Protocol The effectiveness and acceptability of face-to-face rehabilitation for patients with Long Covid who were not hospitalised…, 2026, Kontou+

[SNT Gatchaman]

The effectiveness and acceptability of face-to-face rehabilitation for patients with Long Covid who were not hospitalised with their acute infection: a mixed-methods study comprising a randomised controlled trial RCT with embedded qualitative component

Spoiler: Authors

Kontou, Kate; Daynes, Enya; Singh, Sally J; Evans, Rachael A; Gardiner, Nikki; Chaplin, Emma; Richardson, Matthew; Bishop, Nicolette; Creese, Jennifer; Bateman, Nicola; Wright, Adam; Zivtins, Elga; Houchen-Wolloff, Linzy

BACKGROUND
Long Covid is a term used to describe a multisystem condition that presents with a myriad of physical and psychological symptoms that continue or develop after acute COVID-19. Long Covid is a significant public health problem because of the nature of the illness, its negative impfact on everyday functioning, and the healthcare inequalities evident in access and experience, notably in terms of ethnicity and socioeconomic status. Evidence in patients hospitalised with their acute infection suggests exercise-based rehabilitation could be helpful to improve exercise tolerance, respiratory symptoms, fatigue, and cognition; however, research is needed to determine whether exercise-based rehabilitation is effective and acceptable for patients with Long Covid who were not hospitalised.

METHODS
This mixed-methods study comprises a single-centre, randomised controlled trial to determine whether face-to-face rehabilitation increases exercise capacity compared to usual care alone in non-hospitalised patients with Long Covid, with embedded qualitative components to explore intervention acceptability in the context of healthcare inequalities. Usual care is as defined by the National Institute for Clinical Excellence (NICE) Covid-19 guidance. The rehabilitation intervention will take place twice a week for 6 weeks and will combine symptom-titrated exercise with self-management education. The proposed sample size of 56 for the randomised controlled trial is calculated on the primary outcome of Incremental Shuttle Walking Test (ISWT) distance, with a change of 50metres (m) at 90% power, a standard deviation of 17 m, and a 0.05 type 1 error.

DISCUSSION
A mixed-methods approach has been chosen as quantitative data alone would be insufficient to answer the research question, and mixing the data will enable a more comprehensive understanding and ensure there is an equal focus on outcomes and experiences of a face-to-face exercise-based rehabilitation programme. A healthcare inequalities lens will explore who may be under-represented, with the qualitative work providing further evidence as to why this may be the case. It is recognised that meeting recruitment targets in the context of reducing referral rates and funding for Long Covid services may prove challenging. Trial registration ISRCTN trial registry (ISRCTN33340595). Registered on 30 September 2024.

Web | DOI | PDF | Trials | Open Access

 

[SNT Gatchaman]

Participants will be carefully monitored with particular attention to those displaying signs of post exertional malaise (PEM) and post exertional symptom exacerbation (PESE) via the DePaul outcome measure. Steps have been taken to ensure those with known PEM / PESE are not recruited to this trial to ensure their symptoms are not worsened by rehabilitation. If it appears that someone is experiencing PEM / PESE during the intervention phase, then they will be suspended from the trial, upon discussion with the individual, and referred to the appropriate clinic(s).

 

[Utsikt]

Yet another rehab trial with either subjective outcomes with no blinding or irrelevant objective outcomes that for the most part only measure adherence by proxy.

Why not look at potentially useful data like step count, hours worked, wages or other things that might tell us if the patients are actually doing better and not just being slightly fitter?

And why so short follow-up?

 

[Sean]

A standard of 50m gain over 6 weeks rehab is pathetic.

Either this is a fundamentally different form of deconditioning being experienced by patients, which would require a fundamentally different approach.

Or there is no significant deconditioning to reverse.

 

[rvallee]

A standard of 50m gain over 6 weeks rehab is pathetic.

Either this is a fundamentally different form of deconditioning being experienced by patients, which would require a fundamentally different approach.

Or there is no significant deconditioning to reverse.

I find this to be one of the most frustrating part of this lying ideology, because it's so damn obvious. The very best they can do ever do is barely reach the minimal threshold they settle on for effectiveness, except those are so low that they are useless for all intents and purposes even if they reached them. Even if 100% of the participants managed to improve by that much, this approach is still a massive failure because the gains are so pathetically low.

And still the vast majority of trials don't even meet those ridiculous minimums, and when they do it's never even a fraction more than that. None of this has ever shown promise. No reliable trial has found this to be true in hospitalized patients, or non-hospitalized ones, and it's been the standard approach from day one, and for decades before, and academics proposing to try this for the very first time(TM) are still getting approved and funded. This is functionally and ethically as ridiculous as doing one thousand trials of homeopathic water.

Regardless of everything else, it's frankly absurd to argue that the people doing this even want their patients to recover. Everything they do is incompatible with the outcomes they pretend to be trying to achieve, with methods that they cannot possibly already know have proven to be a complete dead-end. The systems that support that have abandoned not just their primary but even their secondary obligations.

 

[Sean]

Regardless of everything else, it's frankly absurd to argue that the people doing this even want their patients to recover. Everything they do is incompatible with the outcomes they pretend to be trying to achieve, with methods that they cannot possibly already know have proven to be a complete dead-end. The systems that support that have abandoned not just their primary but even their secondary obligations.

Yep. It is beyond dispute now that these clowns have no interest at all in our welfare. They have no excuses left whatsoever, and could not make their real intentions and agenda any clearer.

The failure and corruption is as complete and brazen as it gets. They are beyond all saving or reform. The only practical answer now is to throw the lot of them out and bring in a whole new team from outside the medical establishment.

Not holding my breath.