Preprint Autonomic conditioning therapy reduces fatigue and improves global impression of change in individuals with post-acute COVID-19 syndrome, 2021 Putrino

rvallee

rvallee

Senior Member (Voting Rights)
Post-acute COVID-19 syndrome (PACS) is a collection of persistent and debilitating symptoms lasting weeks to months after acute COVID-19 infection, with fatigue most commonly reported. There is controversy surrounding the role of exercise programs for this condition, due to concerns over the potential to worsen fatigue. We developed a novel physical therapy program known as Autonomic Conditioning Therapy (ACT) for PACS, and report on the preliminary patient-reported outcome (PRO) data from individuals who completed ACT for PACS, compared with those who did not. Seventy-eight (55 [71%] female, median [range] age 43 [12 to 78]) met the inclusion criteria and consented to have their data included in the analyses. A total of 31 (40%) individuals completed ACT for PACS. There was within-group improvement in fatigue in individuals who completed ACT for PACS (mean difference [95% CI] -14 [-27 to -1], p = 0.03), as well as greater between-group impression of change measured on the Patient Global Impression of Change scale (ACT for PACS median [range] 5 [1 to 7], no ACT for PACS 4 [1 to 7], p < 0.01). ACT for PACS is a novel physical therapy program that can reduce fatigue in individuals with PACS.

Pre-print: https://www.researchsquare.com/article/rs-440909/v1
 
Disappointing paper, I thought the Putrino lab were serious. Here they report "success" in improving "fatigue" and... uh... global impression of change. Which... uh... yay? It's GET, simple classic GET, but somewhat symptom-contingent and seems to assume deconditioning, though without saying it other than the name, which is sort of a big tell. Seems to assume that Long Covid is primarily about fatigue, or that affecting fatigue is significant. Newbie mistake.

60% drop-outs, doesn't appear to be any examination of why. No mention or understanding of PEM. No other significant outcomes measures. Not a single objective outcome measure that I can see. Yet another low quality study.

And yet I heard Putrino talk several times and he seems to understand the issue. Not sure what happened, maybe trying to simplify things too much. But this is a useless study given the framing it puts, turning a failure into false effectiveness. They do the usual mistake of mostly admitting failure in the text but the headline says something different. And we know most people only read the headlines and the abstract, even when they are assessing evidence. Same old tripe, very disappointing.
 
Underwhelming.

Retrospective analysis of data from people who either:

- did the therapy described (autonomic conditioning therapy)
- or were either on a waiting list or referred for physical therapy (so not a proper control group, and no indication of what this group actually did)

There was a just significant improvement (p = 0.03) within the ACT group on the subjective fatigue scale, but the between group difference was not statistically significant.

Yet they headline this as a successful treatment for fatigue in Post covid patients, and say it should be rolled out for all.
 
Lol. One of the authors called it a 'meaningful start' on twitter.

As you both mentioned earlier, they might examine why 60% of patients opted to NOT to proceed in the program. It was clearly not a red flag for them at all!

I truly do not understand the fascination with deconditioning as a main cause of these symptoms, such as fatigue. It could not be further from the truth in my personal experience.

Was also struck by the absence of PEM in the paper. Was it due to the authors' own ignorance or because the patients were self reporting their symptoms and didn't have a name for the symptom? Hard to believe such a key symptom could be overlooked.
 
wingate said:
I truly do not understand the fascination with deconditioning as a main cause of these symptoms, such as fatigue. It could not be further from the truth in my personal experience
Click to expand...
Simply that deconditioning is such a slam-dunk concept. It agrees with what they learned in med school and is gets the patient circulating out of their office while they still pass go and claim 400$.
 
I don't think it's accurate to describe it as 60% dropouts from the therapy. The 60% were eligible but never started it, with 3 reasons given - administrative delay, enrolling for physical therapy and personal choice. No numbers given for each of these.

And I don't think it was based entirely on a deconditioning model. The name 'autonomic conditioning therapy' seems to imply more that they were trying to use gradually increasing activity within what symptoms would allow, to reset an autonomic imbalance, as they also try to do in POTS. Whether that makes any more sense biologically I have no idea.

Edit: I still think the retrospective look at their clinical data tells us nothing meaningful about whether the program affects fatigue, but it does tell us that if there was any benefit it was very slight.
 
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