Correlates and predictors of symptom severity over time in people under investigation for ... (POTS), 2024, Moss-Morris et al

[Andy]

Full title: Correlates and predictors of symptom severity over time in people under investigation for postural orthostatic tachycardia syndrome (POTS)

Abstract

Objective
Postural Orthostatic Tachycardia Syndrome (POTS) is a poorly understood chronic disorder characterised by an unexplained excessive increase in heartbeat upon standing. The aim of this study was to investigate psychosocial and physiological correlates and predictors of symptom severity over time in patients presenting with POTS-like symptoms.

Methods
Longitudinal cohort study of patients under investigation for POTS (n = 149). Patients completed questionnaires at one month pre-clinic appointment and 6 months later. Diagnosis, blood pressure (BP) and heart rate (HR) measures were collected from medical records. Data were analysed using hierarchical linear multiple regression.

Results
Orthostatic and small fibre neuropathy (SFN) symptoms remained stable over time and were significantly correlated with distress, cardiac anxiety, threatening views of the illness, and cognitive-behavioural responses to symptoms, but not with emotional reactivity or social support. Baseline psychosocial factors collectively explained 48% (F = 5.37, p < .001) of the variance in orthostatic symptoms, and 35% (F = 3.49, p < .001) of the variance of SFN symptoms at baseline, but a non-significant amount of variance in symptoms at 6 months when controlling for baseline symptoms. Haemodynamic measures explained a significant 4% (F = 3.37, p = .026) of variance of orthostatic symptoms at 6 months.

Conclusion
Symptom burden in patients with suspected POTS remained high over 6 months. Psychosocial factors explained a large amount of the variance in symptoms at baseline. As symptoms did not change/improve over time, baseline symptoms accounted for most of the variance in symptoms at 6 months. An integrated approach addressing psychosocial factors alongside medical treatments may promote adjustment to the condition and lessen symptom burden for this group.

Paywall, https://journals.lww.com/psychosoma..._predictors_of_symptom_severity_over.240.aspx

 

[jaded]

Really surprised Dr Gall is associated with this. He truly believes patients and knows they’re not “mad” yet has been affiliated with a few of these articles as of late. I don’t understand what is happening.

He personally said to me that it’s sad what the BPS lobby are doing with “MUS” and that they’re trying to change this with a few like minded colleagues. I’m not sure how…

 

[rvallee]

Clownish pseudoscience, identical to the mass of clownish pseudoscience that preceded it, with made-up numbers from quacks who understand nothing of this. But, hey, they got a paper on their record and that's all they care about.

 

[bobbler]

I dread anything with this name on it

the conclusion in the abstract literally makes no semantic sense as a stance I assume because it’s so aimed towards misleading in implication whilst having to skirt ‘content’ that doesn’t exist to support it being missing

I’d hope any researcher or lay professional would read that and think the writer not up to snuff if they can’t make their sentence make sense.

but what should have failed even getting an initial module in undergrad is in the method daring to list causations then use the word ‘explained’

 

[bobbler]

I dread anything with this name on it

the conclusion in the abstract literally makes no semantic sense as a stance I assume because it’s so aimed towards misleading in implication whilst having to skirt ‘content’ that doesn’t exist to support it being missing

I’d hope any researcher or lay professional would read that and think the writer not up to snuff if they can’t make their sentence make sense.

but what should have failed even getting an initial module in undergrad is in the method daring to list causations then use the word ‘explained’

there might be a correlation between being a researcher in a certain niche ideology and ability to understand what correlation doesn’t mean , but that flaw itself doesn’t entirely explain why they are in the jobs they are in and might have been ‘learned forgetting’ ie cart before horse

 

[bobbler]

This just feels like Trojan horse ‘research’ for certain individuals to propaganda the term ‘unexplained’ and a few of her choice hysterical woman suggestions of ‘factors’ (like ‘distress’) to scan-reading choirs

 

[bobbler]

From the little bit of actual results that seems to be included by the penultimate line of the results, noting that seems contrived given the primacy and decency effect it wouldn’t be the last line (is this another classic pay walled content of the article so you can’t compare results section with claims from ‘interpretation’?) it looks like

at 6months psychosocial factors correlated LESS and were non-significant vs baseline , which i assume means they didn’t change the illness or symptoms?

This would, if so, have been proving the null hypothesis thereby making the conclusions line the opposite and I don’t know what word you can technically use so I’ll say ‘a switcheroo that feels deliberate’

like saying the aspirin worked because the headache eased but it didn’t change the measures in the blood work for the disease/condition actually being studied or claimed to fix ?

vs suggesting aspirin is a good idea for the condition ‘because symptoms didn’t change’….

which wouldn’t be the ‘logical’ conclusion to follow from any of those results

this feels like a lot of non sequitur

 

[Nightsong]

I'm quite amazed that a PPI group of 14 patients signed off on this very transparent psychosomatisation attempt, especially one based on the Deary PPS model. A brief look at some of the questionnaires used highlights their inappropriateness for POTS (for instance the CAQ, the "Cardiac Anxiety Questionnaire", with questions like "I avoid exercise or other physical work", "I take it easy as much as possible" and "I avoid physical exertion" as indicia of cardio-centric anxiety). Add to that the tertiary-care patient population (likely to be patients whose symptoms are of the highest severity) and the underpowered regression models... interestingly the authors also report low response & follow-up rates; I suspect many patients would not see "research" such as this as remotely useful to them. 26.2% of the patients had a diagnosis of ME/CFS; linked data available here.

If anyone knows anyone at POTS UK, who promoted this study, it might be worth explaining to them in detail just how poor quality most psychosomatic research actually is & that the adoption of the model proposed will certainly increase, rather than decrease, the stigma that they campaign against (they're even promoting CBT on their website despite acknowledging the lack of evidence for it). Far too many patient groups seem to think that any research is good research.