Preprint Increased physical performance and reduced fatigue after personalised physiotherapy and nutritional counselling in long COVID, 2024, Jimenez Garcia

https://www.researchsquare.com/article/rs-4914245/v1

Article

Increased physical performance and reduced fatigue after personalised physiotherapy and nutritional counselling in long COVID

Berenice Jimenez Garcia1

Stijn Roggeman

Lynn Leemans

Wilfried Cools

David Beckwée

Elisabeth De Waele1

1 Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel)

https://doi.org/10.21203/rs.3.rs-4914245/v1

This work is licensed under a CC BY 4.0 License

Background
Long COVID is a multisystemic condition with debilitating symptoms, including fatigue and post-exertional malaise. Personalised nutritional counselling and physiotherapy could provide a synergistic effect to alleviate these symptoms. However, there is a lack of evidence of the feasibility and effectiveness of such personalised multimodal therapy (PMT) including both nutrition and physiotherapy.

Methods
In this pilot study, 65 participants were randomised into either standard physiotherapy or the PMT. Nutritional counselling focussed on tailoring the energy and protein intake to the individual needs based on indirect calorimetry and nutritional assessments. Personalised physiotherapy focused on symptom-contingent pacing. The aim was to evaluate the feasibility in light of a randomised controlled trial (RCT) and to assess the effectiveness of the PMT compared to standard physiotherapy. Effectiveness outcomes (1-minute sit-to-stand test (1-MSTS), 6-minute walk test (6-MWT), and the Multidimensional Fatigue Inventory (MFI-20)) were assessed after 6, 12 and 18 weeks. Descriptive statistics and sample size calculations were performed.

Results
We observed an advancement in both groups, however, the PMT group showed a significant improvement, for 1-MST, 6-MWT and physical fatigue at 18 weeks. Participant specific trajectories suggest a growing estimated difference between groups throughout the trial. To prove these interesting finding, 181 participants should be recruited in a RCT. Study feasibility was proven.

Conclusions
The study revealed a positive trend for improved physical function and reduced fatigue in adults with long COVID after combined nutritional counselling and physiotherapy. A large-scale RCT is needed to prove the effectiveness, but the current results are hopeful.

 

The intervention arm included dietary advice and symptom-contingent exercise. They write: "A symptom-titrated pacing strategy was implemented to account for exercise intolerance or PEM." The control group received standard physiotherapy.

Unfortunately, it seems that there were no significant effects. The primary outcome was 1-minute sitto-stand (1-MSTS) repetitions which showed a non-significant difference of -0.97 [-3.70, 1.75]. The authors defined a minimally clinically important difference as 3 points.

Other outcomes also did not show a significant difference. The paper highlights the difference for physical fatigue at time point 3 which was 2.21 [0.13, 4.29]. But at time point 2 (post-treatment), the difference was smaller and not significant: 0.51 [-1.24, 2.25]. Given the number of outcomes and timepoints tested, this might have occurred by chance (as they did not correct for multiple testing).

 

This thing where they spend years "trying" the things that were the common standard on day one, which hundreds of thousands were subjected to, looks absolutely ridiculous and no one seems to have the courage to say it out loud in the rooms where this happens.

Always small pilot studies with inconclusive results. For something that hundreds of thousands have been put through. Completely ridiculous.