Trajectories of persistent physical symptoms in primary care: A secondary analysis of the PsicAP randomized clinical trial... 2026 Prieto-Vila et al

Andy

Andy

Senior Member (Voting rights)
Full title: Trajectories of persistent physical symptoms in primary care: A secondary analysis of the PsicAP randomized clinical trial comparing CBT versus treatment as usual

Highlights

• Distinct 12-month PPS trajectories were identified: recovery, moderate chronic, and severe chronic.
• Distributions of the trajectories differed between TAU and TDG-CBT.
• In TAU, chronicity linked to being a woman, partnership, depressive symptoms.
• In TDG-CBT, chronicity linked to no partner, low income, depression, panic.
• Trajectory identification and baseline factors may guide tailored PPS interventions.

Abstract

Background
The course of persistent physical symptoms (PPS) is heterogeneous, yet little is known about distinct symptom trajectories and their baseline predictors across treatment conditions in primary care. This study aimed to identify PPS trajectories and their associated baseline characteristics in patients receiving treatment as usual (TAU) or transdiagnostic group cognitive behavioral therapy (TDG-CBT).

Methods
Latent Class Growth Analysis (LCGA) was used to identify trajectories of PPS (PHQ-15) over 12 months in 497 participants from the PsicAP randomized clinical trial (TAU: n = 242; TDG-CBT: n = 255). Baseline predictors of trajectory membership were examined using multinomial logistic regression.

Results
Three trajectories were identified within each treatment group: recovery, moderate chronic, and severe chronic. Recovery (class 1) was more frequent in TDG-CBT (54.9%) than in TAU (28.9%), whereas moderate chronic (class 2) and severe chronic (class 3) were more common in TAU (class 2 = 49.2%, class 3 = 21.9%) than in TDG-CBT (class 2 = 32.6%, class 3 = 12.6%). In TAU, chronic trajectories were associated with being female, having a partner, and higher baseline depressive symptoms. In TDG-CBT, chronic trajectories were associated with not having a partner, lower income, higher depressive and panic symptoms, and antidepressant use.

Conclusions
TDG-CBT nearly doubles the likelihood of recovery and reduces chronic symptom trajectories compared with TAU. Baseline clinical severity and socioeconomic vulnerability may help identify patients at risk of chronic symptom courses and guide more tailored treatment strategies.

Open access
 
So when people have treatment as usual, being in a partnership is predictive of not recovering. When people have CBT, not being in a partnership is predictive of not recovering. It's sounding a bit random.

They talk about 'baseline predictors of trajectory membership' and link depression with non-recovery. But, of course, chronic illness can cause depression.
 
(Above cross-posted with Hutan) The authors didn't dwell on this question. The discussion says —

In TAU, having a partner was associated with chronic trajectories, whereas in TDG-CBT it was associated with a lower likelihood of moderate chronic trajectories. The mechanisms underlying this pattern remain unclear, as relational quality and perceived social support were not assessed.
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SNT Gatchaman said:
Wait, so if you don't "treat" them —

Having a partner leads to chronicity.

But if you do "treat" them (with group CBT) —

Having a partner leads to not chronicity.

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Could we skip the CBT and just take away their partner and then they'll get better?
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The research parodying itself. Bigly :banghead:

"The mechanisms underlying this pattern remain unclear, as relational quality and perceived social support were not assessed."

Oh dear...... It must be hard to face that using such research methods and trying to unpack, unpick or derive anything meaningful is vanishingly unlikely. Gives people jobs and meaning, I guess. The patients, not so much.
 
Yet another BPS paper that makes the basic mistake of comparing in-group changes between groups, rather than comparing between-group changes directly.

If you have an arm with more bias, that arm will always compare favourably if you look at how many in each arm that crosses any given threshold. This is the same trick Nerli used in SIPCOV.

In the original trail there seems to be an error in the graphs:

Table 2 says that the treatment group had a mean of 6.6 for GAD-7 at 12 months, but the graph puts it at below 6. For CAU it was 8.8, which aligns with the graph.

Regardless, the MCID for GAD-7 is usually set to 3-4 points, so the intervention was clearly not effective even in a very biased trial.

I haven’t checked any of the other numbers.

They claim to have used some kind of statistical measurement for MCID instead, but give no explanation for why that’s better than using the regular MCID. Presumably it makes it easier to claim you have a positive result..
 
I fail to see how any of this is more useful than doing astrological phrenology instead, or whatever. It's so obviously arbitrary and pointless.
The paper said:
In TAU, chronic trajectories were associated with being female, having a partner, and higher baseline depressive symptoms. In TDG-CBT, chronic trajectories were associated with not having a partner, lower income, higher depressive and panic symptoms, and antidepressant use.
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It would not be hard to fish for similar 'associations' having to do with astrological, uh, things, and cranial morphology. Or hobbies. Perhaps skin tone, or pet preferences.
little is known about distinct symptom trajectories and their baseline predictors across treatment conditions in primary care
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A fact that remains unchanged after every study, including this one. Although, is this a study, or a trial? Both, I guess? Neither? Just winging it because reasons.

A parody of research indeed, @Joan Crawford.
 
Hutan said:
Unfortunately, there are enough natural experiments of that to enable us to say pretty safely that 'taking away the partner' is not a cure for ME/CFS.
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No, but it is likely a cure for a lot of other things in many circumstances, even if not for ME/CFS. I have a few couples I know where I wish they'd take away the partner!!
 
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