Open The Chronic Illness Survey Adventure (Symptom Cluster Characterization in Complex Chronic Disease)

Signed up, out of curiosity as much as anything, and have just completed the first part of the survey (they're sent out in monthly installments).

There were a few technical hitches:

When you tick 'other (please describe)' there isn't a field where to do the describing in.

I selected the non-gamified version and then received a couple of different-looking emails both stating rather confusingly "Some survey-takers received a link with broken code early on in the survey-taking process. If you received this email more than once, this email is the one that contains the corrected URL."

When you click on the back arrow once you're a few pages in it takes you right back to the very first page, not to the one just before the one you're on.

Also be aware that once you select an answer option (of the circle type) you can no longer change your mind should you wish to skip the question without answering after all. You can select a different option but you can no longer select no option, i.e. deselect all.

Regarding the survey questions:

They use some of the standard questionnaires about health and functioning, with all the associated problems of interpretation we've discussed on the forum elsewhere, like asking about the last 4 weeks compared to usual (what's usual?), or how you rate your health in general without specifying if that means apart from ME (pretty good) or with ME (awful), or function scales that mix up different aspects like how much daily assistance you need (a lot) and what level of medical care you need (not much).

They ask about a wide range of conditions diagnosed by a medical professional. What qualifies as a medical professional isn't specified.

There's no room to add comments about diagnoses received or not received. Apart from screening healthy controls for their actual level of healthy, it's not clear what the answers will be used for. This makes it difficult to answer meaningfully. For example:

I've been diagnosed with MS, and later was undiagnosed again. Is that a yes or a no?
I've been diagnosed with IBS and still am even though I have never ever actually met any diagnostic criteria for IBS. So strictly speaking a yes, but a yes would be misleading.
And the opposite, I very clearly meet diagnostic criteria for POT(S) but have never been diagnosed with it. So technically speaking a no, but a no would be misleading.

It may be that the intention is to look at how reported symptoms match reported diagnoses to get a handle on rates of misdiagnosis, which would make some sense, but that's not clear from this first survey.

Other questions are also too open to interpretation, e.g. they ask about being worse after a lumbar puncture. Which I was - I had nerve pain down my leg for a couple of years because of the needle hitting the wrong spot - but that's probably not the sort of worse they mean.

All in all underwhelming so far. Hope it gets better.

I would have preferred to get all the questions at once to get an overview. That often helps me answer questions more meaningfully. I know they're splitting the survey so as not to overload patients but I don't see what difference that makes since you have a year to answer everything and can save as you go and come back to it.
I see a few backs-and-forth on Twitter with Jaime, they are debugging this live a bit. Not ideal but they are responding quickly so it will improve in the next few days and weeks. QA is expensive, always more than people expect.
 
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Symptoms are only any use as part of a history. If we ask if someone has pain we get nowhere unless we ask six further questions that give us some idea what to make of it - how long it has been there, where is it, what is its character, what is its time course, what makes it better or makes it worse, are there any associated features like swelling?
So far that's what I've seen, same with the Body Politic research, you are pretty much describing what this project is doing (or trying to), as far as I can tell, so I think that's a good start. They don't just ask for lists of symptoms, they add many other details like severity, timeline, pretty much the obvious standard follow-ups.

I 100% agree that just asking a list of symptoms with no details isn't useful at all, but that's not what I'm seeing, each further research is about adding details guided by early and more open-ended questions. Which makes sense, starting out more general and digging deeper based on responses and with the fewest possible assumptions. Basically: following the evidence.

I have also never seen any such research before, whether by scientists of BPSers (well, other than Ramsay anyway). Studies only ever restrict themselves to a few pre-selected symptoms, if not just fatigue, and ask nothing beyond that. So that's why I see this as potentially useful, just a question of how execution goes.
 
I think there is something potentially useful but it will depend on how this data is inteprerpreted and analysed.

In our experience there are only some symptoms that seem to " count" medically.

It's only on forums like this that symptoms are discussed and you realise how many there are and that some are less common than others but still symptoms

Medicine seems to cut off after a handful to the extent that in paediatrics at least you are not listened to if its not on the standard tick box list. And that list is not very long, but a little bit longer than accouple of years ago if you have a consultant who is conversant with the common comorbidities.

If network analysis is used on data it could be interesting. But only if some of the glitches mentioned are addressed
 
And why is this a problem? It's perfectly possible that for example hEDS is often just ME/CFS that was diagnosed differently because the patient happened to see a doctor that believed more in hEDS than ME/CFS.

We should be trying to find out if this could be the case or not.

The diagnoses given to patients are influenced by their own biases in society and the healthcare system.

FWIW I once saw a rheumatologist who wanted to say I had "some degree of" EDS III rather than acknowledging my ME/CFS. (My thumbs bent back at the time). I did not know what that meant. Does it come in degrees? Do I "have" it or not? Is it vague as to whether I have it or not? He preferred EDS and POTS generally and so that was how he went about his practice. I got the sense this is how he dealt with young women coming in with these kinds of symptoms. He was generally very rude and told me patronizingly I should be going out and having a good time (I was in my 20s). He got angry when I wanted to discuss what the treatment plan might be. I did not go back.

I filled out this survey; I did not put down anything about an EDS diagnosis. Diagnoses often seem like something people like to give to justify whatever treatment they happen to use or want to put you on, it's often just down to their practice and what they usually do. Some rheumatologists prefer putting people down as "fibromyalgia" rather than ME/CFS and I have also had someone want to go down this route. (I don't have it; I don't have a pain presentation). Any survey results will also be dependent on patients making judgements about whether certain doctors' questionable diagnoses can simply be disregarded, for fear of creating statistical noise.

I am glad they are trying to do some sort of survey although I'm not sure of its usefulness - just hope they qualify whatever the results are appropriately.
 
Diagnoses often seem like something people like to give to justify whatever treatment they happen to use or want to put you on, it's often just down to their practice and what they usually do
That is tricky to me. There are clear cut diagnosis out there. Cancer would be one. You either have cancer, or you don’t. Appendicitis. Hepatitis. Bone fractures. Essentially everything that is diagnosed using a biomarker or is visible through imaging or under a microscope.

i agree with the example you give, fibromyalgia, and that it is frequent that patients do not receive the correct diagnosis when it comes to ME, FM and other, there is a clear knowledge gap in medicine.
 
That is tricky to me. There are clear cut diagnosis out there. Cancer would be one. You either have cancer, or you don’t. Appendicitis. Hepatitis. Bone fractures. Essentially everything that is diagnosed using a biomarker or is visible through imaging or under a microscope.

i agree with the example you give, fibromyalgia, and that it is frequent that patients do not receive the correct diagnosis when it comes to ME, FM and other, there is a clear knowledge gap in medicine.

Yes, I should have been more clear. I did not mean diagnoses as a whole. I meant that re: chronic illness patients, what diagnoses they get often end up going this way - just an artefact of the kind of practice the doctor runs that they go to. It is not good practice, but in my experience that seems to be what happens. Maybe it's just because so few doctors seem comfortable working with ME/CFS.
 
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