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Functional Neurological Disorder Responds Favorably to Interdisciplinary Rehabilitation Models, 2019, Jimenez et al

Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Aug 11, 2019.

  1. Andy

    Andy Committee Member & Outreach

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    Not a recommendation.
    Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0033318219301203
    Sci hub, https://sci-hub.se/10.1016/j.psym.2019.07.002
     
  2. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    63 patients with FND who participated in the iCPRP were identified between the years 2013 and 2017. Of these, 49 (78%) completed treatment (14 were either discharged early or left voluntarily).

    I wonder why people were discharged early or why some left voluntarily. Failures they didn't want to mention in the final results perhaps?

    As someone who was told they had a functional disorder 20 years ago this paper just reeks of sadism. I was diagnosed with IBS, but the word "functional" got bandied about as well and I had it explained to me that my symptoms were all in my head and my brain was making them up because I was depressed. The cause of my IBS was found and fixed with surgery in 2003, and the surgery wasn't performed on my head!
     
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  3. Trish

    Trish Moderator Staff Member

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    So where's the control group. Maybe doing nothing would be even better for these patients.
     
  4. rvallee

    rvallee Senior Member (Voting Rights)

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    Why bother? PACE normalize non-controlled research and it's basically hailed as the very peak of mount science, the very notion that it may be flawed in any way is surefire evidence of paranoid delusion. "We prefer this outcome" is now peer-reviewed valid justification for massive deviation from protocol so why even bother having one?
     
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  5. Annamaria

    Annamaria Senior Member (Voting Rights)

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    Should it be nicknamed 'iCRAPS'?
     
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  6. Hutan

    Hutan Moderator Staff Member

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    • Yeah, small sample size - tick.
    • Selective recruitment - tick.
    • Large % of dropouts - tick.
    • Heterogeneous sample - tick.
    • Poor rigour and lack of consistent approach to diagnosis - tick.
    • No controls - patients not given alternative treatment without the magic ingredient - tick.
    • No controls - no data on expected improvement in objective measures from factors not related to real improvement e.g. improvement due to familiarity with the specific exercise - tick
    • Results of subjective outcomes from non-blinded treatment assumed to show real benefit - tick.
    • Objective outcomes irrelevant to patient's illness - tick
    • Uncritically quotes waffling pseudoscience about brain imaging - tick.
    • Unwarranted negative labelling of people - tick
    • Unwarranted conclusion - tick
    Study not worth the paper it's written on - tick.
     
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  7. rvallee

    rvallee Senior Member (Voting Rights)

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    One thing you can't fault the authors, their bullshitspeak game is on point. It takes years of thinking nonsense in order to come up with stuff like that. This is pro-level gibberish.

    One proposed change: replace ", and other deficits" with ", or whatever". Same effect.

    Alternatively, scrap the whole thing and just replace it with a good old plumbus infomercial, no one could tell the difference:
     
  8. Hutan

    Hutan Moderator Staff Member

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    Just to express my amazement at the rubbish that gets published a bit more:

    Imagine there's a study on the impact of a 3 week 'inter-disciplinary functional restoration program' course for blind people. The outcome measure is a 6 minute walk without a cane, because the researchers have noted that blind people tend to walk slowly and hesitantly without a cane. At the end of the course, the blind people are managing to walk the corridor faster; they know when to turn. Some may even have got a bit fitter.

    The study write-up notes that blind people are excessively timid in new situations and that the intervention was a success. They conclude
    Makes as much sense as this FND study.
     
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  9. obeat

    obeat Senior Member (Voting Rights)

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    You need to turn this checklist into a paper for EBM live or send it to F Godlee!
     
  10. Annamaria

    Annamaria Senior Member (Voting Rights)

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  11. Mithriel

    Mithriel Senior Member (Voting Rights)

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    "Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach"

    The PACE trial was looking at chronic fatigue so outcomes like the 6 minute walking test were appropriate, even the questionnaires had a dubious relevance but these seem irrelevant to FND and just highlight that they are making a single category of diverse biological problems.

    As was said, the difference in the physical tests were probably the result of practice and we all know that CBT primes for answering questions. If IBS and interstitial cystitis are included the number of trips to the toilet is the only useful outcome measure. If there was someone with a deformed foot then the angle of the ankle would be useful and so on.

    Again it is impossible to guess their logic. FND is caused by anxiety, so a questionnaire showing less anxiety is a positive result even if the patient still has the original problem.
     
  12. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    I guess we'll have to assume that IRB had granted ethics approval?

    I'm not sure how the stair climbing test and six minute walking test are relevant to those groups of patients.
     

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