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

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.

 

60% drop out and they still feel that their GET program is successful? Where has good science gone?

 

One of the authors is on Twitter

 

Good science is hard. Even bad science is hard. Hustling is very easy.

 

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.

 

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$.

 

Is ACT not used as a name for Acceptance Therapy?

 

Well that's not going to be the problem it might be as long as you know to avoid both!