The thing with hours worked is that on sickleave in Norway you can be on 50% sickleave but have 100% attendance, you just do less in the workplace. I’m not quite sure in what type of job this works but that’s the idea at least.
The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial 2023 Abrahamsen
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It was even given an award:
Vestfold-fastlege belønnet med pris for samtaleverktøy-forskning
Fastlege og forsker Cathrine Abrahamsen får Allmennmedisinsk forskningsfond (AMFF) sitt reisestipend 2024 for prosjektet der hun har testet det egenutviklede samtaleverktøyet ICIT i en randomisert studie. Høy kvalitet og originalitet på forskningen, mener pris-juryen.
www.legeforeningen.no
It’s very much in use. Abrahamsen is in the news what feels like every month and I think the latest number from earlier this year was that >40 % of GPs have been through her course, and some of the counties appear to be offering it to all their GPs.
Yes, the sick leave refers to productivity, not hours spent in the workplace.
+1
Randomisation is necessary, but not even close to being enough on its own.
I haven't read the method and instructions of said 'course' but isn't this point exactly where the con is:
GPs are in charge of whether or not someone gets sick leave. If they so no I'm not giving you another sicknote then there is no sickleave? And yet this is 'the measure' they are trying to parade as success. That isn't the same as attendance at work or ability to do it once there.
Is this really an unbelieveably major con where the measure could actually even be 'a snapshot measure' of sick leave status at points bsaeline, 1, 2 comparing a group with no inside information (usual care) with those put on a plan that tells the GP to send people back to work at certain points. Is it really like a manual saying 'remove sicknotes at 10weeks' then uses a measure of 'were they on sickleave last week' taken at week 11, as the measure for controls vs subjects?
And those in control of those assessments, and coercive levers are 'believers in ideology' vs GPs who aren't? ANd what the participants fill in questionnaires that pass thru those GPs hands (GPs who control everything for that patient - NAV and employer info)
More to the point it could just be about one group following a set timing for 'sending back to work' that coordinates with when they want the measures done to tick the box for the study and could have had their patients on sick leave until week 10 vs the controls could have been forced to try and carry on for those 10 weeks so by week 11 collapse out. And by week 12 both are disabled. So 1. what a farce, but 2. what's it got to do with health rather than manipulation of workplace policy over a short period of time - with no measure checking whether anyone longer term ends up more or less disabled.
Indeed part 3 of 'the plan' is explicitly
There is an ambiguous para talking about GPs being free to schedule appointments (sorry it says participants, but in what land do patients actually have control of this - if people get one a week with the same GP then it is because the GP decided to 'put them in their schedule') and not a prescribed number of sessions, but there are 3 parts to the plan and homework for the patient after each and apparently a required 2 sessions to adress homework after the plan has been signed off. After the initial sessions apparently validating them, then telling them about allostatic load theory then running thru these 3 parts as 'the plan'.
I don't know when 'the final session of the study' is but given there is then 11week follow-up, is that after the end has been done with, or after baseline and therefore theoretically people might still have not completed the homework yet unless the GP is actually making sure they do it in 6 weeks etc?
So apparently if the 'measure' is some BS interpretation of 'baseline' taken out of context, because is there specification of what counts or doesn't count ie is it just the 11 weeks before? or the year - how do they justify such assessments as equivalent? Because we all know that taking a day off after you've already had 4 weeks this year is more serious than being the type who gets to take a day off with a slight cold 'because I must be wonderful as I never take one (because they are never unfortunate enough to be ill)'.
And the term they use is 'sick leave status' at the baseline, last session, 11 weeks could then just mean 'have you been sent back to work by your GP this week' not whether you are actually well enough, or any measure of leave for the last 3 months etc.
We know from people with or without ME/CFS of varying severity that we are generally a lot that are indeed vulnerable ie 'made vulnerable' by each and every individual in the system (time they take responsibility for their actions not someone on the receiving end of them be made responsible for their actions) and also keen to get their lives back/not 'demotivated'.
But also that if someone is coercing us, whether they kid themselves or not that is what they are playing a role in doing, by threats of financial ruin and inciting supporters around us or worse then we will prioritise absolutely everything just like (because we are) someone who has had to choose short-term survival over long-term survival because there is no long term either way anymore (you don't have it if you don't get thru the short-term by fawning to the threat, you won't ever get long-term because their actions will ruin you but you can't get thru the short term by worrying about that).
OK so
and there is another strange concern in the footnote of table 2
I'm sorry but that means that before anything happened 17 more people assigned to the intervention received partial long-term benefits
Which could mean all sorts, but basically means if their GP is being instructed to send suggestions to NAV based on a bas***ised 'CBT' these people are extremely vulnerable and have a lot to lose so there is no way that this could be called a therapy vs just the coercion 'working', given to repeat the quote in the comment above, the final part of the 'plan' given to people is:
ie the plan isn't healthcare , it is telling a group of GPs who will be 'measured' by a snapshot of whether their patient is on sickleave at certain points to take them off sick leave and report this 'initiative' to NAV (which I guess affects all financial support?) at almost the exact point people will be measured.
I'd personally also like to have the stats and info on ill-health retirement that could be unrelated to NAV/not impacted by that as it was split across control vs non-control , the age stats shows 46.9yrs (12.9) for control vs 45.3 (13.2) for non-control which isn't 'the same' either and could easily mean they slipped in a few more people who were near retirement anyway into the control.
The chart of 'flow of participants through the study' is revealing too: https://www.thelancet.com/cms/10.10...fce-87eb-ac0d078a7f86/main.assets/gr1_lrg.jpg
for controls 231 participants completed baseline measures and 7 didn't = 238
for participants 278 did and 25 didn't = 303
And so the usual drop-out trend continues
for controls, (from 231) 223 completed measures (96%), 8 didn't, 1 withdrew
for participants (from 278) 236 completed measures (85%), 42 didn't, 1 withdrew
But actually if it was from the enrolled then it is for controls: 223/238 (94%) vs participants 236/303 (78%)
This was the primary measures:
Except the treatment plan by this point has involved that last step regarding work, but before that the following 2 steps:
I'm just guessing but given the GP is actually in control of what they (given CBT is combative) will agree is 'controllable' and therefore on the list of things 'to choose to focus on' could mean picking eg hayfever knowing that antihistamines will work vs you know fixing the OI/exhaustion preventing showering most days. But maybe it really is CBT heavy and suggesting someone 'sorts out that disorganised kitchen that's being begging to be tidied up'.
Isn't this basically 'teaching to the test'?
Particularly after you've done the literal magician's trick of diversoin of attention by directing people explicitly to focus on the one symptom/'challenge' that has apparently been addressed - when filling in this one question PGIC (of course don't forget what a disaster this time of year used to be like with your hayfever/how much time you spent trying to find things in that kitchen?)
vs not having the manipulative prompt if you are in the control group.
Plus of course telling people who have a condition where they get PEM to build in rest periods, and taking a measure after they've tried that is kind of asking for the answer to be at worst 'I need a bit more, but it is better than it was with no rest'.
So timing of taking this measure just after people have had a number of weeks of this, and before they've had to actually feel the impact of adding in workplace demands...
well it seems like tosh doesn't it?
If you put a 'oh life is so busy' person on this vs a person with a degenerative disease they'd both experience the same given the manipulative timings are intended to produce that.
SO the control is BS pretence isn't it? All it measures is how if you don't coerce to control what people can do at certain times then you don't get the snapshot answers to your liking.
It's a bit like measuring what a difference access to air conditioning makes to someone's life and putting one group on a 'programme' that means that measure is taken well before and mid/after the summer time then calling the 'control' a group when the measures are taken just x weeks apart but any time of the year?
Except the treatment plan by this point has involved that last step regarding work, but before that the following 2 steps:
I'm just guessing but given the GP is actually in control of what they (given CBT is combative) will agree is 'controllable' and therefore on the list of things 'to choose to focus on' could mean picking eg hayfever knowing that antihistamines will work vs you know fixing the OI/exhaustion preventing showering most days. But maybe it really is CBT heavy and suggesting someone 'sorts out that disorganised kitchen that's being begging to be tidied up'.
Isn't this basically 'teaching to the test'?
Particularly after you've done the literal magician's trick of diversoin of attention by directing people explicitly to focus on the one symptom/'challenge' that has apparently been addressed - when filling in this one question PGIC (of course don't forget what a disaster this time of year used to be like with your hayfever/how much time you spent trying to find things in that kitchen?)
vs not having the manipulative prompt if you are in the control group.
Plus of course telling people who have a condition where they get PEM to build in rest periods, and taking a measure after they've tried that is kind of asking for the answer to be at worst 'I need a bit more, but it is better than it was with no rest'.
So timing of taking this measure just after people have had a number of weeks of this, and before they've had to actually feel the impact of adding in workplace demands...
well it seems like tosh doesn't it?
If you put a 'oh life is so busy' person on this vs a person with a degenerative disease they'd both experience the same given the manipulative timings are intended to produce that.
SO the control is BS pretence isn't it? All it measures is how if you don't coerce to control what people can do at certain times then you don't get the snapshot answers to your liking.
It's a bit like measuring what a difference access to air conditioning makes to someone's life and putting one group on a 'programme' that means that measure is taken well before and mid/after the summer time then calling the 'control' a group when the measures are taken just x weeks apart but any time of the year?
SO on the secondary outcomes
Sick leave is a measure that is entirely controlled and coerced by what the GPs are ordered to 'do to' and the most vulnerable patients (on disability) being loaded into the intervention group in larger numbers.
Worse, the write-up and appendix document uses the following as justification of their use of this measure in the way the have:
I do not think the work efficacy survey can be seen as an uncoerced measure because they have not clarified that the GP who is writing a report to NAV isn't being given sight of the questionnaire, and the person who is being forced into the workplace by their sick leave being withdrawn is also finding that the same person has written to NAV and their employer regarding capability and adjustments. Both of which they must absolutely have to complete their questionnaire answers in correspondence with 'because they agreed'. Apparently. That has been dictated to them. BY someone with all the power for everything
Patient experience with intervention questionnaire
Except again is this not polluted by the questionnaire not being guaranteed not to get back to the GP who will be writing to their employer and NAV?
Oh and ahem... the drop-out rate for the intervention group was actually 303-232 by the end (74%) compared to just 8/9 dropping out (96% completion) in the control. Isn't it downright weird that 71 people dropped out of this 'fantastic experience' and reporting back vs 8/9 who just had a normal one to report on ? And therefore isn't it totally false to count the claims above without noting all those who didn't feel comfortable to fill it in?
So really.. there is only one measure in the lot where it is even worth taking any look - the RAND quality of life measure , and I haven't looked at the issues there yet. But I'm not too happy about it only being reported in some coefficient, and then 'adjusted' measure of that in the table: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00439-X/fulltext#tbl3
Sick leave is a measure that is entirely controlled and coerced by what the GPs are ordered to 'do to' and the most vulnerable patients (on disability) being loaded into the intervention group in larger numbers.
Worse, the write-up and appendix document uses the following as justification of their use of this measure in the way the have:
Unless I have read this incorrectly (?) this means they've used one study as justification that might well be rubbish anyway, but at least did follow-up at 12months, as justification of using the same calculations on data taken at 11weeks?
I do not think the work efficacy survey can be seen as an uncoerced measure because they have not clarified that the GP who is writing a report to NAV isn't being given sight of the questionnaire, and the person who is being forced into the workplace by their sick leave being withdrawn is also finding that the same person has written to NAV and their employer regarding capability and adjustments. Both of which they must absolutely have to complete their questionnaire answers in correspondence with 'because they agreed'. Apparently. That has been dictated to them. BY someone with all the power for everything
Patient experience with intervention questionnaire
Except again is this not polluted by the questionnaire not being guaranteed not to get back to the GP who will be writing to their employer and NAV?
Oh and ahem... the drop-out rate for the intervention group was actually 303-232 by the end (74%) compared to just 8/9 dropping out (96% completion) in the control. Isn't it downright weird that 71 people dropped out of this 'fantastic experience' and reporting back vs 8/9 who just had a normal one to report on ? And therefore isn't it totally false to count the claims above without noting all those who didn't feel comfortable to fill it in?
So really.. there is only one measure in the lot where it is even worth taking any look - the RAND quality of life measure , and I haven't looked at the issues there yet. But I'm not too happy about it only being reported in some coefficient, and then 'adjusted' measure of that in the table: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00439-X/fulltext#tbl3
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