Rehabilitation interventions are associated with improvement in functional exercise capacity, dyspnea, and quality of life in patients with post-COVID-19 condition (PCC), according to a study in JAMA Network Open.
Study authors sought to assess the value of rehabilitation interventions for post-COVID-19 condition (PCC), defined by the World Health Organization as having symptoms that develop or persist 3 months after an initial COVID-19 infection. Outcomes included improvements in functional exercise capacity, muscle function, dyspnea, respiratory function, and quality of life. The primary outcome was functional exercise capacity based on the 6-minute walk test performance.
The systematic review and meta-analysis included a literature search in the MEDLINE, Scopus, CINAHL, and Clinical Trials Registry databases from January 2020 to February 2023. Eligible studies were randomized clinical trials that compared rehabilitation interventions, including respiratory training aerobic exercises and resistance exercises, with placebo, usual care, waitlist, or a control in adults with PCC.
The analysis included 14 trials with 1244 participants (median age, 50 [interquartile range {IQR}, 47-56] years; 45% female). The most common treatment interventions were breathing exercises, either alone (6 trials, 815 participants) or combined with resistance and/or aerobic training (5 trials, 298 participants). The most frequently used comparator was usual care with respiratory training and exercise-based, self-management education (13 studies, 1156 participants).
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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.
A total of 7 trials (389 participants) reported outcomes for functional exercise capacity with the 6-minute walk test, and the median follow-up regarding the primary outcome was 6 (IQR, 5.5-7.0) weeks. Rehabilitation interventions were associated with a higher level of improvement in functional exercise capacity vs usual care (standardized mean difference [SMD], -0.56; 95% credible interval [CrI], -0.87 to -0.22).
Intervention group participants covered greater distance (mean [SD] 35.84 [6.55] m) than patients in the usual care group during the 6-minute walk test (95% CI, 34.97-36.71 m). Low heterogeneity was demonstrated for exercise capacity (T2=0.04; 95% CrI, 0.00-0.60).
For dyspnea, 8 trials (573 participants) reported treatment outcomes, and rehabilitation interventions were associated with more improvement in functional exercise capacity vs usual care (SMD, -1.00; 95% CrI, -1.94 to -0.10). Quality of life was reported in 5 trials (366 participants), and rehabilitation interventions were associated with greater improvement in quality of life vs the comparison group (SMD, -0.41; 95% CrI, -0.73 to -0.06).
No strong evidence was observed for a difference in the odds of adverse events in 5 trials, with a wide 95% CrI suggesting a high level of uncertainty and imprecision in the estimate (OR, 1.68; 95% CrI, 0.32-9.94).
Notably, although fatigue is the most commonly observed symptom of PCC, the reviewers found limited evidence regarding the effect of rehabilitation interventions on the fatigue experienced by patients with PCC during daily activities.
Limitations of the published evidence include the lack of a meta-analysis component. Also, the overall evidence grade was moderate, and bias in the included studies regarding allocation concealment, blinding, and missing data may have resulted in an overestimation of the treatment outcomes. Furthermore, long-term follow-up was not performed.
“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 study authors concluded. However, they noted that “the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes,” and that more definitive evidence is needed.
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.