality level did not improve on average (ΔM=−10.30, SD=20.84) because participants tended to consume less whole-wheats products (ΔM=−1.49, SD=3.41) and nuts (ΔM=−1.90, SD=4.00), and more processed meats (ΔM=−1.36, SD=3.86) and unhealthy choices (e.g., high-sugar snacks) (ΔM=−1.04, SD=3.91). Overall diet quality levels decreased in 30 participants (ΔM=−19.36, SD=18.48), were stable in 2 participants and improved in 14 participants (ΔM=9.79, SD=7.50)." ​

 

Poorly-run trial of two identical biased open label interventions finds no difference in outcomes: "yeah this is good I guess they're both great!". The entire methodology is built around comparing outcomes, itself fraught with issues, and they don't even bother with that. And all such "tailored" interventions are generic regardless, there isn't even a distinction, let alone a difference.

Only in evidence-based medicine. And, really, only there would you find anything this absurd. Anyone promoting this would scoff at the exact same process being done for, say, homeopathy, and yet cannot find anything wrong with doing the same based on their own biases. Truly absurd.

Meanwhile in serious professions, especially in technology, anything that is less than 99% reliable is generally considered problematic, often doesn't even get considered because standards are much higher. This is a joke discipline.

 

Not surprising that the FITNET authors are still hyping CBT as effective eventhough it's a sinking ship. Quite painful to read. They're also ignoring this report where children with ME (ICC) rated their experience with CBT/GET. Maybe interesting for @dave30th to write about as well?

Survey children Support for Appropriate Care Offer (OPaZ) program of the Ministry of Health, Welfare and Sport.

CBT N=24 :

- 54% of the youngsters were not satisfied with this treatment because it actually deteriorated them.
- 1 patiënt considered it the most traumatic experience ever.
- 38% had een neutral opinion about CBT.
- Only 8% were satisfied

GET N=11:

- 89% dissatisfied, caused deterioration.

https://www.regelhulp.nl/complexe-z.../opaz/rapporten/1/eindrapport-onbegrepen-ziek

Google translated doc:

 

I wrote a post about it on LinkedIn and tagged the author. I hope she gets to read it...

https://www.linkedin.com/posts/anil...cE?utm_source=share&utm_medium=member_android