Addressing post-COVID-19 musculoskeletal symptoms through pulmonary rehabilitation with an evidence-based eHealth education tool, 2025,Sánchez-Romero+

Line breaks and bullet points added:

Twelve patients referred from the ICU, Pneumology, Internal Medicine, and Rehabilitation Services of Rey Juan Carlos Hospital were finally included (Fig. 1), considering the following inclusion criteria:

• patients between 18 and 64 years of age,
• with a previous diagnosis of COVID-19 infection who required hospital admission,
• who at the time of starting the training presented a negative polymerase chain reaction test and decided to voluntarily enter the program,
• and patients who presented some degree of functional impairment at the time of hospital discharge, such as dysfunction/atrophy of the peripheral muscles and/or respiratory muscles.

Exclusion:
Patients with

• symptoms suggestive of active COVID-19,
• comorbidities in the acute phase,
• decompensated cardiovascular pathologies such as arterial hypertension (diastolic blood pressure > 100 mm Hg and systolic pressure > 170 mm Hg),
• acute respiratory pathologies such as decompensated chronic obstructive pulmonary disease with oxygen saturation below 90%, pulmonary thromboembolism,
• osteoarticular involvement preventing cycle ergometer training,
• moderate/severe cognitive impairment,
• and/or other symptoms such as uncontrolled diffuse pain, general fatigue, chest pain, severe cough, and fever were excluded.[3,18]

Enrollment

• Assessed for eligibility (n=95)
• Excluded (n=83)
• Not meeting inclusion criteria (n=32)
• Declined to participate (n=35)
• Other reasons (n=16)
• Included (n=12, 6 in each group)

 

They say that the patients were ‘blinded’ to their treatment, but the eHealth group received this in addition:

• Evidence-based eHealth ET intervention: In addition to FTF sessions, patients participated in weekly eHealth ET sessions led by a chest physiotherapy specialist with 15 years of clinical experience and an expert in telemedicine.

• The patients underwent 6 sessions, each lasting for 1 hour. These sessions, held prior to the FTF exercise sessions, focused on therapeutic education,[26–28]respiratory exercises, physical activity, and pain management.

• The first session served as an introduction, covering the understanding of COVID-19, the distinctions between COVID-19 and long-term COVID, current theories of origin, general symptoms, and potential treatments, such as self-management, therapeutic exercise, and respiratory reeducation.

• The second session addressed long-term symptoms and presented a visual representation of the symptoms that could be addressed by chest rehabilitation. These included muscle weakness, myalgia, fatigue, postexertion fatigue, dyspnea, and cough, as well as self-monitoring of these symptoms on a daily basis and during exercise.

• The third session focused on the benefits and importance of physical activity, exercise, therapeutic exercise, and rehabilitation. It also includes self-assessment exercises for physical activity status in daily life and pacing strategies.

• The fourth session concentrated on the pulmonary situation and breathing exercises. The primary focus was on the diaphragm, mechanics, and breathing patterns. Diaphragmatic breathing exercises and other techniques such as humming were performed.

• The fifth session discussed the benefits and importance of aerobic exercise and strength training. Minimum recommendations and options for incorporation into daily life are presented. Patients were encouraged to express potential concerns regarding their daily activities based on their symptoms and were guided on self-management strategies utilizing information from previous sessions. The knowledge gained from prior sessions enabled the patients to self-evaluate their condition using various scales.

• The final session centered on pain as a neurological symptom and provided therapeutic education in neuroscience and the pain experience.

The ‘placebo’ group did not receive anything extra. So it doesn’t seem very ‘blind’ to me.

It’s notable that the eHealth group got education on fatigue when fatigue was an exclusion criteria.

 

There were no significant differences between the outcome variables except in the Tampa Scale of Kinesiofobia-11 posttreatment (Z = 1.936, P = .048), with a lower score in telehealth (16.00 ± 2.71 vs 23.17 ± 5.49 points) and a large and significant effect size (R = 0.812, 95% confidence interval [0.715–0.893]) (Table 2 and Figure 2).

Barthel index:
Baseline eHealth: 99.00 ± 2.45
Post-eHealth:100.00 ± 0.00
Basline control: 100.00 ± 0.00
Post-control: 100.00 ± 0.00

Physical exercise at baseline:


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The eHealth group had more participants that did not exercise at all. So when you spend a lot of time telling the participants that exercise is good for you, they might be inclined to report less fear of exercise.

 

I love papers like this. They give away the whole game, how "evidence-based" is a purely marketing term without an actual meaning, revealing how evidence is actually entirely irrelevant in evidence-based medicine. On what basis did they decide that pulmonary rehabilitation is crucial? Absolutely nothing. It's what they to be true, so they just say it like it is.

But here they develop some BS program and test it in a 'pilot' trial. So how can it be evidence-based in the formal term, if they're constantly re-developed? Mostly because they are fully generic and the substance doesn't matter, which is the actual working process of "Imagine a world"-based medicine.

They simply imagine a world in which pulmonary rehabilitation is crucial, and aren't bothered by finding that the generic program they developed is actually worthless. If they asked enough weird questions, they may find that there is a statistical significant improvement in perception of color, or some other unrelated BS.

What relation is there between this imagine "kinesiophobia" and pulmonary rehabilitation? Nothing at all. But like every other alternative medicine out there, they simply fish for whatever blip of a positive effect they can make out, always at the lowest possible level of significance, and pretend like they must be related. Even with bullshit concepts like this imagine kinesiophobia. The whole game is to ask for more money. Always more of the same research, done over and again, the same way, with the same intent and methods.

Also, how can a generic program tested in a pilot study, mostly identical to dozens more already tested before, have important clinical implications? Experimental studies obviously cannot have clinical implications, what a load of crap. The whole thing is ridiculous. What they're doing is basically like practicing, tweaking and tuning, then when they find some combination of results that seem positive, they call it the main competition. And pretend like they won. Or whatever. Completely unserious.

 

Isn’t this like the issue noted in Jonathan’s testimony for the Nice guideline - they’ve proved the therapy/theiry/ideology is wrong and doesn’t work because they managed to effectively brainwash what they’ve called kiniesphobia but is their interpretation of being careful about exertion

but by doing so no one has got any better in their actual illness or symptoms or pain or function

the outrageous but is they don’t measure harms but have had the gall to suggest the therapy is worth doing based on the reduction in a man invented ‘problem’ that was a management strategy

on the basis it was ‘effective’ at delivering a change /content that was neither helpful or useful or therefore healthy ie the wrong thing. And probably harmful if they’d allowed that to be measured, particularly long term

Which is like giving a lesson in maths through a new pedagogic technique claiming it will cure dyslexia and reading issues then claiming because people reported they felt more confident for their next maths lesson but can’t read for toffees still that it’s definitely a treatment for reading issues.

or using an injection to increase peoples iron claiming that would treat acne and finding no acne measures were any better but as peoples iron level was increased then ‘injections’ as the model for treatment was the way forward? Rather than it being proof it definitely isn’t iron that’s the issue because effectively increasing that did nothing for the actual problem.


gaslighting people for the sake of making money isn’t cool. Making disabled people pretend to act normal when it’s behaviour that’s against the interests of their health is that and isn’t cool and doing a conversion course to make them hate themselves for being wary of exertion when too much makes symptoms worse is like taking away someone’s defence mechanism to put out their arms if they fall or take their hand off the stove when they feel pain by telling them they are mad or abnormal for feeling that

it’s all very well claiming it’s a good thing and very clever as a switch and bait when you’ve no real results if you can get away with such a short measuring period not many subjects have yet fallen over badly or touches anything hot , and even better if you work in a field that allows itself to be outside the reporting of harms but not reported doesn’t mean doesn’t exist even in their reframing land