Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review, 2023, Singh Chandan et al

[Dolphin]

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https://www.mdpi.com/1660-4601/20/4/3477

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review
by
by Joht Singh Chandan 1,*,Kirsty R. Brown 1,2,Nikita Simms-Williams 1,Nasir Z. Bashir 3,Jenny Camaradou 4,Dominic Heining 5,Grace M. Turner 1,6,Samantha Cruz Rivera 1,6,7,Richard Hotham 1,Sonica Minhas 1,Krishnarajah Nirantharakumar 1,8,Manoj Sivan 9,Kamlesh Khunti 10,Devan Raindi 11,Steven Marwaha 12,Sarah E. Hughes 1,6,7,13,Christel McMullan 1,6,Tom Marshall 1,Melanie J. Calvert 1,6,7,13,14,15,Shamil Haroon 1,† and
Olalekan Lee Aiyegbusi
1,6,7,13,† on behalf of the TLC Study


1
Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
2
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
3
School of Oral and Dental Sciences, University of Bristol, Bristol BS8 1TH, UK
4
School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
5
Department of Microbiology, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
6
Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
7
Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
8
Midlands Health Data Research UK, Birmingham B15 2TT, UK
9
School of Medicine, University of Leeds, Leeds LS2 9JT, UK
10
Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
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*
Author to whom correspondence should be addressed.
†
Joint senior author.
Int. J. Environ. Res. Public Health 2023, 20(4), 3477; https://doi.org/10.3390/ijerph20043477
Received: 10 January 2023 / Revised: 11 February 2023 / Accepted: 13 February 2023 / Published: 16 February 2023
(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)


Abstract

Background:

Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection.

Non-pharmacological treatments for these symptoms are poorly understood.

This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS.

Methods:

We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo.

The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability.

We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021.

The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively.

Findings:

Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria.

Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients.

Interpretation:

In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID.

Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS.

Registration:

The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.

Keywords:
post-viral syndromes; PVS; COVID-19; Long COVID; post-COVID-19 condition; post-acute sequelae of SARS-CoV-2 infection (PASC); rehabilitation; systematic review; non-pharmacological intervention

 

[Sean]

...study quality was appraised using the Cochrane risk-of-bias tool,...

...we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID.

Oops.

 

[Andy]

"Based on our study inclusion criteria, we were unable to find any trials conducted to support patients with ongoing fatigue symptoms following confirmed viral exposure. However, a recent systematic review with broader inclusion criteria, which included both pharmacological and non-pharmacological interventions to support patients with unexplained chronic fatigue syndrome/fibromyalgia, identified forty relevant trials [14]. Despite the number of these trials, the authors of that review found that relatively few approaches were effective in managing fatigue, and of those included, the existing evidence only applied to a narrow range of people with fatigue, a relatively homogeneous group of patients in an age group between 45–55 years, which is not representative of the whole patient cohort thought to experience Long COVID in the UK and elsewhere [5,14]."

Ref 14 is to A mixed-methods systematic review of post-viral fatigue interventions: Are there lessons for long Covid?, 2021, Fowler-Davis et al

 

[Andy]

"A key challenge with these interventions (Pilates, resistance exercises, and neuromodulation) relates to their scalability, which is particularly important when considering the scale of the public health burden in a context of limited health service capacity. However, these therapies were not assessed in trials for home use. Additionally, relating to Pilates and resistance exercises, NICE recently recommended against the use of graded exercise therapies in supporting patients with myalgic encephalitis (ME) and chronic fatigue syndrome (CFS) [108]. Although the aetiology of ME/CFS remains under investigation, patients with these conditions experience ongoing fatigue similar to Long COVID. Through expert consultation, it was deemed that people experiencing such symptoms should undertake therapy options where they remain within their energy limits and care should be given to undertake activities that do not worsen symptoms [108]. Therefore, before the widespread adoption of exercise-based therapies, such as Pilates or resistance exercises is considered for patients with Long COVID, further research is needed to identify which patients are most likely to benefit from these therapies."

 

[rvallee]

How can a systematic review end up with only 5 studies when there have been hundreds, probably north of a thousand? All poor quality, sure, but so are the included ones. This is not what systematic means, at least the word.

Because routinely we see "systematic reviews" that exclude 99% or so of the studies. Those studies were expensive, if only for the fact that there have been hundreds of them spanning decades. Somehow this is not a concern, the discipline can go on its merry way doing stuff even though 99% of it isn't just useless, it's considered invalid by people doing study reviews. Validating what we have been saying for decades.

Probably because of the PVS framing and how all the BPS "studies" are generic and exclude any association with infections. But this is horseshit, it's the same issue, no matter how they label it. So is the confirmed infection, this was a choice and it applies just as well to Long Covid. Medicine moved away from the infectious-based model to a generic one and somehow we are the ones who suffer the consequences of their massive failures while they keep doing the same things in circles.

I can't say for the whole of EBM, but the BPS version of EBM is a scam, a fraud perpetrated on the public, a con made-up by quacks selling their credentials like medical mercenaries.

It's not even normal to throw away 99% of prototypes. A 1% yield is pathetic in any context. This is about finished products meant to be used in the real world on real people and 99% is garbage and it all keeps going anyway.

Therefore, before the widespread adoption of exercise-based therapies, such as Pilates or resistance exercises is considered for patients with Long COVID

Oh, you can't look out for a second to the outside world, where this is exactly what has been happening for 3 years? Too far high in your ivory towers to even glimpse at the real world below? Good grief this "aw shucks we don't know what's going on out there" is pathetic coming from experts who then impose their ignorant opinions on us.