Trial Report Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach, 2024, Szarvas et al

[Wyva]

Abstract


The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021–31/DEC/2022, while an age-matched control group (n = 100) received a single check-up.

To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05).

Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.


Open access: https://link.springer.com/article/10.1007/s11357-024-01179-z

 

[Wyva]

Study group:

All participants were enrolled by their pulmonologist from the outpatient clinic of the Department of Pulmonology. During the enrollment process 200 people were culled (Fig. 1). According to their performance 100 age-matched patients (56.7 ± 12 years of age, 43 female and 57 male) received a one-time checkup with a draft of a home-based program without supervision and 100 participants (56.7 ± 14.2 years of age, 43 female and 57 male) were involved in the rehabilitation program.

About PEM:

Limitations
The study faced several challenges: initially, 100 patients enrolled in the 2-week rehabilitation program, but only 73 returned for the 2-month follow-up, and just 38 attended the 3-month assessment, indicating a dropout rate of 27% at 2 months and 62% at 3 months in the follow-up phase. Secondly, the original study design did not include arrival CPET at the beginning of the rehabilitation program. Additionally, the study lacked comprehensive data on COVID vaccination statuses, although this was not deemed crucial to evaluating the rehabilitation's impact. Lastly, the pre-enrollment physical examination was designed to screen for post-exertional symptom exacerbation (PESE) and post-exertional malaise (PEM), opting against the use of the DePaul Post-Exertional Malaise Questionnaire for enhanced patient safety.

 

[Wyva]

Btw, do we know what the normally experienced drop-out rate of similar interventions is in studies that are not about ME/CFS/long covid?

 

[Trish]

Surely the abstract should highlight the huge drop out rate, which make the claims of success nonsense.

 

[EndME]

Surely the abstract should highlight the huge drop out rate, which make the claims of success nonsense.

Reminds me of one of the reasonings one of my university professors had when the majority of students (beyond 60%) failed his exams: If you exclude those students who failed the exam, the average grade is actually acceptable and managed to pass the exam, so there's no need to do anything different.

 

[rvallee]

They are testing the 'hypothesis' for the treatment model that has been most used from day 1. Right. As one does. Has anyone bothered to test whether drinking cold water works for minor aches, lately? Anyone? Bueller?

Their excuse for drop-outs, reasons for are not documented, is speculation that it was so effective that participants forgot they were part of a study and so didn't respond to follow-up, I guess expecting that the follow-up would be more exercise, which they would not benefit from anymore, presumably as they are now cured, having successfully completed rehabilitation.

Because why not? One prior study of CBT (Wyller, I think) put down the lack of efficacy on bad press about the study, which participants may or may not have seen. It's not as if anyone seems to care, their conclusions is that it worked in part because there were so many dropouts, it seems.

The dropout in the rehabilitation program itself was 0%, but the patient compliance in the follow-up phase can occur for various reasons, such as personal reasons. With a successfully completed rehabilitation program, participants recovered and gained back their workability and quality of life. It could lead to significantly decreased compliance and loss of interest, as they no longer expect any further benefit from the program.

Their program, which had a 68% dropout rate, was so effective that 2 weeks of exercise provides additional benefits 2 months later. Or something like it:

Our CPET data showed increased performance at the 3-month follow-up compared to the 2-month follow-up

They made their main outcome a statistical analysis of the impact of 3 variables, including the 6 minute walking test, which had a null outcome anyway: 477 (402.5–502.5) for controls and 471 (368.5–534.5) for the program, which seems to have been done once anyway, but it's not noted when (presumably at the end of the 2 week program, but who knows?!).

Our findings demonstrate that a 2-week intensive, patient-focused pulmonary rehabilitation program significantly boosts general health and aids participants in resuming their normal lives.

No evidence or data supports participants resuming their normal lives. It's just assumed so, or something. In part based on speculation that most dropped out. The state of medical research...

Again I am quite confident that once AI models start getting used to produce reviews and analyses, they will throw out all of this with extreme prejudice. All of this is garbage. They will probably argue against funding any more, especially once they become able to reason and notice that despite hundreds of those trials, of the most widely-used treatment model, trialists are still producing nothing but feasibility/acceptability pilot studies. Absurd. I've rarely seen people so careless while having so much influence and responsibility on millions of people.