Review Return to work with long COVID: a rapid review of support and challenges 2025 Daniels et al

[Andy]

Abstract​

Objectives To explore existing evidence for the provision of support for return to work (RTW) in long COVID (LC) patients and the barriers and facilitators to taking up this support.

Design A rapid review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was preregistered in PROSPERO (ID: CRD42023478126).

Data sources Searches were completed in June 2024 across major databases including MEDLINE, Embase, PsycINFO, evidence-based medicine reviews, Web of Science and Google Scholar.

Eligibility criteria Included studies focused on people with LC (PwLC) symptoms lasting over 12 weeks and addressed either: (1) non-workplace- or workplace-based support for RTW and/or (2) barriers and facilitators to RTW in this population.

Data extraction and synthesis A quality assessment was conducted using the JBI Systematic Reviews critical appraisal tool. The data were summarised in tabular format and a narrative synthesis.

Results Twenty-five studies were included. While many studies demonstrated rigorous methodologies and low risk of bias levels, some had high and medium risk levels. Non-workplace-based support was mostly measured quantitatively and included interdisciplinary healthcare programmes, clinical interventions and rehabilitation programmes focusing on pacing and breathing strategies. Compensation and insurance schemes were important funders of these interventions.

Workplace-based support was mostly measured qualitatively. Barriers to the provision of support at organisational level included lack of understanding of LC symptoms, insufficient workplace guidance and educational gaps among managers. Individual barriers included threat of income loss, remote working and disconnection from the workplace. Facilitators for support included recognition and validation of LC and its symptoms, and eligibility for disability benefits associated with work.

Conclusions RTW is an important outcome of health-related absence and should be systematically recorded in studies of PwLC. The heterogeneity and unpredictability of LC symptoms create challenges for supporting working age populations. Further research is crucial to better understand the specific RTW needs for PwLC and address potential barriers and facilitators to workplace-based support, particularly through interventions, organisational practices and employ-led policies that enable sustained RTW. Consistent guidelines on LC’s definition and disability status may facilitate the provision of support and the development of interventions.

Open access

 

[Eleanor]

All studies had one or more limitations, including unclear LC ascertainment, lack of confounder control, unreported or unclear measurement tool validity and unaddressed incomplete follow-up.

 

[Eleanor]

Structural workplace changes, like modifying the physical environment or job tasks, appear to be more helpful for PwLC than solely educational or supportive measures, though the underlying reasons for this remain unclear.

Mysterious indeed

 

[Utsikt]

I think there is something fundamentally wrong when a qualitative study or a case study can be rated as low risk of bias. They keep inventing new ways to lower the standards.

«We’ve noticed that all case studies are rated as high risk of bias, so we’ve created a bias assessment tool for case studies specifically to rank their risk of bias relative to each other.»

 

[rvallee]

Well, this could have been an email: sick people struggle to work. I have no idea what studies like this are supposed to add. Even when they stare the bloody obvious in the face they can't focus:

Structural workplace changes, like modifying the physical environment or job tasks, appear to be more helpful for PwLC than solely educational or supportive measures, though the underlying reasons for this remain unclear.

What's the main barrier for people with Long Covid, or any other chronic illness, to return to work? It's the chronic illness. If you don't fix the problem, you don't get the benefits of solving the problem. All the other non-health care barriers derive from it, while the health care barriers all derive from the psychosomatic belief system falsely framing this problem as being about rehabilitation, mindset, or whatever the hell they are going on about these days.

This is all very silly, frankly. Always trying to find excuses for why medicine has failed to do its job, never thinking about actually working on the problem, because it would "medicalize" a medical issue. Funny how it works: when you systematically refuse to medicalize a medical issue, it goes unsolved.

Compensation and insurance schemes were important funders of these interventions.

Uh, I wonder why it could be that when you hear things from the patients' perspective, things are almost universally awful, while we get a wildly different perspective from people who have significant biases towards creating the appearance that things are actually fine.

But, really, the whole bias thing is ridiculous, as @Utsikt says. All of these studies are heavily biased, literally more biased than any other type of study from every other scientific discipline. As things stand, it's professionals who need to be educated, the idea that they will educate anyone when they so openly show their ignorance is just a layer of silly on top of a core of pure silliness.