Neuropsychological outcome of indoor rehabilitation in post-COVID-19 condition—results of the PoCoRe study 2025 Jöbges et al

Background: Post COVID-19 condition (PCC) is increasingly recognized as a debilitating condition characterized by persistent symptoms following SARS-CoV-2 infection. Neuropsychological deficits, including cognitive impairments and fatigue, are prevalent in individuals with PCC. The PoCoRe study aimed to evaluate the burden of neuropsychological deficits in PCC patients undergoing multidisciplinary indoor rehabilitation and to describe possible changes in this symptomatology.

Methods: The PoCoRe study, a prospective, non-randomized, controlled longitudinal study, recruited PCC patients from six German indoor rehabilitation centers. Eligible participants underwent comprehensive neuropsychological assessments at admission and discharge. Various measures were employed, including the fatigue scale for motor functioning and cognition (FSMC), the Test Battery for Attention (TAP) and the Montreal Cognitive Assessment (MoCA).

Results: Out of the 1,086 recruited participants, a total of N = 701 participants were included in the main data analysis. The prevalence of fatigue on admission was high (84.6%) and decreased significantly by discharge (77.4%), with a mild effect size. Reaction times on the alertness subtest were abnormal in 70% of patients on admission and 50% on discharge. Sustained attention was abnormal in 55% of patients on admission, decreasing to 43% on discharge. These differences were significant with mild effect sizes. Furthermore, of the 27% of participants with pathological MoCA scores at admission, 63% improved to normative levels during rehabilitation, indicating a significant treatment effect (p ≤ 0.001). However, the MoCA demonstrated limited sensitivity in detecting attention deficits.

Conclusion: The PoCoRe study highlights the high prevalence of neuropsychological deficits and fatigue in PCC patients, with notable improvements observed following multidisciplinary rehabilitation. Challenges remain in accurately identifying and addressing these deficits, underscoring the importance of comprehensive neuropsychological assessment and tailored rehabilitation interventions. Further research is warranted to optimize screening tools and enhance neuropsychological care for PCC patients in both rehabilitation and outpatient settings.

Open access

 

Eligibility criteria


• SARS-CoV-2-infection and following PCC: Complaints that are still present more than 12 weeks after the onset of SARS-CoV-2 infection and cannot be explained otherwise.

• As a consequence of PCC at the time of the start of rehabilitation the presence of functional limitations that may threaten the ability to work.

• Written informed consent to participate in the study.

• Aged 18 years or above.

• Sufficient knowledge of the German language to participate in the study.

• Patients with ME/CFS were not excluded. However, we did not assess ME/CFS symptoms systematically within our study design.


Interventions

The clinics and their treatment programs are reported previously (7). The specializations diverge in the duration and frequency of the therapies, but uniformly cover all essential symptom areas of the PCC with corresponding offers (psychoeducation, exercise, psychotherapy, pacing, breathing and relaxation therapy, cognitive training). Within in this framework, the treatment program was adapted to the individual needs of the patient, including adaptations for individuals affected by ME/CFS.

 

In the protocol, they classify PEM as an adverse event, and I’m not clear on how they define PEM and how they «measured» it.

Some sections:

Furthermore, this study addresses the phenomenon of post-exercise malaise, which is postulated in the line to the post-COVID syndrome, but for which there is a lack of reliable data on whether or how often this phenomenon actually occurs.

(…)

Research questions:

• 3.2 Is the type of illness behaviour (avoidance-endurance) a predictor of symptomatology and socio-medical performance assessment?
  
  
• 3.2 Is there evidence of post-exercise malaise or other adverse events? Are there patients who deteriorate in the course of rehabilitation? (especially in the Six-Minute Walk Test)

(…)

Post-exercise malaise/adverse events monitoring
Structured recording of adverse events/fatigue
In the psychotherapy group, the fatigue level and adverse events that result in post-exercise malaise are recorded and logged in a structured manner with the addition of behavioural analysis.

https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-022-00892-8

 

Not how this works, but standards don't get in the way of good narrative building when they're just suggestions to be thrown away whenever said narrative is in high demand. The high number of obviously invalid statements that routinely get published in academic papers suggests a likely higher number of not-so-obvious-invalid statements and a general disregard for validity.