Patients with [long Covid] attending a multidisciplinary evaluation: Characteristics, medical conclusions, and satisfaction, Gouraud et al, 2023

Patients with persistent symptoms after COVID-19 attending a multidisciplinary evaluation: Characteristics, medical conclusions, and satisfaction
Gouraud; Thoreux; Ouazana-Vedrines; Pitron; Betouche; Bolloch; Caumes; Guemouni; Xiang; Lemogne; Ranque

Objective
Among patients attending a multidisciplinary day-hospital program for persistent symptoms after COVID-19, we aimed i) to describe their characteristics ii) to present the medical conclusions (diagnoses and recommendations) and iii) to assess the patients' satisfaction and its correlates.

Methods
For this retrospective chart review study, frequent symptoms were systematically assessed. Standardized questionnaires explored fatigue (Pichot scale), physical activity (Ricci & Gagnon scale), health-related quality of life (Short-Form Health Survey), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and associated psychological burden (Somatic-Symptom-Disorder B criteria Scale). Medical record conclusions were collected and a satisfaction survey was performed at 3-months follow-up.

Results
Among 286 consecutive patients (median age: 44 years; 70% women), the most frequent symptoms were fatigue (86%), breathlessness (65%), joint/muscular pain (61%) and cognitive dysfunction (58%), with a median duration of 429 days (Inter-quartile range (IqR): 216–624). Questionnaires revealed low levels of physical activity and quality of life, and high levels of fatigue, anxiety, depression, and psychological burden, with 32% and 23% meeting the diagnostic criteria for a depressive or anxiety disorder, respectively. Positive arguments for a functional somatic disorder were found in 76% of patients, including 96% with no abnormal clinical or test findings that may explain the symptoms. Physical activity rehabilitation was recommended for 91% of patients. Patients' median satisfaction was 8/10 (IqR: 6–9).

Conclusion
Most patients attending this program presented with long-lasting symptoms and severe quality of life impairment, received a diagnosis of functional somatic disorder, and reported high levels of satisfaction regarding the program.

Highlights

• Patients with persistent symptoms after COVID-19, attending a day-hospital program.

• Abnormal clinical or test findings that may explain the symptoms were rare (<10%).

• A functional somatic disorder was diagnosed in 72% of patients.

• A large majority of patients were recommended physical activity rehabilitation.

• Satisfaction regarding the program was high, regardless of the main diagnosis.

Link | Paywall (Journal of Psychosomatic Research)

 

Selected quotes from methods —

 

Selected quotes from results —

 

Selected quotes from discussion —

 

Again, as we keep saying, no-one does this. The patients all report trying to get back to normal life and exertion (as I did). Perhaps they didn't even have a symptomatic episode, but rather an asymptomatic one (also as I suspect I did).

I guess at least the needle has moved from "promising" to "could be promising".

 

So heavily invested in repeating the same wilful mistakes of the past. gigo again.

 

Still concluding —

This high level of satisfaction might result from our approach that does not oppose psychological mechanisms to other mechanisms. Indeed, although the conclusion of clinical or paraclinical abnormal findings potentially explaining the symptoms was associated with higher levels of overall satisfaction, the conclusion of positive arguments in favor of a diagnosis of functional somatic disorder did not alter satisfaction levels.

A recognition that their "psychoeducational intervention" and language obfuscation may have had an effect —

Of course it will. We could write the paper for them now: "promising".

 

Merged thread

Besides the low quality of evidence (retrospective study with a satisfaction survey), Prof Lemogne is an associate editor of the Journal of Psychosomatic Research. He was part of Matta et al’s study in JAMA Internal Medicine that purported to show that long Covid was associated with the belief of having had Covid but not serological testing, which was thoroughly scrutinized and subsequently corrected.

 

I do not have access to the paper but I have been told that it was 50%.

Yes, long haulers who have been there do not recommend it at all. ApresJ20, the main long Covid patient organization in France, does not recommend it either.

Last year, as part of a small documentary on treatments for long Covid, a journalist with long Covid from the French public TV channel France 2 filmed the treatment that she was given at this clinic. Lemogne and Ranque were presenting FND-like explanations for long Covid symptoms and offered mindfulness therapy. The journalist ridiculed them in the report.

CASPER is one of the only long Covid clinics based at a public hospital and it is in the heart of Paris, so this is why patients are being referred there, not because they have some particular inclination to believe in functional disorders.

 

This is all very disturbing in that it shows that clinicians and researchers will report positive conclusions regardless of outcomes, even when there is widespread condemnation and reports of harm and psychological distress caused by gaslighting. There is a complete disconnect between patients and physicians, and as we've seen in a paper posted today, they will simply blame the patients no matter what, insisting that they are right simply because they could not possibly be wrong.

How can we trust the rest of medical evidence given this? This is terrible for trust in experts.