Daily Dose: Long-COVID Rehabilitation Interventions

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in JAMA Network Open that aimed to synthesize the findings of existing studies that report on physical capacity and quality of life (QoL) outcomes following rehabilitation interventions in patients with post-COVID-19 condition (PCC).

The study

Researchers searched MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry for studies published between January 2020 and February 2023. Eligible Studies were randomized trials of individuals with PCC that compared rehabilitation interventions (eg, respiratory training and aerobic and resistance exercises) with a common comparison group identified as “control” (placebo, sham, waiting list, or usual care).

For the primary outcome, investigators were interested in participants’ capacity for functional exercise, assessed via 6-minute walking test at the closest post intervention time. They identified secondary outcomes as fatigue, lower limb muscle function, dyspnea, respiratory function, and QoL.

Findings

Eligible randomized trials numbered 14, which included 1244 participants. Six trials included those who had been hospitalized for COVID-19; participants in 3 trials had not been hospitalized for their infection; and 5 trials included a mix of hospitalized and nonhospitalized participants.

The most common comparator to the specified rehabilitation interventions was usual care which most often took the form of respiratory training and exercise-based, self-management education; the most common limitations when usual care was unsupervised were incorrect use of equipment and poor execution of breathing techniques.

Overall, the research team reported, rehabilitation interventions for individuals affected by PCC were associated with a greater improvement in functional exercise capacity, dyspnea, and QoL compared with usual care. They found consistently that the interventions had a greater probability of superiority vs usual care across all of the outcomes, with a range between 85% and 99%. Rehabilitation programs also showed greater probability of reaching the minimum important difference threshold for functional aerobic capacity, functional lower limb strength, dyspnea, and QoL when compared with usual care; those probabilities ranged 84% and 95%.

Given the largely positive findings for the potential effects of structured rehabilitation after infection with COVID-19, the investigators end their results section stating that they did not find compelling evidence among the studies reviewed for a difference in the odds of adverse events.

Authors' comment

"The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary."

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