Rehabilitative interventions in patients with persistent post COVID-19 symptoms—a review of recent advances and future perspectives

Abstract

The SARS-CoV-2 pandemic has not only caused millions of deaths but left also millions of people with persistent symptoms behind. These long-term COVID-19 sequelae cause a considerable burden on individuals´ health, healthcare systems, and economies worldwide given the high rate of SARS-CoV-2 infections. Therefore, rehabilitative interventions and strategies are needed to counteract the post COVID-19 sequelae. The importance of rehabilitation for patients with persistent COVID-19 symptoms has been recently also highlighted in a Call for Action by the World Health Organisation. Based on previously published research, but also in line with clinical experience, COVID-19 is not one specific disease but rather presents in different phenotypes that vary in their pathophysiological mechanisms, symptomatic manifestations, and potential interventional approaches. This review provides a proposal for differentiating post COVID-19 patients in non-organ-specific phenotypes that may help clinicians to evaluate patients and to plan therapeutic options. Furthermore, we present current unmet needs and suggest a potential pathway for a specific rehabilitation approach in people with persistent post-COVID symptoms.

Experiences of physiotherapists working with adults living with Long COVID in Canada: a qualitative study

“…Existing Long COVID clinical practice guidelines from the WHO that were available at the time of the interviews prioritize red-flag screening, individualized care, psychological support, and avoiding graded exercise therapy in the presence of PESE or PEM (30,31). Thus, it is critical for physiotherapists to remain up-to-date with evolving literature to ensure safe rehabilitation focusing on symptom stabilization and optimising function while preventing exacerbation of symptoms (30,32). There is a need for enhanced Long COVID education within physiotherapy entry-to-practice curricula and continuing education opportunities for physiotherapists to foster evidence-informed, safe, and effective rehabilitation with persons living with Long COVID.…”

“…Long COVID clinical practice guidelines from the WHO that were available at the time of the interviews prioritize red-flag screening, individualized care, psychological support, and avoiding graded exercise therapy in the presence of PESE or PEM (30,31). Thus, it is critical for physiotherapists to remain up-to-date with evolving literature to ensure safe rehabilitation focusing on symptom stabilization and optimising function while preventing exacerbation of symptoms (30,32).…”

“…The World Health Organization (WHO) COVID-19 Clinical Management: Living Guideline (30) highlights the importance of multidisciplinary, coordinated, person-centred, and safe rehabilitation with persons living with Long COVID (6,7,31,32). Specifically, physiotherapists (physical therapists), may help to mitigate disability and prevent symptoms associated with Long COVID such as dyspnea, fatigue, and pain, and guide workplace accommodations (7,17,(31)(32)(33)(34)(35)(36)(37)(38). It is critical for physiotherapists to screen for complications from COVID-19 before rehabilitation and on an ongoing basis, including PESE, cardiac impairment, exertional oxygen desaturation, and autonomic dysfunction.…”

“…Safe rehabilitation, focused on symptom stabilization and avoiding exacerbation, has a potential role in addressing the multidimensional nature of disability experienced by people living with Long COVID (16,17,29). The World Health Organization (WHO) COVID-19 Clinical Management: Living Guideline (30) highlights the importance of multidisciplinary, coordinated, person-centred, and safe rehabilitation with persons living with Long COVID (6,7,31,32). Specifically, physiotherapists (physical therapists), may help to mitigate disability and prevent symptoms associated with Long COVID such as dyspnea, fatigue, and pain, and guide workplace accommodations (7,17,(31)(32)(33)(34)(35)(36)(37)(38).…”

Long COVID Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation

“…The findings of clinical severity types and the fluctuating nature of the condition have widespread implications for self-management and the interventions provided by healthcare professionals, as well as the support provided by carers and family members. There is established evidence for PEM or PESE in the literature as a hallmark finding in LC and other post-viral illness [26][27][28]. Relapse can be triggered by physical, cognitive, or emotional exertion, and evidence suggests that cognitive and emotional exertion can be responsible in equal measure to physical exertion.…”