Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis, 2022, Adamowicz et al.

Abstract

Objective
Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease.

Methods
PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve.

Results
The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18–0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis.

Conclusion
Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.

(Paywalled, Preview availabe)

Citation:
Jenna L. Adamowicz, Miriam Vélez-Bermúdez, Emily B.K. Thomas,
Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis,
Journal of Psychosomatic Research, Volume 159, 2022, 110951,
https://doi.org/10.1016/j.jpsychores.2022.110951.

 

Haven't read the paper so don't know if they discuss the question about cause and effect which isn't acknowledged in the abstract.

Nevertheless, maybe it's interesting that they found only a "small, positive association between fatigue severity and avoidance".

Among the references much psychosomatic research into ME/CFS done by the usual suspects, including the recent paper by M. Sharpe et al.(2022), Evidence-based care for people with chronic fatigue syndrome and myalgic encephalomyelitis, Gen. Intern. Med , Thread here

 

Isn’t this yet another case of a study finding the more ill people are the more ill they are? Avoiding activity may be a perfectly rational and constructive response to you’re underlying condition, fatigue being a useful indicator of when you need to avoid activity.

 

Of course! They always interpret associations as causal but in the wrong direction

 

And build circular models claiming 'multifactorality' and dismiss any critique by stating they distinguish between initial and maintaining factors even if that misses the point of the critique.

Still thought it would be interesting to see what they actually investigated and what it means that they only found a small association.

 

It's included in the preview snippet of the 'discussion' :

"Given the current meta-analysis draws from correlational data, causality and directionality of this relation cannot be inferred."

Another common practice in this type of research: Acknowledge most relevant limitations in the discussion section but imply in your paper's abstract and conclusion that there's evidence for a particular outcome even if you acknowledged that your research couldn't provide evidence for it.

If someone criticizes you for the implication of causality and direction, you just refer to the discussion section and state that you highlighted these limitations...

 

I wonder how avoidance was defined in these 66 studies.

 

They defined it as tendency to avoid unwanted experiences.

 

...

...which isn't necessarily what all of the included studies measured.

Can access this online journal's volumes only until 2002, and no idea how they selected the references for the preiview -- "There are more references available in the full text version of this article".

Here's the preview's selection -- studies with an * were included in the meta-analysis:

 

Do they just literally not understand the meaning of words? That words aren't just meaningless labels? Or are symptoms just impossible to understand for medically trained people? I don't get it. This is like finding that chronic projectile vomiting is associated with eating less and arguing that getting people engaged in projectile vomiting to eat more will solve the vomiting.

Like they read the definition of fatigue, and it actually means nothing to them, there is nothing in the box that is labeled with fatigue, only a label that means "stuff gets associated with stuff in there".

It's so simple:

1. Poor people are defined as not having sufficient money
2. Poor people buy a lot less stuff than people who have sufficient money
3. Therefore getting poor people to buy more stuff will solve their problem of not having enough money

Damn it was that simple all along, the solution to poverty.

Now give me academic money, or something? I guess it really is that simple. Sorry I can't do production value, but the substance is exactly the same here.

This is truly revolutionary stuff if you don't think about it.

How to solve paraplegia and mobility issues?

1. People with mobility issues are defined as having less mobility
2. People with less mobility tend to be less mobile
3. Just get people with mobility issues to move more, mobility issue resolved

You can probably use a shock collar or something like that. As long as you properly defined trashing in pain or spasming in shock as moving, you can call it a rousing success.

You can even apply the same genius formula to lost limbs:

1. People who lost a limb are defined as not being able to use that limb
2. People who lost a limb cannot use that limb
3. Just get those people to use their lost limb, therefore making their lost limb no longer lost

G E N I U S