Diary-based outcome predictors in a selfmanagement trial in chronic fatigue syndrome

[Dolphin]

Jenna L. Adamowicz & Indre Caikauskaite (2016) Diary-based outcome predictors in a self-management trial in chronic fatigue syndrome, Fatigue: Biomedicine, Health & Behavior, 4:4, 193-194, DOI: 10.1080/21641846.2016.1217666

Main findings:

SM=self-management

Based on home-diary data from the formal intervention period, fatigue improvement at 12-month follow-up was significantly associated with pacing at work (r = .50; p = .03) and asking for social support (r = .48; p = .02). In addition, clinically significant fatigue change at 12-month follow-up was predicted by these diary variables (assessed at intervention termination): positive changes in enjoyment (r = .50; p = .02), less activity difficulty (r = .53; p = .02), and a reduction in how ‘pressured’ the subject felt to do things (r = −.40; p = .08). Diaryrecorded SM activities rated (0–10 scale) as most helpful during the 90-day SM period were: non-walking exercise (M = 5.73 (2.76)), walking (M = 4.50 (3.04)), and relaxation (M = 3.54 (2.19)). Lower ratings (M = 2.0–2.9) were reported for these activities: support from others, coping ideas, pleasant activities, sleep techniques, and pacing.

 

[RogerBlack]

Interesting. We need more of this type of thing.
I need to dig into it tomorrow to see if they mention PEM duration and factors and percentage 'recovery' and thresholds.

 

[trishrhymes]

Has anyone got a link so we can read the whole paper. I confess I don't really understand the research from this summary. When I see a statement like

'clinically significant fatigue change at 12-month follow-up was predicted by these diary variables (assessed at intervention termination): positive changes in enjoyment (r = .50; p = .02), less activity difficulty (r = .53; p = .02)'

it sounds to me like a statement of the bleedin' obvious - if you're less fatigued, you're more likely to enjoy things, and if you're finding activity less difficult isn't that just another way of expressing the fact that you're less fatigued...

I wonder what fatigue measure they used. If it was Chalder Fatigue Scale, the whole thing is a non starter, since it doesn't measure degree of fatigue.

And were any objective measures used - actometers, heart rate monitors, step tests, walking tests, ...

And what diagnostic criteria did they use for recruitment to the trial? Did they record episodes of PEM, etc etc. And what was the sample size? The p values quoted are not strongly significant, so if it's a small sample with no objective measures and poor quality questionnaire measures, it's a non starter as far as I'm concerned.

 

[AndyPR]

PDF download http://twin.sci-hub.cc/7441a33dc26c7b738d9a8dbe8d25bacb/adamowicz2016.pdf

Not the whole study, as I understand it, as it hasn't been published yet, this is a letter to the editor of the publication, but is the source of the information in the first post in this thread.

 

[Woolie]

it sounds to me like a statement of the bleedin' obvious - if you're less fatigued, you're more likely to enjoy things, and if you're finding activity less difficult isn't that just another way of expressing the fact that you're less fatigued...

Yea, this smells of the usual confusion of causation and correlation.

I bet these authors never go to hospital - admission into a hospital is a major predictor of imminent death!

 

[trishrhymes]

Thanks for the link, Andy.

It's very confusing - they say it's a study of severely affected patients, then talk about 'pacing at work', and walking as a helpful form of exercise. Surely if a person is severely affected they can't possibly be working, and walking is likely to be severely curtailed.

And why on earth no objective tests? I see it's a New York based study. I would have hoped for better.