Evaluation of a multidisciplinary neurological rehabilitation program for the post-COVID-19 condition, 2026, Egger et al.

[SNT Gatchaman]

Evaluation of a multidisciplinary neurological rehabilitation program for the post-COVID-19 condition

Spoiler: Authors

Egger, Marion; Strobl, Ralf; Vogelgesang, Lena; Reitelbach, Judith; Grill, Eva; Jahn, Klaus

OBJECTIVE
To evaluate a multidisciplinary therapy program with a neurological focus for individuals with post-COVID-19 condition, aiming to reduce symptom burden and improve functioning.

DESIGN
Non-experimental prospective before–after study. Subjects/patients Individuals diagnosed with post-COVID-19 condition, defined as experiencing persistent signs and symptoms for more than 12 weeks after initial SARS-CoV-2 infection.

METHODS
We conducted a 2 week multidisciplinary rehabilitation program at the Schoen Clinic Bad Aibling, Germany. The intervention included multi-professional therapies. Assessments were conducted at six time points: baseline at the start of the 2-week control period, pre- and post-intervention, and at 2, 8, and 24 weeks post-intervention. Mixed-effects regression models were used to analyze changes over time. Outcome measures included health-related quality of life (HRQoL; EQ-5D-5L), fatigue, anxiety, depression, symptom severity, breathing difficulties, cognitive function, functional disability, and performance measures.

RESULTS
A total of 47 participants (60% female; mean age 49 years; range 21–80) were enrolled, with a median of 220 days (Q1: 156–Q3: 376) since initial infection. No significant improvement in HRQoL, grip strength, cognitive function, walking capacity, or balance was observed during the intervention compared to the control period. Fatigue, anxiety, depression, symptom severity, functional disability, and dyspnea improved significantly.

CONCLUSION
This study indicates beneficial effects of a 2 week multidisciplinary therapy program on symptom burden and functional outcomes of the post-COVID-19 condition. Further research including randomized controlled trials is warranted. Trial registration German Clinical Trials Register, DRKS00029415. Registered 04 July, 2022. Retrospectively registered. https://drks.de/search/en/trial/DRKS00029415

Web | DOI | PDF | Journal of Neurology | Open Access

 

[SNT Gatchaman]

The intervention was developed specifically for this study by an interdisciplinary team of local experts (physiotherapists, occupational therapists, neuropsychologists, physicians, and rehabilitation specialists). Its design was informed by clinical experience with post-COVID-19 patients and principles of neurorehabilitation, aiming to address physical, cognitive, and mental symptom domains while minimizing the risk of overexertion. The program was delivered 5 days per week, constituting a full-time, daybased intervention that included a mix of different rehabilitative interventions (e.g., Nordic walking, balance training, and cognitive training).

Post-exertional malaise (PEM) is characterized by a worsening of symptoms following even minor physical or mental exertion that was tolerated previously and must be accounted for in rehabilitation programs, as it may negatively impact the rehabilitation outcome over time. PEM was defined as the presence of next-day soreness following nonstrenuous activity or physical fatigue after minimal exertion, as assessed by the items 2 and 3 of the DePaul Symptom Questionnaire at Visit 1.

We did not implement a pacing protocol, but participants were taught about the concept, and pacing was considered in each unit of the program. To control for PEM in the analyses, we classified patients with PEM and included the condition as a covariate. No significant interactions with PEM were found.

 

[SNT Gatchaman]

No significant improvements could be shown for HRQoL, WHODAS-12, and all performance measures (MoCA, handgrip strength, walking, and balance) during the intervention period (p > 0.05) compared to the preceding control period. Significant decreases in fatigue, anxiety, depression, symptom severity, functional disability, and dyspnea, and a better subjective health score were observed during the intervention period compared to the change in the control period. At the start of the intervention, 83% reported substantial fatigue, 70% from anxiety, and 66% from depression. After the intervention, percentages decreased to 74% (fatigue), 61% (anxiety), and 54% (depression).

Steps per day and resting heart rate were not available for all patients due to technical issues or lack of compliance. Resting heart rate (beats per minute) did not change significantly over time […] Mean number of steps per day was 8358 ± 4313 in the 2 weeks before therapy (n = 34), 9551 ± 3414 during the on-site therapy (n = 37), 8335 ± 4023 in the 2 weeks after the therapy intervention (n = 34), and 7849 ± 3358 in the 2 weeks around V5 (n = 28). Participants conducted on average 1,000 more steps per day during the intervention compared to the control period (p = 0.024).

Although post-COVID-19 condition represents a distinct clinical entity, the design of our multidisciplinary rehabilitation program was informed by established principles of neurorehabilitation derived from large randomized controlled trials in other neurological disorders, such as Parkinson’s disease, which already have demonstrated the benefits of structured, exercise-based and multimodal rehabilitation approaches.

Definitely promising though.

Changes in outcomes over time did not differ for patients with PEM or cognitive impairment. Given the exploratory design, lack of a control group, absence of a formal sample size calculation, and the short intervention duration, these findings, although promising, should be interpreted cautiously. Nevertheless, the results suggest that multidisciplinary rehabilitation approaches may have the potential to address neurological and non-neurological symptoms of post-COVID-19 condition.

 

[Amw66]

Whats " functional disability" given objective aspects like cognitive function , balance and walking did not improve ?

How are benefits of human interaction and validation accounted for , as ever , being listened to and talking with others has it's own therapeutic value irrespective of any treatment .

Is this simply another version of learning how to fill out questionnaires better ?

ETA only read intro .
PEM really needs a better general definition.
What was drop out rate given non compliance is noted .
Interesting that steps per day decreased after the interventions .

 

[Utsikt]

No significant improvement in HRQoL, grip strength, cognitive function, walking capacity, or balance was observed during the intervention compared to the control period. Fatigue, anxiety, depression, symptom severity, functional disability, and dyspnea improved significantly.

So all of the subjective and vague outcomes got «better», while the objective and more direct subjective ones (QoL) stayed the same.

Mean number of steps per day was 8358 ± 4313 in the 2 weeks before therapy (n = 34), 9551 ± 3414 during the on-site therapy (n = 37), 8335 ± 4023 in the 2 weeks after the therapy intervention (n = 34), and 7849 ± 3358 in the 2 weeks around V5 (n = 28). Participants conducted on average 1,000 more steps per day during the intervention compared to the control period (p = 0.024).

The intervention was followed by a slight reduction in step count long term.

 

[rvallee]

Clueless, as usual. Doing things like this while boasting about how it comes from their clinical experience and expertise only achieves making it clear they have no such thing, or have missed everything that matters. They are making it clear they don't listen, and have no relevant skills or insights into the problem. All they are doing is cheapening their expertise, even making it worse in the process.

Why not just do a simpler approach and just goad and harass the participants into reporting they are better? Might as well, it's not as if it makes any difference. "Say you're better". "But, I'm not." "Come on.". "..." "Come ooooon." "..." "Say it." "..." "Oh, you're just mean."

And, again, the thing where people who develop their own thing 'test' that thing is completely ridiculous. All pretense of adhering to equipoise has disappeared entirely. Plus, what the hell does any of this even have to do with Parkinson's?

It's really all getting worse, and the only thing they refuse to consider is that they are wrong. I've never seen anything like this outside of politics or corrupt abuse of power.