Effectiveness of a personalised self-management intervention for people living with long covid (Listen trial), 2025, Jones et al

rvallee

rvallee

Senior Member (Voting Rights)
Effectiveness of a personalised self-management intervention for people living with long covid (Listen trial): pragmatic, multicentre, parallel group, randomised controlled trial
https://bmjmedicine.bmj.com/content/4/1/e001068

Abstract

Objective: To evaluate the effectiveness of Listen, a self-management support intervention, for people living with long covid who were not in hospital.

Design: Pragmatic, multicentre, parallel group, randomised controlled trial.

Setting: Twenty four sites in England and Wales.

Participants: Identified from long covid clinic waiting lists, word of mouth, and adverts/social media self-referred to the trial, 554 adults with long covid were randomised to receive either the Listen trial intervention or NHS usual care.

Interventions: The Listen intervention involved up to six one-to-one personalised sessions with trained healthcare practitioners and an accompanying handbook co-designed by people with lived experience and health professionals. Usual NHS care was variable, ranging from no access, access to mobile applications and resources, and to specialist long covid clinics.

Main outcome measures: The primary outcome was the Oxford participation and activities questionnaire (Ox-PAQ) routine activities scale score at three months assessed in the intention-to-treat population. Secondary outcomes included Ox-PAQ emotional wellbeing and social engagement scale scores, the Short Form-12 (SF-12) health survey, the fatigue impact scale, and the generalised self-efficacy scale at three months. The EuroQol five-dimension five-level (EQ-5D-5L) assessed health utility. Serious adverse events were recorded.

Results: Between 27 May 2022 and 15 September 2023, 554 people with long covid (mean age 50 (standard deviation 12.3) years; 394 (72.4%) women) were randomly assigned. At three months, participants assigned to the intervention group reported small non-significant improvements in the primary outcome of capacity for daily activities as assessed by Ox-PAQ routine activities scale score (adjusted mean difference −2.68 (95% confidence interval (CI) −5.38 to 0.02), P=0.052) compared with usual NHS care. For the secondary outcomes, people receiving the intervention also reported significant improvements in mental health (Ox-PAQ emotional wellbeing −5.29 (95% CI −8.37 to −2.20), P=0.001; SF-12 2.36 (95% CI 0.77 to 3.96), P=0.004), reductions in fatigue (fatigue impact score −7.93 (95% CI −11.97 to −3.88), P<0.001), and increases in self-efficacy (generalised self-efficacy scale 2.63 (95% CI 1.50 to 3.75), P<0.001). No differences were found in social engagement (−2.07 (95% CI −5.36 to 1.22), P=0.218) or SF-12 physical health (0.32 (95% CI −0.93 to 1.57), P=0.612). No intervention related serious adverse events were reported.

Conclusions: The personalised self-management support intervention of the Listen trial resulted in non-significant short term improvements in routine activities when compared with usual care. Improvements in emotional wellbeing, fatigue, quality of life, and self-efficacy for people living with long covid were also reported. Physical health and social engagement were not affected by the trial intervention. The limited understanding of how much change is clinically meaningful in this population along with the unblinded design, the use of self-referral as a recruitment method and variable usual care may have introduced unintended bias and thus limits robust conclusions about this intervention. Further research is required to fully establish the impact of the intervention.
 
As is typical with such pragmatic trials, which is somehow framed as a controlled trial despite only being poorly randomized, the outcome is a bust but they misrepresent it as successful anyway, or at least promising, demanding not only more research but implementation within health care services.

This industry is completely mad. Nothing seems to matter to anyone, they just randomly do things, don't bother evaluating them properly and think this is what professionals are supposed to be doing with their time. Absurd.


What this study adds
  • Listen is a relatively brief, personalised self-management support intervention that integrates theoretical evidenced based outputs and real-world lived experiences and contexts of people with long covid and not in hospital

  • A non-significant effect on our primary outcome of everyday activities was noted

  • Secondary outcome data suggested a modest benefit in fatigue management, emotional wellbeing, and confidence to self-manage but no impact on physical health or social engagement

How this study might affect research, practice, or policy
  • Personalised support sessions using core principles, such as those evaluated in the Listen intervention, show promise

  • Training healthcare practitioners to listen, validate symptoms, and facilitate problem solving to support other self-management strategies are worth considering when planning health services that accommodate varied needs of people living with long covid

  • Further research to explore clinical outcomes of the intervention with a longer follow-up, and implementation across different healthcare settings are warranted
 
The limited understanding of how much change is clinically meaningful in this population along with the unblinded design, the use of self-referral as a recruitment method and variable usual care may have introduced unintended bias and thus limits robust conclusions about this intervention.
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Bless their hearts.
 
The paper said:
Training healthcare practitioners to listen, validate symptoms, and facilitate problem solving to support other self-management strategies
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I have no idea what this is even supposed to mean. It's just meaningless waffle. The idea of HCPs listening to symptoms seem so unusual they have to highlight it as "a good idea". What does "validate symptoms" even mean? This is not even a thing. And they don't facilitate problem-solving because they don't know how to do any of this. All of this is "imagine a world in which we could do what we can't do" wishcare bullshit.
 
Eleanor said:
Bless their hearts.
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"We curiously notice that, after applying deceitful methods to put our fingers on the scale, when we put our fingers on the scale at multiple timepoints and using various subtle finger-pressing methods, we get results we otherwise wouldn't. It's a mystery. The relationship between the mind finger and body scale is so complex and safe and effective."
 
rvallee said:
Long covid as a long term condition
https://bmjmedicine.bmj.com/content/4/1/e001366
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One of the striking findings of the LISTEN study is the small change seen in most of the outcome measures, suggesting only a partial improvement rather than a full recovery. The EQ-5D-5L utility or index scores, a measure of overall health status, improved very little during the trial. The unadjusted index score value changed in the usual care group by 0.01 (0.52 at baseline to 0.53 at follow-up) and in the intervention group by 0.04 (0.49 at baseline to 0.53 at follow-up). Such incomplete recovery has also been observed in the NHS England long covid service evaluation study and some other studies too.10 11 The final EQ-5D utility scores in the LISTEN trial were below the normative values in the other long-term conditions such as diabetes mellitus (0.83), chronic kidney disease (0.70), cancer (0.75) and multiple sclerosis (0.56).12 This highlights the personal burden of long covid as a chronic condition or long term condition and reinforces the need to redouble our efforts to improve intervention.

The LISTEN trial illustrates the need and value of further research in to personalised treatments delivered by a multidisciplinary team in community settings and people's homes.
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"We don't understand why what we're doing isn't working, so you should definitely keep paying us to do more of it."
 
This is from the discussion section of the paper:
We observed an average reduction of less than three points in the Ox-PAQ routine activities scale score for people receiving the Listen intervention compared with usual care, less than half the published minimum important difference for Ox-PAQ routine activities scale score of 7.51 points
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it seems that the intervention was something that was made up, together with people living with Long Covid.
In the intervention, key sources of self-efficacy included goal mastery and vicarious peer modelling experiences, with self-efficacy as a proposed mediator of change. In this approach to self-management, interactions by healthcare practitioners become less directive and more collaborative, facilitating individuals' problem solving skills. The Listen programme theory highlighted self-efficacy, gaining control and stability of symptoms and knowledge about living day-to-day with long covid as key mechanisms of impact.
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Not sure why this idea would warrant a trial of more than 500 people...
 
ME/CFS Skeptic said:
it seems that the intervention was something that was made up, together with people living with Long Covid.

Not sure why this idea would warrant a trial of more than 500 people...
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Basically as a pilot project, although of course it's the exact same old we are used to. For which they demand a larger trial to determine the impact. I guess because they couldn't determine that with 500 people in a 4 year trial that had no impact.
 
The LISTEN trial illustrates the need and value of further research in to personalised treatments delivered by a multidisciplinary team in community settings and people's homes.

It does no such thing, you liars.

Eleanor said:
Bless their hearts.
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Just in case anybody doesn't know, in the south of the USA, at least, that is an insult.

NelliePledge said:
They’re trying to make peer support into something that needs health practitioner involvement.
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From the very crowd who insist of the evils of over-medicalising.
 
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