Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference, Rethorn et. al, 2020

Rethorn ZD, Pettitt RW, Dykstra E, Pettitt CD (2020) Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference. PLOS ONE 15(7): e0236734. https://doi.org/10.1371/journal.pone.0236734

Abstract:

 

Other than fact that this is a non-controlled study with subjective outcomes, 206 patients (49.16%) dropped out of the program within the first 6 months. And only 181 (43%) completed the full 12 months.

Here's the authors' justification for the dropout rate (bolding mine):

In other words: the program did no better (arguably worse) than other BPS interventions, but patients with chronic pain are too demanding of their treatments. The blame is put on them from dropping out, but nowhere do the authors ask themselves whether there were issues with the contents of, or the hypotheses underlying, the program...

It is misleading to say "the HWC program was not directly designed to reduce pain, but instead aimed to improve quality of life", while touting these two outcomes as results in the abstract:

Also:

However, a quick search on Google for the first (lead?) author's name -- Zachary Rethorn -- shows that he provides health coaching sessions for chronic pain to "help you heal pain and live well" https://www.instagram.com/rethorn_pt/

His website FAQ reads (https://www.rethornpt.com/copy-of-home):

Is this lack of disclosure a violation of what's written in the "Funding" or "Competing interests" sections above?

EDIT: The study didn't include a long-term follow-up after completion of the program. Concerning the "lifestyle changes" made through these coaching sessions, I wonder:
1) how feasible it is for patients to maintain them
2) how sustainable they are without coaching sessions (i.e. once there is no more external motivation to follow them)

For example, the program might call for a diet change which requires cooking at home much more often. This might be difficult for patients to do during the program, but they may still invest their energy into it if they are motivated to do so by the coach. Then it is likely that they would stop shortly after the program ends.

 

I guess that's counted as one of those "happy surprises" that an intervention not designed to reduce pain actually did. Not that pain can be measured and that any evaluation becomes entirely meaningless when the intervention is all about manipulating people into not thinking about pain then asking them how much they're thinking about it. Especially if you don't mind that over half drop out because they get the point that you're clueless hacks.

This is actually incorrect. Anyone who has dealt for years with chronic pain basically has no expectations at this point because they've endured how ineffective and generally inept medicine is. It's basically a coping mechanism to have no expectations, otherwise you just get too disappointed. But it blames the patients so that's all good. Speculation is just as good as facts, I guess.

Screw it just go straight with healing crystals and other voodoo. Maybe a reverse pin doll? Where they place pins where the pain is supposed to be and they take it out while yelling NO at their pain? Why even pretend at this point? EBM is a complete and total disaster. 60% dropouts and yeah let's cherry-pick a bunch of mathemagics. S C I E N C E.

 

PLOS ONE is one of those pay-to-publish 'journals'. This sort of paper would support the notion that it is, in fact, spam.

[Edit]
I mixed this up in my head as a 'predatory journal' which it isn't. All sorts of journals charge you for publication. This paper is spam though.

 

I have a question. What type or category of trial would this be considered? It's not a clinical trial is it?

And answering that what are the rules, policies, requirements that should be adhered to for the type of trial?

 

I disagree, PLOS One is a reputable journal. But it seems the peer-reviewers for this one happened to be a bit to like-minded.

 

I suppose it's unfair to single it out given current Lancet and BMJ behavior. However the incentives seem off. Although again that's not at all unique to them now that I think about it.

This paper is pretty blatant spam though.

[Edit]
I got 'pay-to-publish' mixed up with so-called 'predatory journals' which Plos One isn't.