General practitioners should provide the cardiorespiratory rehabilitation’ ‘minimum advice’ for long COVID-19 patients, 2021, Benzarti et al

Excerpts from the letter:

Nowadays, there are several recommendations/guidelines related to the management of long COVID-19 patient [6–10]. These guidelines target the specialist physicians, mainly pulmonologists [6], cardiologists [8], physical medicine and rehabilitation specialists [7], or a combination of different specialists [9]. The cardiorespiratory rehabilitation (CRR), which is a pillar of the aforementioned guidelines [10], significantly relieves the symptoms of dyspnea, anxiety and depression, and eventually improves the patients’ physical functions and quality of life [11].

GPs are probably unable to perform (or demand) the aforementioned pre/post-CRR evaluations specific tests, or to correctly apply the full guidelines addressed for specialists [6–9]. Therefore, an alternative including the CRR ‘minimal advice’ that a GP should provide to long COVID-19 patients, seems to be necessary to respond to the needs of GPs to face their involvement with long COVID-19 patients. Thus, this paper aimed to ‘report’ the CRR ‘minimal advice’ that should be provided by GPs managing long COVID-19 patients with incapacity (ie; alteration of the cardiorespiratory and muscular chain).

In practice, the authors ‘recommend’ that the GPs divide their long COVID-19 patients into small groups (n = 3–5 patients by group, for example), and to plan two meetings (ie; pre/post the CRR program) (Figure 1). During the pre-CRR meeting, that can be scheduled few days before the CRR, the GPs should: i) explain the ‘minimal CRR program’, such as its content and items, ii) focus on patient education regarding general topics (eg; comorbidities, smoking cessation when applicable); iii) provide a psychological/emotional support and nutritional counseling, iv) ‘View’, if possible, videos/illustrations explaining the exercise-training modalities [21], v) evaluate the patients’ dyspnea using the modified medical research council or the visual analogue scales [22,23] (Figure 2), and vi) answer patient’s inquiries. The post-CRR meeting can be scheduled some days after the end of the CRR program, in order to check its results in terms of dyspnea, to get the patients’ feedback, and to encourage patients keeping the exercise-training program as long as possible (Figure 2).

The exercise-training, which is the angular stone of the CRR program [5], should ‘ideally’ include at least 12 sessions (ie; three sessions/week for four weeks) (Figure 2). Each session duration is about 50 minutes.

Open access full text
https://www.tandfonline.com/doi/full/10.1080/19932820.2021.2009101

 

So, in the face of not even having a functioning GP service that can cope with routine medical care why add a completely un-evidenced workload like this?

This is what frightened me at the NICE roundtable - my colleagues seem only interested in selling their business - in this case rehab. Meanwhile other colleagues who should have got the pandemic under control two years ago are still faffing about achieving nothing.