Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE): Protocol for a Randomized Controlled Trial, 2022, Busse et al

Importance: Chronic, non-cancer pain affects approximately 20-30% of the population in North America, Europe, and Australia, with surgery and trauma frequently cited as inciting events. Prospective studies of fracture patients have demonstrated an association between somatic pre-occupation, poor coping, and low recovery expectations following surgery with persistent pain, functional limitations, and lower rates of return to work. Psychological interventions, such as cognitive behavioural therapy (CBT), that are designed to modify unhelpful beliefs and behaviours have the potential to reduce persistent post-surgical pain and its associated effects among trauma patients.

Objective: To determine whether online CBT, versus usual care, reduces the prevalence of moderate to severe persistent post-surgical pain among participants with an open or closed fracture of the appendicular skeleton.

Design, Setting, and Participants: The Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE) protocol will be followed to conduct a multi-centre randomized controlled trial. Participants undergoing surgical repair of a long bone fracture will be randomized to receive either: (1) online CBT modules with asynchronous therapist feedback or 2) usual care. The primary outcome will be the prevalence of moderate to severe persistent post-surgical pain over 12 months post-fracture. Secondary outcomes include the Short Form-36 Physical and Mental Component Summary scores, return to function, pain severity and pain interference over 12 months post-fracture, and the proportion of patients prescribed opioid class medications (and average dose) at 6- and 12-months post-fracture. The COPE trial will enroll 1,000 participants with open and closed fractures of the appendicular skeleton from approximately 10 hospitals in North America.

Discussion: If CBT is effective in improving outcomes among patients with traumatic fractures, our findings will promote a new model of care that incorporates psychological barriers to recovery.

Preprint, https://www.researchsquare.com/article/rs-1942631/v1

 

They don't even consider that maybe the pain patients are having, after surgery or a fracture, might actually be real?! Throwing Trauma and surgery together as equivalent is absurd.

The "that are designed to modify unhelpful beliefs and behaviours" are continuing to complain to doctors it isn't actually repaired isn't it?!

 

I have cited this friend here before. She had severe chest pain whenever she bent over following open heart surgery. It took many medical consultations, psychological intervention, repeated assurances that it was purely functional and some eighteen months, before she found a doctor willing to prescribe a simple chest xray that revealed the eleven inch stainless steel surgical implement left in her chest cavity.

Fortunately she ignored the advice to exercise through it.

 

I'll predict the conclusion right here: negative findings on all objective outcomes, a trend towards the positive on secondary subjective outcomes (squinting may be necessary), more research will be needed to figure out responders from non-responders, it's promising and all that. Oh, and of course: 70-80% drop-out rates for the minimum number of séances and <10% completed a full course, which in BPSland means that it's acceptable, or whatever.

The good thing about this trial is that all fractures are identical on identical bodies with the exact same lived experience and all operations are exactly identical so you can be very confident that the only factor being evaluated is the CBT. It's very important in scientific experiments to evaluate one thing only with all other things being equal and this is met here to a very high threshold, all factors are equal except the CBT, which itself is obviously identical in every séance, for every patient and from every therapist.

I'm frankly not sure if even the obsession with the Philosopher's stone was as excessive. A race to the bottom, with the lowest possible expectations. Having long given up, in a nutshell.

 

Honestly are there meetings where they come up with this stuff? "If we can get access to the post-surgical patients, we can get anything!"

 

I think medical researchers have, as a group, just decided to leave sanity, compassion, empathy, and honesty behind.

 

The Canadian government, https://www.chairs-chaires.gc.ca/home-accueil-eng.aspx

 

So that's the same Busse we've been discussing in other threads? A chiropractor, funded by our equivalent of the NIH? Who, somehow, despite having no relevant expertise, thinks he can define core outcomes for research in ME?

Medicine has truly lost the plot. We are at the thoughts and prayers phase of experts having given up long ago. What medical science needs is a return to basics, fundamental stuff, the way physics has been doing for decades, so many leads that have never been followed, so many "common wisdom" beliefs just begging to be debunked.

Instead they do this, the equivalent of NASA having a large astrology department. Beyond absurd.

 

I loved that when I read it correctly. I first misread astrology as astronomy and got a bit confused.

 

I wonder if Paul Garner and Gordon Guyana really thought through the implications of co-authoring a rapid response to BMJ about PACE and NICE with a man who has trained in a profession where THERE IS NO VALID EVIDENCE FOR ANYTHING.

 

Well, given that Garner is prone to staring down barrels of guns, so I'm not sure that he is prone to thinking things through.

 

More risking things through his thinking, you mean?

 

How can you say he has no re;rvant experience? he must. at McMaster and Prima have worked alongside one of the leading experts of the day. Arthur Cott, for it is he, needs to be better recognised. What for is a wholly different matter.

 

@Hutan
Interesting career trajectory this Dr. Jason Busse. Undergrad degree in microbiology. Masters in molecular and medical genetics. Chiropractic professional degree (why?). Then a Phd from McMaster's in epidemiology (these are on his Linked-in account).

On the Chronic Pain Network website ( https://cpn.mcmaster.ca/contact-us/full-bio/jason-busse), he states that his first clinical interest (in order of listing) is insurance medicine. I'm not exactly sure what that means, except it sounds a bit fishy to me, as in denial of claims.

His academic appointment is in the department of Anesthesiology and Health Research and Methods at McMaster. He is involved in setting up research studies. especially in the field of preventing the progression of acute to a chronic pain state.

I can see the CBT cost-cutting ("insurance medicine" angle) tack here. Of course there are many psychs on the pain network who funnel in their viewpoints.

 

"Insurance medicine" LOL. I am going to think of that whenever I see "CBT" now, along with a range of other key terms.

 

According to this report Busse is a co-director of the Cochrane Insurance Medicine Group https://insuremed.cochrane.org/sites/insuremed.cochrane.org/files/uploads/annualreport2021.pdf
He's not listed as a director on the website https://insuremed.cochrane.org/about-us, but he is listed as a collaborator.
Insurance medicine does sound like evidence and practice will be weighted in favour of insurers rather than patients...cheap scalable (aka digital) treatments, and threadbare if any evidence of effectiveness needed.

 

Somewhere on the forum I posted a document showing how Arthur Cott ,of McMaster and Prisma, was responsible for drawing up treatment guidelines to be adopted by the Canadian Insurance Association. I think it was in 2000. There were, I think, three insurance companies involved with him in the drafting. Busse seems to have been involved with Prisma at that time, though the exact nature of his interests are not known.

I could probably find it if it is of interest to anyone. I think I posted it on the SW thread. Surprisingly I posted it in defence of SW against those who claimed that he was responsible for the situation in Canada. Canada was quite capable of producing illness behaviour nonsense unaided.

 

Thanks @Hutan

"Insurance Medicine" - who knew there is an American Academy of Insurance Medicine!!

Our physician members typically serve as medical directors to insurance companies. Members may serve these companies as advisors for underwriting and consultants for claims and disability management. Other roles include medical and actuarial research, underwriting guideline development, employee health education and care, and as professional liaison to the medical community, legislative bodies and regulatory agencies.​