Preprint Virtual rehabilitation for individuals with Long COVID: a randomized controlled trial, 2024, Janaudis-Ferreira et al.

[SNT Gatchaman]

Virtual rehabilitation for individuals with Long COVID: a randomized controlled trial
Tania Janaudis-Ferreira; Marla K. Beauchamp; Amanda Rizk; Catherine M. Tansey; Maria Sedeno; Laura Barreto; Jean Bourbeau; Bryan A. Ross; Andrea Benedetti; Pei Zhi Li; Kriti Agarwal; Rebecca Zucco; Julie Lopez; Emily Crowley; Julie Cloutier

BACKGROUND
Our primary objective was to investigate whether an 8-week virtual rehabilitation program for individuals with long COVID improves functional mobility compared to usual care.

METHODS
Subjects were randomly assigned to receive either i) virtual rehabilitation plus usual outpatient care or ii) usual outpatient care. The intervention group underwent an 8-week virtual rehabilitation program which consisted of personalised and symptom-titrated functional aerobic and resistance exercises as well as long COVID educational sessions. The primary outcome was the Activity Measure for Post-Acute Care (AM-PAC) mobility score. Secondary outcomes included the Baseline and Transition Dyspnea Index (BDI/TDI), the Fatigue Visual Analog Scale, 12-item short-form, EuroQol 5 Dimension 5 Level (EQ-5D-5L), DePaul Symptom Questionnaire -PEM, physical function tests, questionnaires on mental health, acceptability and adverse events.

FINDINGS
132 individuals with long COVID (mean age 48 (SD=11.8); 75% female) were enrolled. The adherence rate was 96%; however, 25 participants (39%) in the intervention group were unable to progress their exercises through the FITT (frequency, intensity, time, and type) principle due to symptoms. No between group differences were found for change in AM-PAC mobility (95% CI -0.91 to 2.13). The proportion of participants achieving the minimal detectable change in the AM-PAC mobility at the end of the intervention period was higher in the intervention group (35.8% (SE 6.0%) vs. 17.0% (SE 4.7%)) (95% CI 3.9 to 33.8). Compared with controls, scores on the EQ-5D-5L pain/discomfort (95% CI -0.70 to -0.03), EQ-5D-5L VAS (95% CI 1.05 to 14.43), VAS fatigue (95% CI -1.78 to -0.02), as well as for the TDI functional (95% CI 0.07 to 0.72), effort (95% CI 0.10 to 1.12) and total scores (95% CI 0.10 to 2.37) were greater in the intervention group. There were no between-group differences in other outcomes and no serious adverse events.

INTERPRETATION
An 8-week virtual rehabilitation program did not improve self-reported mobility for most patients with long COVID, however we did find improvements in health status and symptom persistence. Progression of exercise training is challenging in this population.


Link | PDF (Preprint: MedRxiv) [Open Access]

 

[SNT Gatchaman]

The majority of the sample had not been hospitalized due to COVID-19 infection (78%), had a median number of symptoms of 4, were vaccinated (median of 4 times), were seldom active at the time of completing the questionnaire (78%) and had experienced symptoms of PEM at the study entry (93.2%).

While 52% of participants in the intervention group reported at least one adverse event that was definitely or possibly related to the intervention, these events were classified as mild or moderate, involving either minor symptoms that did not require medication, or limited disruptions to age-appropriate instrumental activities of daily living, which required only minimal local intervention (rest or medication as-needed).

Our post hoc analyses, however, offer valuable insights into the characteristics of individuals with long COVID who may be more susceptible to adverse events including those PEM-related. Specifically, our findings suggest that those with comorbid cardiac disease and higher PEM scores at baseline may be at greater risk for experiencing adverse events during exercise training and those with comorbid cardiac disease, higher PEM scores at baseline, PEM triggered by mental effort, and a shorter hospital stay may be at greater risk for experiencing PEM-related adverse events during exercise training. To our knowledge, this is the first study to highlight these potential risk factors in this population.

 

[rvallee]

This study was funded by the Canadian Institutes of Health Research (CIHR)

Data from the large population-based Canadian Longitudinal Study on Aging similarly demonstrated new onset mobility problems even in the absence of hospitalization.7 These data suggest that individuals with long COVID may benefit from a physical rehabilitation intervention to address their persisting symptoms and functional limitation

This is not a valid reason to "try" what has been tried hundreds of times already. The idea that generic rehabilitation should work for those specific problems is completely ridiculous. Finding that people are ill doesn't justify any of this, what a bunch of mindless nonsense. Data do not "suggest" anything, people do. For ridiculous reasons and completely mindless unreasoning.

Just as childish as kids in the back seat of a car during a long trip going "are we there yet? are we there yet? are we there yet?" but this trip is never getting anywhere, and it's actually the driver doing that.

At least they reported honestly, but still with the usual worthless "maybe there's some secondary benefits somewhere". Now here's to the next 100 identical trials of the same useless junk. Then the next 100. And so on until either civilization falls or AI simply makes this obsolete.

 

[Hutan]

"virtual rehabilitation"
Reminds me of "recovery" achieved by reframing expectations

 

[Sean]

It is okay, folks, these patients are in the 'process of recovery'. Give it time.

About 30 years or so.

 

[rvallee]

"virtual rehabilitation"
Reminds me of "recovery" achieved by reframing expectations

It's such a weird aberration caused by dysfunctional systems that can't correct their own failures. In-person rehabilitation doesn't even work, but the industry pretends that it does. So it makes them do all sorts of silly additional busywork like figuring how who it works for, who it doesn't work for, how to tweak it to make it work for some, how to deliver it better, faster.

All of which is entirely useless because none of it works. Not even in its most perfect, highly expensive and slow-delivered, form, a format that doesn't scale and so any service would never be able to see more than 1% of patients anyway. Which is what the PACE trial showed, and not just for ME/CFS but for generic chronic fatigue. This was all revealed to be a giant clown car the day the "definitive trial" went bust but the industry pretended that it proved that it works.

It's all so mindless and ridiculous.