Post-Covid-19 Syndrome: Improvements in Health-Related [QoL] Following Psychology-Led Interdisciplinary Virtual Rehabilitation, 2021, Harenwall et al

[Andy]

Full title: Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation

Abstract

Coronavirus disease 2019 (COVID-19) is increasingly recognized as having significant long-term impact on physical and mental health. The Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT) is a psychology-led specialist interdisciplinary team of health professionals specializing in persistent physical symptoms (PPS) and Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) with an emphasis on holistic integrated care. The PCWBS quickly recognized the risk of the long-term effects of COVID-19, particularly for social, health and care staff, and developed a 7-week virtual rehabilitation course which was piloted in October 2020.

The “Recovering from COVID” course takes a whole system, biopsychosocial approach to understanding COVID-19 and post-viral fatigue (PVF) and is delivered by an interdisciplinary team consisting of a clinical psychologist, physiotherapist, occupational therapist, dietitian, speech and language therapist, assistant psychologist, and a personal support navigator with support from a team administrator. The course focuses on understanding PVF, sleep optimization, nutrition, swallowing, activity management, energy conservation, stress management, breathing optimization, managing setbacks, and signposting to appropriate resources and services. Since the pilot, PCWBS has delivered 7 courses to support over 200 people suffering from post-COVID-19 syndrome.

One hundred and forty-nine individuals that enrolled on the “Recovering from COVID” course completed the EQ-5D-5L to assess Health-related quality of life (HRQoL) across 5 dimensions, including problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Subsequently, 76 individuals completed these measures at the end of the rehabilitation course showing that patient ratings were significantly improved. In response to the NIHR recommendation for rapid evaluation of different service models for supporting people with post-COVID-19 syndrome, this data offers hope that rehabilitation is effective in reversing some of the problems faced by people living with the long-term effects of COVID-19.

Open access, https://journals.sagepub.com/doi/10.1177/21501319211067674

 

[Jonathan Edwards]

Subsequently, 76 individuals completed these measures at the end of the rehabilitation course showing that patient ratings were significantly improved.

So 76 on average reported a bit better. 73 decided not to report - probably no better or worse or didn't think the rehab as any use.

Pretty bad, when politeness is taken into account.

In response to the NIHR recommendation for rapid evaluation of different service models for supporting people with post-COVID-19 syndrome

Indicating just how shoddy the NIHR approach is.

 

[rvallee]

In what way is any of this "rehabilitation"? Because this is just the passage of time, and for the most part giving the opposite advice of standard rehabilitation, the current standard. Are they entirely unaware of the course of the illness? And not bothering to take it into account? And the reviewers and editor unaware or indifferent that it did not take account of this very important context? Of course, of course.

If anything this paper is in a sense the anti-PACE, since it clearly advocates for convalescence, while doing away with the problem of being the exact opposite of the usual advice, by simply calling it "rehabilitation". Although they advise pacing, they completely misunderstand it as "promoting a return to daily activities". Simply unable to tell process and outcome apart.

And their cognitive stuff is basically a mash-up of all the hits:

The workbook draws upon third wave cognitive behavioral therapies (CBT) such as acceptance and commitment therapy (ACT),41 compassion focused therapy (CFT),38 mindfulness-based cognitive therapy,42 and polyvagal theory23 to consider bi-directional pathways between the mind and body

Basically the kitchen sink, and the kitchen, and everything that is neither the kitchen nor the sink.

Telling that the number of responses is significantly lower than the number who completed at least half the course:

Attendance for the course was very good and 92.1% of participants attended at least 4 times out of the 7-week course with 74.5% attending at least 6 times. Evaluation of participant feedback (n = 76) showed that 96% of people felt more knowledgeable and informed about their symptoms, 100% felt the exercises throughout the course were helpful, 91% felt confident in implementing strategies to manage symptoms, and 99% of participants would recommend the course to others.

Although participants showed significant improvements, it is evident that health and quality of life remain significantly affected in post-COVID-19 syndrome with only 3% of participants returning to full health. We advocate that post-COVID-19 syndrome should be considered a long-term health condition that requires continuing support from an interdisciplinary team.

Not a single objective assessment. Very weak formulaic methodology. Spurious conclusions detached from what the data say. Very high drop-out rates. Yup, this is definitely a BPS thingy, where the passage of time does all the work and you can just sit back and take all the credit, even when there is nothing to credit at all.

The conclusion clearly states that this program is effective at "reversing some of the problems". There is simply no basis to claim any causal factor here. This is fanciful and should not have been part of the conclusion.

About as random as it gets:

 

[Cheshire]

No control group to study improvement in a condition where natural improvement is known to occur in many cases.
Recipe for automatic positive results.
Well done again, BPS team!

 

[NelliePledge]

Merged thread

The PACE wonky wheel being reinvented.

 

[rvallee]

No controls. No objective data or assessment. <34% completed vague questionnaires at the end, with many not even bothering to answer anything and who just dropped out. None of this even constitutes "rehabilitation", and yet the conclusion is that rehabilitation is effective, even though there is no way to attribute any such assertion based on this. Such a poorly-run trial literally cannot make any causal claim. And yet here we are, this passed peer review because the whole system is so dysfunctional this is basically typical.

They even call it self-management, so I guess that self-management, i.e. deal with your own problems, is rehabilitation now? Do they know that long haulers have to manage precisely because this is the BS medicine has produced from decades of wasted efforts? Also no recognition of PEM, they just threw in the "boom and bust" crap and called it good enough.

Typical BPS study: it's a jobs program for people who can't do real medicine. It has nothing to do with patients, this is a binky for physicians. They find that 53% had some improvement, while the rest did not. This is about as random noise as it gets.