Non-pharmacological therapies for postviral syndromes, including Long COVID: a systematic review and meta-analysis protocol, 2022, Chandan et al

Abstract
Introduction Postviral syndromes (PVS) describe the sustained presence of symptoms following an acute viral infection, for months or even years. Exposure to the SARS-CoV-2 virus and subsequent development of COVID-19 has shown to have similar effects with individuals continuing to exhibit symptoms for greater than 12 weeks. The sustained presence of symptoms is variably referred to as ‘post COVID-19 syndrome’, ‘post-COVID condition’ or more commonly ‘Long COVID’. Knowledge of the long-term health impacts and treatments for Long COVID are evolving. To minimise overlap with existing work in the field exploring treatments of Long COVID, we have only chosen to focus on non-pharmacological treatments.

Aims This review aims to summarise the effectiveness of non-pharmacological treatments for PVS, including Long COVID. A secondary aim is to summarise the symptoms and health impacts associated with PVS in individuals recruited to treatment studies.

Methods and analysis Primary electronic searches will be performed in bibliographic databases including: Embase, MEDLINE, PyscINFO, CINAHL and MedRxiv from 1 January 2001 to 29 October 2021. At least two independent reviewers will screen each study for inclusion and data will be extracted from all eligible studies onto a data extraction form. The quality of all included studies will be assessed using Cochrane risk of bias tools and the Newcastle-Ottawa grading system. Non-pharmacological treatments for PVS and Long COVID will be narratively summarised and effect estimates will be pooled using random effects meta-analysis where there is sufficient methodological homogeneity. The symptoms and health impacts reported in the included studies on non-pharmacological interventions will be extracted and narratively reported.

Ethics and dissemination This systematic review does not require ethical approval. The findings from this study will be submitted for peer-reviewed publication, shared at conference presentations and disseminated to both clinical and patient groups.

https://bmjopen.bmj.com/content/12/4/e057885

 

Hmm.. "The review findings will present the non-pharmacological treatments for previous postviral syndromes and Long COVID."

*Edited to add that it excludes ME/CFS unless the original virus is identified ie seems to focus on the original viruses.

"At least two independent reviewers will assess the strength of the body of evidence (according to the following categories: high, moderate, low and very low) for each individual outcome using the five Grades of Recommendations, Assessment, Development and Evaluation (GRADE)...."

How does this compare to the 'reassess the NICE assessment of quality of research using GRADE in a different way' requests that certain quarters were making/discussing following the guidelines?

Under the patient participation and involvement (4 patients, who were given a presentation on how there were similarities between postviral syndromes and long covid by the research team among other things) section:
"they stressed the impact of Long COVID on employment and that the loss of income was very important to patients. Therefore, a key goal of this work should be to identify potential non-pharmacological interventions that will facilitate the rehabilitation of patients with long COVID so that they can be fit to return to work. Based on their feedback, we will ensure that this review will report interventions designed to improve the physical function of patients which will facilitate their return to work."

It feels 'unexplained' in their small amount of wording to say that the 'patient group suggested employment', but instead of 'and so = focus on studies that measure employment' (the logical result of that) we decided to focus only on 'designed to improve physical function' (with no definition of measures used).

I italic designed on the basis that viagra was created as a heart drug so wouldn't be included for its other uses then? And an interesting random google on things designed for some other intention revealed that the slinky ( https://www.istockphoto.com/photo/slinky-toy-gm178456953-24338955 ) was apparently initially intended to stabilise naval equipment on rough seas, as just one example. Do they still keep including that in meta-analyses of naval engineering studies, because papers stated that intention?

Shouldn't they be defining their filters based on objective outcomes ie 'the correct measures' (employability, objective measures of improvement) over blurb and intentions/claims within them? Or is that something for the analysis stage/that has to be left until then ie a requirement to include all studies even if they use subjective measures?