Dynergia

EN DE

FOR PHYSICIANS

A companion instrument — not an assessment.

Dynergia measures weekly how a person's functional capacity develops during psychiatric sick leave. It provides trajectory data for the time between your consultations. It does not assess work capacity, does not diagnose, and does not recommend treatment.

The decision stays where it belongs.

Assessing work capacity is a medical and legal task. Dynergia does not perform it and is not intended to prepare it. What the instrument provides is objective observation over time — where nothing is currently recorded: between consultations, across weeks, in the person’s everyday life.

Clinical judgement takes precedence: a differing medical decision is not a contradiction of the report but its intended application.

Three boundaries, stated explicitly:

No diagnosticsThe figure is not a screening instrument, not a test for a disorder, not a symptom measure.
No treatment recommendationNothing follows from the data — not medication, not therapy, not a work percentage.
No benefit decisionsUse for entitlement assessment, underwriting, or disclosure to employers is contractually excluded.

The Dynergia Method is care-management decision support anchored in the treating physician's authority. It informs reintegration decisions with objective longitudinal functional data; it does not adjudicate work capacity and does not prescribe treatment.

Function, not mood.

Three channels, combined weekly into one trajectory figure — always compared only with the same person’s own baseline, never with other people and never with a norm sample.

Attentional capacityA short performance test in the browser. What is measured is not whether someone can solve a task, but how stable performance remains over the duration of the test. Specifically: a 10-minute vigilance test within a session of about 13–15 minutes, in one continuous block, using the stimulus parameters of the brief form PVT-B (1–4 s interstimulus interval, 355 ms lapse flag). This exact combination has no published validation, and no norm comparison is claimed or possible.
Day structure & recoveryThe regularity of sleep timing and subjective recovery, reported each morning in a brief sleep block. The primary measure is the night-to-night variability of the sleep midpoint; sleep-timing regularity follows the Sleep Regularity Index, whose founding computation used daily sleep diaries (Phillips et al. 2017, Sci Rep 7:3216) — self-report is that index’s native data source. Where the insured person uploads data from a consumer wearable, passive rest-activity measures (IS, IV, RA, L5, M10) enrich the layer; without a sensor they are recorded as not measured — never estimated. In report-based weeks the layer measures sleep-timing regularity and subjective recovery only, and says so. No step counts, no location data, no content of any kind.
Intention and follow-throughA brief intention question in the morning, a brief follow-through question in the evening. The difference is a functional signal in its own right.

The three channels capture one slice of occupational functioning — social interaction, the capacity to handle conflict, and emotional self-regulation remain clinical judgement.

Foundations

The following work justifies the selection of instruments. It is not evidence for the FCI, which is not clinically validated.

The brief form PVT-B is sensitive to total and partial sleep deprivation; to create it, test duration was shortened from 10 to 3 minutes and the interstimulus interval from the standard 2–10 to 1–4 s (Basner, Mollicone & Dinges 2011, Acta Astronautica 69:949–959). The 3-minute PVT-B shows stable performance across sixteen repeated administrations in healthy adults (Basner et al. 2018, Sleep 41(1):zsx187). Whether that stability holds for our 10-minute variant, or in a clinical population, has not been tested.

For short PVT variants, mean reciprocal reaction time is more stable than lapse count, and the brief and ten-minute forms are not interchangeable (Antler et al. 2022, Front Neurosci 16:815697).

In clinical burnout, sustained mental activity produces earlier-onset subjective mental fatigue, reduced practice gains on attention and processing-speed tasks, and a late decrease in heart-rate variability (Gavelin et al. 2023, Biological Psychology 183:108661; supporting, Krabbe et al. 2017, Stress 20(4):333–340). Our compressed fatigability index is an untested adaptation of that paradigm.

The SART derives from Robertson et al. 1997 (Neuropsychologia 35(6):747–758).

The rhythm measures follow non-parametric chronobiology (Witting et al. 1990; Van Someren et al. 1999). The sleep items are informed by the Consensus Sleep Diary (Carney et al. 2012, Sleep 35(2):287–302) and the Munich Chronotype Questionnaire (Roenneberg et al. 2003, J Biol Rhythms 18(1):80–90); the measure of sleep-timing regularity follows the Sleep Regularity Index, whose founding computation used daily sleep diaries (Phillips et al. 2017, Sci Rep 7:3216).

Your patient decides who receives the report — not the insurer.

This is the core of the architecture, and it distinguishes Dynergia from everything else that reaches you from an insurer:

  • The insured person sees their report first.
  • They choose at the outset — and can change it at any time without justification — who else receives it: you as the treating physician, case management, both, or no one.
  • If a report reaches you, it is because your patient decided so. Not because an insurer paid for it.
  • The insurer receives only anonymised aggregate figures across all accompanied cases — never individual data, never raw data.

No additional obligation.

No monitoring dutyYou are not responsible for watching data or responding to trajectories.
No obligation to respondIf you do not look at a report, nothing follows from that — for you or for your patient.
No documentation burdenNothing has to be reported back, confirmed or countersigned.
No softwareNothing to install, nothing to learn.

Use the trajectory if it helps a conversation. If it does not, ignore it without consequence.

No real-time evaluation

Review is weekly. Up to eight days may pass between a measurement point and its review. Dynergia is not an emergency or crisis system, and it does not replace clinical observation. The crisis numbers 143, 147 and 144 appear on every screen the insured person sees — permanently, and independent of anything they enter.

How the report reaches you is not built yet.

That is a deliberate gap, not an omission. An instrument whose entire logic rests on the physician’s authority must build the route to the physician so that it works in a real practice — and not the way software imagines it.

What is established so far, from conversations with GPs:

Monthly rather than weeklyA weekly report is too much for a practice; the trajectory over a month is the right resolution.
Short and visualThe trajectory must be graspable in seconds.
No forced loginand no additional platform.

The implementation will be developed with the first pilot study, together with the physicians who will use it. If you have a view on this, we want to hear it.

Voices from practice

“For me this is a companion instrument.”

General practitioner, long-standing practice

“How a sick leave is accompanied today depends heavily on which insurer someone is with and who is managing the case. Some wait months before any support begins at all.”

General practitioner, long-standing practice

Questions, objections, disagreement

Dynergia is being built in conversation with physicians, care managers and affected people. If you think something about it is wrong, that is the most useful feedback we can get.

Contact: info@dynergia.ch