The Stanford Hall consensus statement for post-COVID-19 rehabilitation, 2020, Barker-Davies et al

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https://bjsm.bmj.com/content/early/2020/05/31/bjsports-2020-102596

Consensus statement

The Stanford Hall consensus statement for post-COVID-19 rehabilitation
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  1. Robert M Barker-Davies1,2,
  2. Oliver O'Sullivan1,3,
  3. Kahawalage Pumi Prathima Senaratne4,5,
  4. Polly Baker1,6,
  5. Mark Cranley4,
  6. Shreshth Dharm-Datta4,
  7. Henrietta Ellis4,
  8. Duncan Goodall4,7,
  9. Michael Gough4,
  10. Sarah Lewis4,
  11. Jonathan Norman4,
  12. Theodora Papadopoulou4,8,
  13. David Roscoe2,4,
  14. Daniel Sherwood4,
  15. Philippa Turner4,9,
  16. Tammy Walker4,
  17. Alan Mistlin4,
  18. Rhodri Phillip4,
  19. Alastair M Nicol4,10,
  20. Alexander N Bennett1,11,
  21. Sardar Bahadur4
Author affiliations
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Abstract

The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic.

Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death.

Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress.

Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments.

There is a clear need for guidance on the rehabilitation of COVID-19 survivors.

This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK.

Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical.

A chair combined recommendations generated within teams.

A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence.

Authors scored their level of agreement with each recommendation on a scale of 0–10.

Substantial agreement (range 7.5–10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors.

This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.
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I cannot judge for things that fall outside of post-viral illness but for those the outlook is very poor, the medical community is significantly behind even the newly-formed COVID19 patient community and does not seem to have gained any knowledge from symptom presentation in the patient community, questions unasked are simply not factored in and no one will be asking the right questions.

What it looks like is to commit the same failures they did with us in precipitated form. Unclear whether they see the connection but nothing indicates this is the case. Whether they see the connections or not, this is basically naive, in the sense of being born yesterday, thinking that ignores everything relevant to it in favor of ideological leanings to the BPS model. The approach to neurological symptoms is straight out of FND with rousing reassurance condescension.

The COVID-19 community who will fall in the PVFS/ME camp will need to be extremely loud pushing back against this or they are guaranteed to get the worst possible advise and likely even be coerced into it. If this is the starting point, it's heading straight into a compact dimension orthogonal to the reality we inhabit.
 
perhaps things were better when ignorant doctors whent to the default convalescence stage of an illness as in as much rest as possible for 3 months or more dependant on symptom severity . instead of the politically motivated intent to get taxpayers back to work as quickly as possible and damn the cosequences since those most severely affected by this approach cannot expect justice or compensation for the harm caused to them .
 
Graham said:
I had a quick scan, got half way down and lost the will to live. I truly hope that none of these COVID patients fall into the ME camp, because there seems to be a lot of slack in these statements to promote CBT and GET.
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It got better further down than I suspect you looked. I was scan reading and came across this bit

"
Box 4
Exercise rehabilitation recommendations

  • Patients with COVID-19 who required oxygen therapy or exhibited lymphopenia acutely should be identified and tested for radiological pulmonary changes and pulmonary function test abnormalities. Level of evidence: Level 4.

    Level of agreement: mean score 8.95 (95% CI 8.49 to 9.42).

  • Patients with COVID-19 who experience the following symptoms: severe sore throat, body aches, shortness of breath, general fatigue, chest pain, cough or fever should avoid exercise (>3 METs or equivalent) for between 2 weeks and 3 weeks after the cessation of those symptoms. Level of evidence: Level 5.

    Level of agreement: mean score 9.19 (95% CI 8.77 to 9.61).

  • With very mild symptoms which may or may not be due to COVID-19, consider limiting activity to light activity (≤3 METs or equivalent) but limit sedentary periods. Increase rest periods if symptoms deteriorate. Prolonged exhaustive or high intensity training should be avoided. Level of evidence: Level 5.

    Level of agreement: mean score 8.62 (95% CI 7.86 to 9.37).
"

There is, at least, a suggestion of limiting activity.
 
This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK.
 
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