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Trial Report Prognosis of patients with post-Covid-19 condition: Prospective cohort cluster analysis at one year 2024 Liira, Garner et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by RaviHVJ, May 23, 2024.

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  1. RaviHVJ

    RaviHVJ Senior Member (Voting Rights)

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    114
    https://www.sciencedirect.com/science/article/abs/pii/S0022399924002204

    Objective
    We aimed to identify clinically relevant clusters among patients with post-Covid-19 condition (PCC) and assess prognosis overall and within clusters.

    Methods
    Prospective cohort study of patients with PCC attending a rehabilitation clinic. We monitored patient reported outcome measures (PROMs): EuroHIS quality of life and symptoms. Unsupervised hierarchical cluster analyses were performed to identify clusters of patients with different quantity of symptoms, and symptoms presenting together. Preliminary findings on symptom prevalence and quality of life at 12 months are reported.

    Results
    Among 409 patients, 70.4% were women, with an average baseline of 20.3 (SD 6.8) symptoms. Three clusters emerged based on symptom quantity, labelled by the average number of symptoms at baseline: Cluster-11 (17% of all patients), Cluster-17 (35%), and Cluster-25 (48%). Multinomial logistic regression showed female sex, multiple comorbidities predicting more symptoms. Four symptom-based clusters were defined: fatigue and cognitive complaints; pain, trouble sleeping, palpitations and other symptoms; gastrointestinal symptoms; and emotion-related symptoms. Linear regression models showed that female sex, multiple comorbidities, anxiety, use of antidepressants, BMI and smoking were among the determinants of symptom clusters. In 12-month follow-up, symptom count decreased, and quality of life improved across all clusters, with 9% having good quality of life at baseline and 33% at 12 months.

    Conclusion
    Four patient clusters based on symptoms were identified in the PCC cohort. Prognosis was favorable across all clusters, with symptom reduction and improved quality of life observed. Female sex, comorbidities, BMI, and mental-health related variables predicted higher symptom burden, suggesting multifactorial origins of PCC.


    Authors include Helen Liira and Paul Garner
     
    RaviHVJ, May 23, 2024
    #1
    Deanne NZ, Hutan, Peter Trewhitt and 1 other person like this.
  2. Yann04

    Yann04 Senior Member (Voting Rights)

    Messages:
    425
    Location:
    Switzerland (Romandie)
    For anyone unfamiliar with who they are here is the pinned tweet on their profule
    https://twitter.com/user/status/1402977604748128257


    in the article written by Paul Garner:

    Serendipity ultimately led to a path of recovery far too few have access to. An academic colleague connected me to someone who had recovered from chronic fatigue syndrome/ME, and who supported me as my “recovery mentor”. Their compelling explanation of what was happening in relation to the brain and body changed my understanding of the symptoms I was experiencing. I found other personal stories on Recovery Norway, a website set up by people who have recovered from ME/CFS. The narratives the group has compiled gave me hope.

    Over the next two weeks my recovery moved quickly. I used visualisation approaches with my symptoms: I would practise simple meditation or, when fatigued, concentrate on beautiful memories and relive them. I started carefully managed exercise with short, gentle bike rides. This exposed me to small doses of activity each day but stopped me increasing my exertion of energy too quickly. I felt very different, happy – and was eventually able to return to my regular physical training.​
     
    Yann04, May 23, 2024
    #2
    Joan Crawford, Deanne NZ, Hutan and 3 others like this.
  3. MrMagoo

    MrMagoo Senior Member (Voting Rights)

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    399
    I’m sure he’s still doing his regular physical training, now he’s recovered.
     
    MrMagoo, May 23, 2024
    #3
    Deanne NZ, alktipping, Peter Trewhitt and 1 other person like this.
  4. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    12,848
    Location:
    Canada
    So from a rehabilitation clinic, the vast majority are still impaired, and that's good prognosis? The 9% having a good quality of life at the start suggests those must have been the mildest people they could find, which is usually the case. And of course natural improvements explain the improvements, what's openly available only speaks of attending a clinic.

    And again with the "clusters" that don't even make much sense as they're static snapshots in time and there are overlaps anyway. Many studies have done the same and it's worthless.

    Gotta love that more symptoms "predicts" more symptoms. Really smart science here. It rarely gets any more superficial than this, and still the data contradict the conclusion that they somehow published anyway.

    I wonder why they had to publish this in their private journal, but this is definitely not a good prognosis.
     
    rvallee, May 23, 2024
    #4
    Chezboo, Joan Crawford, Deanne NZ and 5 others like this.
  5. Hutan

    Hutan Moderator Staff Member

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    27,595
    Location:
    Aotearoa New Zealand
    Yes, and just to underline the point. Only 33% of the people had a good quality of life after 12 months of care at the rehabilitation clinic. That suggests that the clinic was not being very successful in either curing people or helping people find a new way of living that was not crap.

    Actually, I would have expected a considerably higher increase in the number of people reporting a good quality of life 18 months after onset (i.e. the likely 6 months it takes to get to a clinic plus the 12 months these patients were followed over), just from the natural course of things. Perhaps this clinic is making people feel less good about their lives than if they hadn't attended the clinic?

    I expect there are all sorts of problems with this paper. But, I'm not sure that I can muster up the interest to wade through what is likely to be misogynist and other judgemental 'ist' framing to find them:
    Well, when you define one of your clusters as 'emotion-related symptoms', it is hardly surprising that 'anxiety' and 'use of antidepressants' are some of the determinants of the symptom clusters. Duh!

    The abstract makes no claims about the various factors associated with their symptom clusters affecting recovery. In fact, I suspect they did not find such a link at all, or they would have told us about it.
    Recovery sounds similar across all the clusters.

    It makes it sound as though it's just a problem of fat unhealthy unhappy women who smoke. As Rvallee says though - it's hardly ground breaking to find that people with co-morbidities including mental health symptoms have more symptoms. Whether that has much to do with Long Covid is another question. And the idea that the number of symptoms someone reports (which may or may not be related to the disease) is a good measure of disease impact is pretty flawed.

    Did they account for depression, anxiety and use of anti-depressants as a consequence of Long Covid onset (i.e. occurring after onset) rather than a cause?

    Maybe I'll find some enthusiasm to get past the abstract tomorrow. It's possible that the data is actually quite useful at showing that a reduction in physical symptoms is not related to mental health status.
     
    Hutan, May 24, 2024
    #5
    alktipping, Lilas, Peter Trewhitt and 6 others like this.

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