September 19, 2023

expert reaction to systematic review and meta-analysis of rehabilitation interventions for Long COVID in adults

A review and meta-analysis published in JAMA Network Open looks at rehabilitation interventions for Long COVID in adults.

Prof Fiona Jones, Professor of Rehabilitation Research at St George’s, University of London, said:

“Rehabilitation trials are often highly complex to deliver. They have multiple interacting components made more challenging when evaluating interventions for people living with a condition such as long Covid which fluctuates, has multiple symptoms, and is unpredictable.

“The methodology employed and the systematic quality of the reporting in this study is clear, and the authors reach their conclusion of a high probability of improvements in exercise capacity, dyspnoea and quality of life associated with the interventions but I believe the findings are somewhat overinflated. 

“Whilst the findings are new, rehabilitation trials such as those included in this study raise a considerable number of unanswered questions. Not least whether the focus on one outcome measure (6-minute walk test) at a defined timepoint will answer the question most likely to be asked by people with long Covid about how they can find stability in symptoms and build activity without triggering other complications such as Post Exertional Malaise (PEM). Additionally, inclusion criteria are broad and heterogeneous including participants both hospitalised and non-hospitalised so it cannot be said with any great conviction who these trials work for. The interventions are only respiratory or exercise based but it is well known that people with long Covid live with multiple symptoms – the most common of which is fatigue, of which no conclusions have been made.

“Finally, one of the main points in the discussion is that current standard care (the comparator) is provided in the form of self-management in ambulatory or home-based settings. And that respiratory training and exercised-based rehabilitation has greater benefit. However, none of the trials included detail about the type or content of self-management approaches which could well have been limited the provision of information or access to digital tools and apps. All of which are known to be more effective when combined tailored and combined with holistic based rehabilitation interventions.”

‘Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition’ by Dimitra V. Pouliopoulou et al. was published in JAMA Network Open at 16:00 UK time on Tuesday 19^th September. 

DOI: 10.1001/jamanetworkopen.2023.33838 

Declared interests

Prof Fiona Jones: “I am the Co-CI of the Listen trial, and Chief Executive of a Social Enterprise Bridges Self-Management.”