Individual outcomes after tailored versus generic self-management strategies for persistent fatigue in youth with a fatigue... 2024 Vroegindeweij+

Full title: Individual outcomes after tailored versus generic self-management strategies for persistent fatigue in youth with a fatigue syndrome or rheumatic condition: A multiple single-case study

Abstract

Objective
To examine individual outcomes after tailored lifestyle (PROfeel) or generic dietary advice as self-management intervention for persistent fatigue in adolescents and young adults with a chronic condition, to compare participants who did and did not benefit and to explore changes to factors in the biopsychosocial model of fatigue after PROfeel.

Method
A multiple single-case AB-phase design was embedded in a randomized crossover trial (N = 45). Intensive longitudinal data (ILD) on outcomes ‘fatigue severity’, ‘self-efficacy’ and ‘quality of life’ (QoL) were collected through weekly smartphone measurement for 20 weeks. ILD on biopsychosocial factors were collected through experience sampling methodology for 28 days pre-post first intervention. Baseline characteristics were compared with t-tests and chi-square tests. Permutation distancing tests were used to assess change over time in all ILD.

Results
Regarding weekly measurements, nineteen participants (42.22%) showed small to large positive outcomes (drange = .05 to 2.59), mostly after PROfeel. Eleven participants (24.44%) showed small to moderate negative outcomes (drange = −.02 to −2.46), mostly after dietary advice. Fatigue severity improved most, followed by self-efficacy. Participants who benefitted showed higher QoL levels and lower fatigue and pain levels compared with others at baseline (all p < .02). When positive outcomes were observed after PROfeel, typically ≥1 biopsychosocial factor had been targeted successfully.

Conclusion
Self-management advice has more potential when tailored to individual characteristics, including the biopsychosocial model of fatigue. PROfeel appears particularly useful as fatigue intervention for individuals with relatively less severe symptoms.

Open access, https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12722

 

"There is a growing literature on treatment of persistent fatigue, especially in adolescents and adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (Higson-Sweeney et al., 2022; Malouff et al., 2008; Noor et al., 2021), but also in people suffering from persistent fatigue after infection with for example Coxiella burnetii (Q fever) or COVID-19 (Islam et al., 2020; Koc et al., 2022; Raijmakers et al., 2019), in people with a rheumatic condition (Kant-Smits et al., 2021; Nijhof et al., 2023), in those who survived cancer (Higson-Sweeney et al., 2022; Schellekens et al., 2021), or who have a diagnosis such as fibromyalgia or irritable bowel syndrome (Aman et al., 2018; Higson-Sweeney et al., 2022). Thus far, no curative treatment has been developed. Therefore, treatment focuses on alleviating persistent fatigue and its' impact on daily life (Noor et al., 2021)."

"In a preceding article, we also identified a large heterogeneity in perpetuating and protective biopsychosocial factors across adolescents and young adults (AYA) with a (post-infection) chronic fatigue syndrome or rheumatic condition – suggesting there are many ways to tailor treatment to the needs of an individual patient"
The preceding article is discussed here, Dynamic modeling of experience sampling methodology data reveals large heterogeneity in [BPS] factors associated w/persistent fatigue... 2023 Nijhof

 

So where they use 'tailored' and 'generic' they actually mean neither word.

This is obviously very generic. It's very unlikely that there would be significant differences between patients. Table 2 has some of those, and it's all completely generic and similar across participants.

This is generic dietary advice, and cannot be compared to other biopsychosocial generic advice. At best it's a null comparator, not expected to lead to any change, but their evaluation is tainted by the fact that it's tailored to the treatment they intend to argue is effective.

Another great example of when a metric becomes a target, it ceases to be a relevant metric:

In other words, "it works better in people who were better to begin with", they say without thinking about what it means:

This is not a valid comparison or trial. These people's job is clearly simply to do trials, and argue that the result of their trials is useful, and that they should do more trials in the future. It's all performative.