Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition, 2021, Daynes et al

Full title: Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – A cohort study

Abstract

Individuals with lasting symptoms of COVID-19 should be offered a comprehensive recovery programme. 30 individuals (mean[SD] age 58[16]) that completed a 6 week, twice supervised rehabilitation programme demonstrated statistically significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Participants improved by 112 m on the Incremental Shuttle Walking Test and 544 seconds on the Endurance Shuttle Walking Test. There were no serious adverse events recorded, and there were no dropouts related to symptom worsening. COVID-19 rehabilitation appears feasible and significantly improves clinical outcomes.

Open access, https://journals.sagepub.com/doi/full/10.1177/14799731211015691

ETA: Added source below

 

No control group, so any gains could be totally down to natural recovery.

They also don't highlight this in the abstract, "The remainder (n = 4 [out of 32]) who reported an increase in fatigue recorded meaningful improvements in their exercise capacity.". So thats 12% of their cohort.

 

One problem medicine is clearly unable to deal with is that improvement is not linear. They take minimal improvement, possibly at the expense of other daily activities, and assume a straight linear trajectory upward.

It's not as if the patients aren't clear enough about this. The claim of no adverse reactions is hard to believe.

No controls. Most (87%) were admitted to hospital so not representative of Long Covid, despite them somehow deciding that believe it is. No consideration of whether this improvement came at the expense of other things, which is typically what happens.

Typical wish-based medicine with artificial targets.

 

I think GRADE needs a new bar for evidence quality: TLELD

Too low even for limbo dancers.

 

This is an aspect of what I see is a growing problem in medicine. That is optimization to inferior or premature outcome markers. If the marker is only an aspect of the disease, or for a secondary issue, or worse only an associated issue, optimization might actually make things worse overall. If they picked the right outcome measure then this is not a problem, but I think we are still trying to figure out optimal outcome measures for many diseases, including type 2 diabetes. Right now the only long term outcome measure that is anything like optimal is long term survival, otherwise known as death from all causes. A major improvement there is nearly always a good thing, and if it substantially worsens then it does not matter what else you measured that looked good.

 

the pr stood out most for me because this is exactly what it is public relations not science .

 

And predictably, it is hyped with claims not backed by the evidence. Did the "exercise" help? Impossible to tell, they actually emphasize in the text that they used a pacing approach. Most people don't need help to exercise, they can do that all on their own and in fact most long haulers seem to have done that already, as they really should know but clearly don't.

Toxic positivity is ruining medicine. People want their hustling to work and they are incentivized to do so. In the end it all becomes a giant PR exercise in self-promotion.

https://twitter.com/user/status/1390593691509829632

 

Yup. It leads people to optimize what they do to perform better on the test and nothing else, a pointless exercise when what is tested for is either a sham or too unreliable to apply in real life. So they are not solving a problem, merely answering their own questions then grading their performance based on how close to their expected answer they are, a process validated by people who do the same thing and expect the same outcomes.

Honestly EBM has become a completely mindless box-ticking exercise whose flaws are hidden by relentless hype and self-promotion. Doesn't get any weaker than this. Not this paper. EBM is just damn weakness in a bureaucratic suit.

 

This is medical disinformation, likely channeled through the SMC. There is no basis for an article making such an assertion based on such poor data, it's a political exercise detached from reality.

This is why people lose trust and this here isn't a journalistic failure, the failure is entirely on the professionals hyping results that cannot be defended scientifically and a health care system that has simply given up making a serious effort.

They are taking credit for the sun rising up in the morning, FFS.

Long Covid fatigue 'reduced with exercise programme'
https://www.bbc.com/news/uk-england-leicestershire-57103372

 

Usually, when trolls and conspiracy theorists agree with you, it's a giant red flag that you are on the wrong side of reality. I am not aware of any real exception to this and this here may be the only official exemption, though one that is acknowledged backward. Anti-maskers, -vaxxers and -lockdown almost all agree with the BPS belief system and its oversimplistic aphorisms. Because they, too, love simple but wrong solutions to complex unsolved problems. They, too, prefer to answer their own questions over actually solving the problem, because it is their answers that guide them, the questions are entirely irrelevant.

As is typical, they also say the exact same things for the same reasons as the BPS ideologues over the magical power of "exercise", no matter how misleading this study is in this thread from a "lockdown skeptic" sub-Reddit. I just think it's interesting to compare the language used, they say the exact same thing as Long Covid deniers of any calibre. It's not even subtle, they use the same words and generally believe the same things. QAnon people on Reddit? Norwegian medical authorities? Two peas in a pod on this topic.

It's the same thing when Rod Liddle, Spiked, NaturalNews and the opinion page of the WSJ agree with you. Normally this should prompt massive self-reflection, these people have a natural talent at being wrong. Except no, it never does, because it's a feature of ideology to reject the possibility of ever being wrong.