Rehabilitation Interventions for Post-Acute COVID-19 Syndrome: A Systematic Review, 2022, Fugazzaro et al

Abstract

Increasing numbers of individuals suffer from post-acute COVID-19 syndrome (PACS), which manifests with persistent symptoms, the most prevalent being dyspnea, fatigue, and musculoskeletal, cognitive, and/or mental health impairments. This systematic review investigated the effectiveness of rehabilitation interventions for individuals with PACS.

We searched the MEDLINE, Embase, Cochrane Register of Controlled Trials, CINHAL, Scopus, Prospero, and PEDro databases and the International Clinical Trials Registry Platform for randomized controlled trials (RCTs) up to November 2021. We screened 516 citations for eligibility, i.e., trials that included individuals with PACS exposed to exercise-based rehabilitation interventions.

Five RCTs were included, accounting for 512 participants (aged 49.2–69.4 years, 65% males). Based on the revised Cochrane risk-of-bias tool (RoB 2.0), two RCTs had “low risk of bias”, and three were in the “some concerns” category. Three RCTs compared experimental rehabilitation interventions with no or minimal rehabilitation, while two compared two active rehabilitation interventions. Rehabilitation seemed to improve dyspnea, anxiety, and kinesiophobia. Results on pulmonary function were inconsistent, while improvements were detected in muscle strength, walking capacity, sit-to-stand performance, and quality of life. Pending further studies based on qualitatively sound designs, these first findings seem to advocate for rehabilitation interventions to lessen disability due to PACS.

Open access, https://www.mdpi.com/1660-4601/19/9/5185/htm

 

When I partook of “Fatigue Clinic” support I often had significant insensitive to tell clinicians that their advise was helpful. They were often quite hostile when I did not improve. I did need them to write letters for my benefits. So it wasn’t really a choice.

In a trial lots of people will probably be working hard to stay positive. Partly to be seen to be behaving in a socially acceptable manner. Also because we are all told positivity is good for health. Everyone everywhere is told “you gotta stay positive”. Most of us will at least try if just on the off chance of placebo recovery. Also it becomes non-optional if you have a psychologised illnesses. If you’re not performing optimism your personality is likely to get the blame for your physical condition.

Also virus damage heals quite well on its own time scale in many instances so maybe people just felt better.

I find it difficult to believe people forgot how to do “active” life until this study rescued them

 

Findings don't advocate for something, people do. The findings here absolutely do not support that. So what is this advocacy doing here? This is explicitly advocacy, out of such a small number of biased low-quality trials. Especially in light of plenty of evidence that remissions and recoveries are staggered over time, which likely explains the improvements?

This concerns millions of lives. It's massively disruptive, personally and socially. And people in healthcare feel confident advocating for a solution based on such flimsy evidence? Seriously this is not normal, no one should feel confident making such decisions based on that little evidence. About anything. Personal decisions? Sure, why not? But about other people? In a professional capacity?! WTH?

There is something seriously wrong in how things are assessed in medicine. How we are seeing simultaneously people being paralyzed, insisting they don't know enough to do anything, but on the other hand we see this? People willing to throw everything at this based on this mediocre biased sampling?

How is that any different than using Tarot cards or any other random process to make life-and-death decisions?