The ME Association Cinical Assessment Toolkit (ME-CAT) and app (autonom-e)

Trish

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The ME Association Cinical Assessment Toolkit (ME-CAT) and app (autonom-e)


Phase I

The toolkit is now available to anyone who wishes to use it. It is available digitally via the apps (one for clinical services and one for the public). It is quicker and easier to complete the toolkit digitally as the scores are calculated automatically, but hard copies to download are also available to maximise access.

The second phase will:

  • Disseminate findings via peer-reviewed publications.
  • Expand the toolkit with three new resources (co-morbidities checklist, care and support plan template, and a version for children and young people).
Read Phase II update

The MEA App​

A publicly available app curated by the ME Association has now been launched with the digital Clinical Assessment Toolkit, including options to use with clinical services.

Features

  • Access the ME Association Clinical Assessment Toolkit to assess: Symptom burden using the TIMES, PEM using the PASS, Clinical needs using the CNAME, Patient experience using the PREM and Activities using the MEAQ.
  • Share clinical reports with clinicians, employers and relatives
  • Access support resources curated by the ME Association
  • Access reporting and future updates from £1.67 per month
 
Honestly the MEA is working for the enemy is my thoughts after this, their erasure for the severe continues as does the minimisation of the disease and its severity and impacts. It also bakes in a model which involves healthcare being paternalistic in providing advice on how to live your life as the only thing they are going to do. This documents should be yeeted into the sun.

below is just a smattering of thoughts as I went through the 4 documents they have provided. It is by no means a coherent set of thoughts or a complete list of the issues, I didn't start out with the intent of anything but reading them but the moment I saw PEM misdescribed I ended up writing.

The times document is about lists of symptoms and whether you have them or not and how severely.
The PASS document is all about triggers and how long the symptoms those triggers cause last for.
CNAME is about what you need in terms of understanding ME/CFS and a care/support plan and which pieces you might need.
The PREM document is the questionnaire they might send you a month after seeing the doctor to ask if it was useful or not.

TIMES document
PEM described as
Post exertional malaise (PEM)
PEM describes a worsening of symptoms after seemingly trivial or undemanding activity of any description. It is often referred to as ‘a crash’. Onset may be delayed and it can be long lasting.
That isn't a correct definition of PEM.

It gets worse, the entire cognitive questions I am not convinced these questions distinguish from something like ADHD in the cognitive symptoms. for example

Difficulty starting and/or finishing tasks
Difficulty making decisions and problem-solving (‘working things out’)
Difficulty getting organised
Difficulty multi-tasking (doing more than one thing at once e.g. walking and talking)

Pain section has jaw and eye pain but not coat hanger and other back pain. That seems backwards in terms of prevalence.

Then in GI symptoms we have this lovely minimising question
Being too tired to eat

NB. If you are unable to eat, answer ‘very severe’​

Too tired? Tired?! Not sure this document is meant to make an ME patient angry and mad but it sure does!

PASS document

Please list which triggers have been most troublesome in the last month​
which is asking for the three triggers that have impacted you in the last month. But the triggers contain Allergies, intolerances, sensory stimulus and change in weather/seasonal changes. The big problem with triggers is that are specific to what has been happening in the last month. If someone was doing building work next door that is a big problem, but its less likely in the winter. Similarly allergies from pollen etc are mostly a spring thing. Having a questionnaire produce different results in different seasons is fatally flawed!

Overall, in the last month what level of activity has typically triggered a worsening of symptoms/ PEM?
NB. This question refers to what is demanding or stressful activity for you at present. It is not asking for a comparison with other people, or how you were before you became ill. Essentially, it is asking for a ballpark figure about how much you can do without worsening your symptoms / triggering PEM. This identifies the size of your ‘energy envelope’, which is an important issue when it comes to managing energy and activity levels, and pacing.​

The distinction between mildly strenuous , moderately strenuous and strenuous seems to me to be a bit problematic, it depends entirely on how severe someone is. Strenuous should basically always cause symptoms when its centred on the persons capacity so the question makes no sense with the note, and without it its severity dependent. Whatever they were trying to get at with this question it fails.

Duration of the change in symptoms
A day or less, several days or a week or more​
Then there is the duration of PEM which has just options up to a week or more. The very concept of a permanent worsening isn't even in here let alone months or years. This very much focusses on the mild and moderate, the idea of rolling PEM for months or years on end doesn't even factor anywhere.

CNAME document
This document is patronising. People with ME do not need help with goals or action plans! There are some things people likely do need help with, like their doctor actually diagnosing them and then supporting PIP applications and speaking to social services for in house support and providing medical/dentist aid in their homes but most of that isn't here. Its just lets explain how your disease works to your family, a leaflet would do that better as would my doctor not dismissing my disease even exists for the past decade!

PREM-ME document
This is just the typical exit "did we do a good job". I do find the question about whether I understand ME/CFS better or worse after the service kind of funny. Obviously I should never feel like we went backwards but I can't help but think its going to be very common to do so given what is being fed into this.
I was helped to develop a care and support plan​
Sigh, its all being put on the patient, still. Got to look after ourselves and even write the plan to do it!

I was helped to identify and set my own goals​
How it is they still think people can set goals with this condition I have no idea, it bites you every time you try to do anything.

I learnt to identify and manage fluctuations, setbacks and relapses​
Something about this question feels a little sinister in the context. Its like they are expecting me to keep crashing and just to treat them as minor setbacks and fluctuations but its OK because I have a plan and goals.

I received information and advice about how to cope with personal activities of daily living (e.g. washing, dressing, toileting)​
I don't want advice I want real help! Advice from someone who has no idea about this disease is of no use whatsoever.

I received help (where possible) to manage or improve my symptoms​
The only question that really matters in the entire thing, which is the entire point of medicine. Even its about as non-committal as you can get to alluding to but not actually offering treatment. The lack of ambition to even consider medicine is astounding given this comes from the MEA.

I was given information about how to obtain on-going health-care support after discharge​
This all but confirms they are going to be discharging patients that are still sick after they have passed information on. This is a completely missed opportunity to build a register of patients and have people available for trials.
 
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Thanks BrightCandle. That is very much my thoughts too. I downloaded the app and did the questionnaires quickly there just to get a feel of how the app works and what is on it.
If you want to fill them in on the app you have to be prepared to give your email address, name and some personal details. There's a lot of stuff about privacy policy but it seems to allow the MEA and researchers to use your anonymised data. I guess you could enter fake details if you want to.

The app just has the quesionnaires, and links to a whole bunch of MEA leaflets.

If you're prepared to pay a monthly or yearly fee, you can get it to calculate your scores on the questionaires and provide a report which I assume will just be summary scores and the bits you've flled in in words.

I looked at the scoring system for the PEM questionnaire on the printable copy. It's bonkers. For example you score more if your PEM is delayed by several days than if it is delayed by less than a day. And all the scores for each of numbers of PEM symptoms, delay time, duration, etc are just added together into a single meaningless number.

I don't recall any question in the PEM one about change in function during PEM, which to me seems the main disabling feature of PEM.

If a clinic wants to use the app with their patients they can pay a licence fee, and I guess a fee per patient as well, the money presumably going to ELAROS. You sign up to the app then using the code the clinic gives you, and then everything you fill in on the questionnaires and the summary reports this generates is accessible to the clinicians.
 
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The distinction between mildly strenuous , moderately strenuous and strenuous seems to me to be a bit problematic, it depends entirely on how severe someone is. Strenuous should basically always cause symptoms when its centred on the persons capacity so the question makes no sense with the note, and without it its severity dependent. Whatever they were trying to get at with this question it fails.
This is one of the areas on the PEM questionnaire that made no sense to me in the earlier versions we tried. My answer is 'how long is a piece of string'.

I agree the whole package is clearly intended to perpetuate the BACME style therapist led clinics for people with mild to moderate ME/CFS.

People with severe and very severe ME/CFS, which is probably most of us at least some of the time, need a completely different sort of service for which this sort of form filling is neither necessary, useful or appropriate. We need a joined up service suitable for all of us as we move through severity levels and needs.
 
I looked at the scoring system for the PEM questionnaire on the printable copy. It's bonkers. For example you score more if your PEM is delayed by several days than if it is delayed by less than a day. And all the scores for each of numbers of PEM symptoms, delay time, duration, etc are just added together into a single meaningless number.

I don't recall any question in the PEM one about change in function during PEM, which to me seems the main disabling feature of PEM.
I missed that and I agree its so dumb, its obviously wrong having a longer PEM cycle doesn't inheritly map to a more severe ME, if it does I feel citation needed!!!

Actually it brings me to a wider problem with the scoring. Adding the scores up makes no sense, since a lot of them are basically pointing at mild, moderate, severe its not adding up that they need, its averaging like FUNCAP. But also even then what FUNCAP is doing is also per area and its not preloaded with an idea of how disabling the disease is because its activities based rather than symptom based. The MEA thinks it can craft a question such that the answers map to the severity levels but where is the science proving this link from these questionaires? They surely need to validate their assumptions and I bet they will fail quite often because of the issues with the questions.

Ultimately this scoring system fails if you are more or less severe in one area than the others because its just a straight sum. Its not validated against the disease and a lot of scoring just doesn't work because severity doesn't map that way.
 
I wonder why they called the MEA app autonom-e.

My first thought was that it might refer to BACME's dysregulation model which on the basis of very weak evidence, puts the autonomic nervous system at the heart of their model of what is perpetuating ME/CFS, especially the stress response.

Or could it be that the app is supposed to replace any medical care, giving us autonomy (hollow laugh).

The test of its value or otherwise will be whether pwME asked to use it as part of their interaction with NHS ME/CFS clinics. I predict most will find it a waste of time after the first couple of clinic visits.
 
I wonder why they called the MEA app autonom-e.

My first thought was that it might refer to BACME's dysregulation model which on the basis of very weak evidence, puts the autonomic nervous system at the heart of their model of what is perpetuating ME/CFS, especially the stress response.

Or could it be that the app is supposed to replace any medical care, giving us autonomy (hollow laugh).

The test of its value or otherwise will be whether pwME asked to use it as part of their interaction with NHS ME/CFS clinics. I predict most will find it a waste of time after the first couple of clinic visits.

Busy-work is one way of putting it but its more than that its being seen to pretned to measure something that is nonsense and a distraction so that they can keep invalidating people. It's terrifying they didn't realise that the 'additive' part was the key bit, along with the 'patterns'

WHat these people seem to have as a mental picture of what ME/CFS is, and therefore what PEM is (which needs to be in a picture that includes both the full spectrum with people moving up and down it and the cumulative 'didn't recover from x, before y piled on thne z 2million times) is nothing to do with the 'gist/penny drop' of what it is.


I think we could do with some really private threads (which can then maybe become members only ones, but whilst we are getting our heads around how to talk about this and figure out some of the 'higher level' findings so we have words to do so then there is that worry of having to think about giving away a lot that is personal about yourself etc) on discussing what we have found on HR-related devices and apps.

One fairly obvious thing is that I have days where - due to PEM or if we want to call it exhaustion - on certain days the same very low-demand 'activities' (toilet, sitting up, lying down being awake, tea etc) produce completely different measures compared to other days.

The idea that on the days where it is 'just' sitting up a bit more (I've had days where this happens lying down) putting that time period into the exertion zone, where the same angle might be the rest zone on another day is to do with something they've invented because they want to deliver some x from their very poor, limited list of therapies instead of understand 'what is happenning' is terrifying. It's also why I'm cautious about the cart-before horsers (or more precisely 'already decided what we want, just fishing for what we can make fit what we want to see') anywhere near the app data until those who are actually good at analysing patterns have worked out how to put protocols on for interpretation.

It's stupid because if I had a heavy day for me 'activity-wise' and then at a later point the effects of that is that Im going over points doing 'nothing' on another day there are all sorts of hazards.

And none of it is to do with 'calming my system', I assume that is there because if my HR wasn't rising to cope with the incline on those days then worse things would happen - the issue is the incline that day is 'a lot'. Resting it off so I then eventually get good restful sleep does that, and the diagram shows that unless you are a predator looking to severely manipulate the interpretation.

I can imagine the deluded advice that would be going on in the minds of these crazy, scaring me new imagined 'whats going on' concepts of 'our being' that someone whose heart rate has to raise for them to sit on days they're more ill due to prior exertion either being told to do slow breathing and meditation first - to do the opposite of what is useful and potentially being stupid enough to think the compensatory mechanism of raised HR to allow us not to collapse when we sit is instead a 'fault' so to be made to do minfulness and slow breathing on it. Or, even stupider for them to think that 'practising sitting' is the issue and will make for a smoother HR - ignoring its variation being due to cumulative exertion prior, and that being obvious because its fine on days after rest but higher on bad days and thinking torturing us to do '40 a day' will make it 'more consistent'.

I find the whole stupidity of that so deeply offensive and terrifyingly dangerous as a new trope to live under and ruin any bits of 'peace' I might manufacture in my very limited life normal people would assume is 'so sad' but you find a way to make it something. It just feels so predatory and all about themselves (whilst telling themselves aren't they great so they don't realise it - I hate that 'BS-helper type' they are a very hamrful demographic who aren't helpers but people who have very defined things they 'will do' and call it help and impose it whether it harms or not and have been destructive to a level that can't be captured or described.

Hence why I'm determined that any conversation on this is not going to give these types any access because they are people determined to not 'hear' or 'learn' but to take out of context and cherry-pick and if they got near a persons HR stuff would cause havoc. Those things are currently just there as a bit of validating and interesting info to us, when we want to look at them and compare them to our experiences that we know aren't at least as deluded as their ideas.

But if your training and role shoves you into a cupboard/cul-de-sac where you can't do science on the medicine side, because you just get to deal with the 'therapising and misogynising/psychologising (which isn't psychology but anti-psych that harms to weaponise cod psych)' then your ability to see in the 'what do you see' when you look at something ends up limited to only being allowed to say you see it is it fits in your territory it seems so is producing some pretty weird stuff.

Their rule seems to be to avoid curiosity on how the body is really working and everything has to only be seen in the context of the housewives tales they think is 'sciene' instead of storytelling versions gleaned for very different populations and conditions that have been mis-extrapolated. How an entire industry that wants to make its business the fake fight or flight story (which is about adrenaline and was from a physiologist: https://pmc.ncbi.nlm.nih.gov/articles/PMC1447286/ ) that has been slowly chinese whispered into different forms and a few other similarly mis-appropriated myths as if they are the principle of gravity, and think everything they see is in those terms rather than 'see what you see first' etc.
 
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Busy-work is one way of putting it but its more than that its being seen to pretned to measure something that is nonsense and a distraction so that they can keep invalidating people. It's terrifying they didn't realise that the 'additive' part was the key bit, along with the 'patterns'

WHat these people seem to have as a mental picture of what ME/CFS is, and therefore what PEM is (which needs to be in a picture that includes both the full spectrum with people moving up and down it and the cumulative 'didn't recover from x, before y piled on thne z 2million times) is nothing to do with the 'gist/penny drop' of what it is.


I think we could do with some really private threads (which can then maybe become members only ones, but whilst we are getting our heads around how to talk about this and figure out some of the 'higher level' findings so we have words to do so then there is that worry of having to think about giving away a lot that is personal about yourself etc) on discussing what we have found on HR-related devices and apps.

One fairly obvious thing is that I have days where - due to PEM or if we want to call it exhaustion - on certain days the same very low-demand 'activities' (toilet, sitting up, lying down being awake, tea etc) produce completely different measures compared to other days.

The idea that on the days where it is 'just' sitting up a bit more (I've had days where this happens lying down) putting that time period into the exertion zone, where the same angle might be the rest zone on another day is to do with something they've invented because they want to deliver some x from their very poor, limited list of therapies instead of understand 'what is happenning' is terrifying. It's also why I'm cautious about the cart-before horsers (or more precisely 'already decided what we want, just fishing for what we can make fit what we want to see') anywhere near the app data until those who are actually good at analysing patterns have worked out how to put protocols on for interpretation.

It's stupid because if I had a heavy day for me 'activity-wise' and then at a later point the effects of that is that Im going over points doing 'nothing' on another day there are all sorts of hazards.

And none of it is to do with 'calming my system', I assume that is there because if my HR wasn't rising to cope with the incline on those days then worse things would happen - the issue is the incline that day is 'a lot'. Resting it off so I then eventually get good restful sleep does that, and the diagram shows that unless you are a predator looking to severely manipulate the interpretation.

I can imagine the deluded advice that would be going on in the minds of these crazy, scaring me new imagined 'whats going on' concepts of 'our being' that someone whose heart rate has to raise for them to sit on days they're more ill due to prior exertion either being told to do slow breathing and meditation first - to do the opposite of what is useful and potentially being stupid enough to think the compensatory mechanism of raised HR to allow us not to collapse when we sit is instead a 'fault' so to be made to do minfulness and slow breathing on it. Or, even stupider for them to think that 'practising sitting' is the issue and will make for a smoother HR - ignoring its variation being due to cumulative exertion prior, and that being obvious because its fine on days after rest but higher on bad days and thinking torturing us to do '40 a day' will make it 'more consistent'.

I find the whole stupidity of that so deeply offensive and terrifyingly dangerous as a new trope to live under and ruin any bits of 'peace' I might manufacture in my very limited life normal people would assume is 'so sad' but you find a way to make it something. It just feels so predatory and all about themselves (whilst telling themselves aren't they great so they don't realise it - I hate that 'BS-helper type' they are a very hamrful demographic who aren't helpers but people who have very defined things they 'will do' and call it help and impose it whether it harms or not and have been destructive to a level that can't be captured or described.

Hence why I'm determined that any conversation on this is not going to give these types any access because they are people determined to not 'hear' or 'learn' but to take out of context and cherry-pick and if they got near a persons HR stuff would cause havoc. Those things are currently just there as a bit of validating and interesting info to us, when we want to look at them and compare them to our experiences that we know aren't at least as deluded as their ideas.

But if your training and role shoves you into a cupboard/cul-de-sac where you can't do science on the medicine side, because you just get to deal with the 'therapising and misogynising/psychologising (which isn't psychology but anti-psych that harms to weaponise cod psych)' then your ability to see in the 'what do you see' when you look at something ends up limited to only being allowed to say you see it is it fits in your territory it seems so is producing some pretty weird stuff.

Their rule seems to be to avoid curiosity on how the body is really working and everything has to only be seen in the context of the housewives tales they think is 'sciene' instead of storytelling versions gleaned for very different populations and conditions that have been mis-extrapolated. How an entire industry that wants to make its business the fake fight or flight story (which is about adrenaline and was from a physiologist: https://pmc.ncbi.nlm.nih.gov/articles/PMC1447286/ ) that has been slowly chinese whispered into different forms and a few other similarly mis-appropriated myths as if they are the principle of gravity, and think everything they see is in those terms rather than 'see what you see first' etc.


This !!

Thank you @bobbler
.
 
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I think we could do with some really private threads (which can then maybe become members only ones, but whilst we are getting our heads around how to talk about this and figure out some of the 'higher level' findings so we have words to do so then there is that worry of having to think about giving away a lot that is personal about yourself etc) on discussing what we have found on HR-related devices and apps.
You can start a members only thread if you want to, or report to mods if you want your post moved to members only, or help with setting up a thread.
 
I wonder which gold standards that were used to create that scoring system..
There was a very long, boring explanation about questionnaire validation methods IIRC, which is fine if you’re the Head of Marketing for Halifax Bank doing a customer satisfaction survey, but clearly hasn't helped in this scenario.

They have ME so you can’t say they don’t understand ME (blows raspberry :dead:)
 
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