Medical Benchmarks and the Myth of the Universal Patient From growth charts to anemia thresholds, clinical standards assume a single human prototype. Why are we still using one-size-fits-all health metrics?

Embracing the #nonergodicity of biology is the future of health.

#complexityscience #medicine

www.newyorker.com/magazine/202...

File under #nonergodicity

“We instead observed substantial interindividual variability..”
#nonergodicity #humanhealth #medicine #painscience

Are Tailored Interventions to Modifiable Psychosocial Risk Factors Effective in Reducing Pain Intensity and Disability in Low Back Pain? A Systematic Review With Meta-Analysis of Randomized Trials | Journal of Orthopaedic & Sports Physical Therapy OBJECTIVE: To determine whether tailored interventions based on patients' psychological profiles enhanced the outcomes of interventions in people with non-specific low back pain (NSLBP), compared to usual care. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Embase, Cochrane, Medline, Web of Science, CINAHL, and PsycINFO were searched from their inception until November 2, 2023. STUDY SELECTION CRITERIA: We included randomized clinical trials (RCTs) that compared psychological interventions to any alternatives without psychological components in patients with NSLBP who were stratified based on their psychological risk factors using the cutoff of the questionnaires measuring a psychological construct. DATA SYNTHESIS: The outcomes were pain intensity and disability. The revised Cochrane risk-of-bias tool for randomized trials was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to judge certainty of evidence. RESULTS: Twenty-nine trials were included, most presenting some concerns for the risk of bias. The certainty of evidence was mostly low, with moderate to substantial heterogeneity. Using psychological stratification, individuals who received a psychological intervention (versus usual care) reported lower pain intensity at short (MD -0.22, 95% confidence interval [CI] -0.41, -0.02) and mid-term (MD -0.37, 95% CI -0.57, -0.16). For disability, there was a larger improvement with psychological interventions versus usual care at short- (SMD -0.17; 95% CI -0.32, -0.02), mid- (SMD -0.16; 95% CI -0.28, -0.05), and long-term (SMD -0.17; 95% CI -0.29, -0.04) follow-ups. CONCLUSIONS: Psychological interventions had a positive impact, although small, on reducing pain intensity and disability in patients with low back pain and psychological risk factors.

While this analysis doesn't account for #nonergodicity, relying on group-level assumptions that must later be compared to individual data. Still, it supports the need for individualized approaches in #chronicpain.
#physio #physicaltherapy #painscience #medicine

www.jospt.org/doi/abs/10.2...

Individual & group #variation across multiple levels of selection

#multilevelselection #evolution&behavior #behavior #pain #painscience #nonergodicity

Gait is an #individual signature and we’re getting better at reading it. Great work @dslijepcevic.bsky.social !

#nonergodicity #medicine #pain #painscience #physio #physiotherapy

The impact of weather on individual health is highly variable once again demonstrating the need to appreciate #nonergodicity and #multilevelselection

#evolution #health #behavior #mentalhealth #painscience #pain

arxiv.org/pdf/2404.11212

Are endurance runners at higher risk of depression? Screening for depression and risk factors - PubMed Depression is an important public health issue. In the general adult population about 6.7% are affected. Little data are available in endurance runners. We conducted a prospective survey study screeni...

Endurance runners have a high rate of depression -another example of our flawed assumptions of universal benefits of #exercise on #wellness in the absence of #context. One size does not fit all #nonergodicity #behavior #medicine #physio #physiotherapy

pubmed.ncbi.nlm.nih.gov/39626779/

Toward empirical process-based case conceptualization: An idionomic network examination of the process-based assessment tool Syndromal classification has failed to produce a progressive science of case conceptualization for mental and behavioral health issues. An idiographic…

#health & #Wellness must be individualized - what works for one person may not work for another. Blanket advice on #exercise, #sleep, #nutrition, or #stressmanagement assumes a "normal" that doesn’t exist.

#nonergodicity #medicine #behavior #painscience #physio
www.sciencedirect.com/science/arti...

Enhancing psychological assessment and treatment of chronic pain: A research agenda for personalized and process-based approaches The heterogeneity of chronic pain and stagnating improvements in treatment effectiveness have prompted calls for a shift toward personalized and proce…

#chronicpain requires true individualization. This requires understanding of the #nonergodicity of biological systems and a new approach to care such as a #processbasedapproach

#painscience #medicine #physio #physicaltherapy #neuroscience #behavior
www.sciencedirect.com/science/arti...

The Influence of “Labels” for Neck Pain on Recovery Expectations Following a Motor Vehicle Crash: An Online-Randomized Vignette-Based Experiment | Journal of Orthopaedic & Sports Physical Therapy OBJECTIVES: To (1) investigate whether different labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management beliefs, (2) explore reasons for low recovery expectations and greater likelihood for lodging a claim, and (3) explore the moderating effect of neck pain history and sociodemographic characteristics. DESIGN: Online randomized experiment with nested qualitative content analysis. METHODS: We randomized 2229 participants from the general population (mean age: 46.7 ± 17.5 years; 72.4% females; 66% with previous or current neck pain; 10% with an MVC experience) to read 1 of 5 scenarios describing a patient with neck pain after an MVC, each was labeled as whiplash injury, whiplash-associated disorder, posttraumatic neck pain, neck pain, or neck strain. The primary outcome was recovery expectations, rated on a 0- to 10-point scale. RESULTS: Participants allocated to whiplash-associated disorder or neck pain had lower recovery expectations than those allocated to neck strain (adjusted mean difference [95% confidence interval]: −0.5 [−0.9 to −0.1] for both comparisons). Whiplash-associated disorder led to more recovery uncertainty, while neck pain led to greater doubt about the health care provider. Most secondary outcomes showed significant but small differences. Participants allocated to neck strain were less inclined to claim than those allocated to whiplash-associated disorder or whiplash injury due to less perceived need for financial support. Neck pain history moderated labeling effects on recovery expectations; household income moderated the claim intention. CONCLUSIONS: Labels for neck pain after an MVC influenced recovery expectations and management preferences. The clinical relevance of the small effects was unclear. J Orthop Sports Phys Ther 2024;54(11):711-720. Epub 5 September 2024. doi:10.2519/jospt.2024.12590

Cultural labels shape our #symbotype and influence our #phenotype over time. Identifying which words matter requires personalized analysis that respects #nonergodicity.

#physio #physiotherapy #painscience #medicine #behavioralscience
www.jospt.org/doi/abs/10.2...

Reproducible biomarkers: Leveraging nonlinear descriptors in the face of non-ergodicity Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different indiv...

That sleek biomarker device or app tracking your #HRV? Its calculations likely aren't tailored to you, making it a poor reflection of your unique physiology—yet another casualty of #nonergodicity.

#interoception #medicine #sportsmedicine #painscience #physio
pmc.ncbi.nlm.nih.gov/articles/PMC...

Needlestick Distal Nerve Injury in Rats Models Symptoms of... : Anesthesia & Analgesia cannot establish causality. Therefore, we, prospectively investigated whether DNIs are sufficient to cause CRPS-like abnormalities in animals. We used needlestick, a cause of human CRPS, to evaluate l...

Needlestick injuries causing #CRPS & #chronicpain follow #nonergodicity, where history & #context drive interindividual variability. Can we truly rule out #adverseevents to justify widespread needling interventions?
#painscience #physio #physicaltherapy #medicine

journals.lww.com/anesthesia-a...

OSF

Exploring #nonergodicity in #chronicpain challenges the notion of static #phenotypes or fixed pain categories. Pain doesn’t fit neatly into boxes—it’s dynamic and uniquely #individual.

#painscience #physio #physicaltherapy #medicine #neuroscience #medicine #idontfitinabox

Lasota addressed early #ergodic problems in biology, highlighting how our normative, linear view of biology is deeply flawed but often overlooked and underdiscussed.

#nonergodicity #science #biology #painscience #medicine #neuroscience #pain

www.numdam.org/item/AST_197...

The Influence of Dietary Carbohydrate on Perceived Recovery Status Differs at the Group and Individual Level—Evidence of Nonergodicity Among Endurance Athletes - Journal of Science in Sport and Exerci... Purpose Research findings are typically reported at the group level but applied to individuals. However, an emerging issue in sports science concerns nonergodicity—whereby group-level data cannot be g...

#nonergodicity in #sportsmedicine & #nutrition - It's time to move beyond "good" or "bad" nutrition for performance and health toward individual-level analysis.

#science #medicine #painscience #sportskyence
link.springer.com/article/10.1...

On the implications of the classical ergodic theorems: analysis of developmental processes has to focus on intra-individual variation - PubMed It is argued that general mathematical-statistical theorems imply that standard statistical analysis techniques of inter-individual variation are invalid to investigate developmental processes. Develo...

Starting a series on #NonErgodicity. Highlighting Molenaar's work: Traditional RCT stats often fail to apply meaningfully to individuals, revealing the limits of group-based insights.
#science #painscience #medicine #behavioralscience #physio #physicaltherapy

pubmed.ncbi.nlm.nih.gov/18085558/

Opinion | The Certainty of Uncertainty There’s no avoiding uncertainty in economics, so we need tools to deal with it

Nonergodicity and complexity theory should be central to modern economics, but they've been ignored to its own detriment. This article offers an accessible summary of the critique according to Amar Bhide.

#complexity #nonergodicity #knightianuncertainty #EconSky #economics #frankknigth #amarbhide