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

cassava7

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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:
Objectives
Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain.

Methods
Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time.

Results
Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges’ g = 1.00) and pain-related interference (Hedges’ g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity.

Discussion
Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.
 
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):
However, only 43% of the participants completed the HWC program. This dropout rate is higher than other HWC programs designed to improve health behaviors related to chronic diseases,[15] but is similar to other yearlong behavioral interventions among patients with chronic pain [39]. Patient expectations regarding treatment for chronic pain are increasingly recognized as an important factor to address. Patients generally have high expectations regarding pain reduction following an intervention [40]. Because the HWC program was not directly designed to reduce pain, but instead aimed to improve quality of life, participant expectations may have influenced the dropout rate.
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:
After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges’ g = 1.00) and pain-related interference (Hedges’ g = 1.13).

Also:
Funding: The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article.

Competing interests: The authors have declared that no competing interests exist.

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):
How do you perform virtual treatments?

A common misconception of physical therapy is that it must involve hands-on treatment. In reality, this is only one tool available to a physical in diagnosing and treating an injury or chronic condition. Educating patients, identifying contributing personal lifestyle and fitness factors, as well as implementing a specific exercise or movement program, are some of the most important things physical therapists do.

Modern physical therapy is no longer reliant on complex machines and manual techniques, and is trending towards guided self-care and coordinated rehabilitation programs, granting you much-needed control of your own recovery. Research has shown that outcomes are enhanced, if not realistically better through online consultation, due to the personal empowerment and easy facilitation we offer.

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.
 
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Because the HWC program was not directly designed to reduce pain
physical functioning and psychological factors were associated with improvements in pain intensity
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.
Patients generally have high expectations regarding pain reduction following an intervention
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.
 
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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.
 
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So only 43% completed the program. It's a retrospective study of data from all participants in the program ove 8 years. And outcome measures are all subjective. No account was taken of any concurrent physical therapy or medication used. This looks like advertising to me, not serious scientific research.
 
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