Talk therapy and rehabilitation can improve long-term COVID symptoms, but the effects are modest

Cognitive behavioral therapy (CBT) and a physical and mental rehabilitation program are likely to improve symptoms of long COVID, but the effects are modest, according to a review of the latest evidence published in The BMJ.

Intermittent aerobic exercise is also likely to improve physical function compared to continuous aerobic exercise. But the researchers found no convincing evidence to support the effectiveness of other interventions, including certain medications, nutritional supplements, inspiratory muscle training, transcranial direct current stimulation, hyperbaric oxygen therapy or mobile education apps.

Although most patients recover from COVID-19, up to 15% (an estimated 65 million people worldwide) may experience long-term health effects, including fatigue, muscle pain (myalgia) and reduced cognitive function.

Healthcare providers are increasingly seeing patients with long-term COVID-19, and in the absence of reliable and up-to-date evidence summaries, patients may receive unproven, costly, and ineffective or harmful treatments.

To address this, researchers searched databases for studies that randomized adults with long-term COVID-19 to drug or non-drug interventions, placebo or dummy treatment, or usual care.

They found 24 relevant studies involving 3,695 patients investigating medications, physical activity or rehabilitation, behavioral interventions, dietary interventions, medical devices and technologies, and combinations of exercise and rehabilitation in mental health care.

The studies were of varying quality, but researchers were able to assess the risk of bias and the certainty of evidence using established tools.

Evidence of moderate certainty suggests that an online CBT program, compared with usual care, is likely to reduce fatigue and improve concentration, and that an online, supervised combined physical and mental health rehabilitation program is likely to increase the number of patients achieving meaningful improvement or recovery experiences and reduces symptoms. of depression and improves quality of life.

Moderate-certainty evidence also suggests that intermittent aerobic exercise 3 to 5 times per week for 4 to 6 weeks is likely to improve physical function compared with continuous aerobic exercise.

However, no convincing evidence was found to support the effectiveness of other interventions, including the antidepressant vortioxetine, the antibody leronlimab, a combination of probiotics and prebiotics, the antioxidant coenzyme Q10, brain retraining, transcranial direct current stimulation, inspiratory muscle training, hyperbaric oxygen. , and a mobile education app about long COVID.

Despite their rigorous literature search, the authors acknowledge that it is possible that they may have missed eligible studies. Furthermore, most of the evidence supporting other interventions was low to very low certainty, and new studies may influence results.

However, this was a rigorous evaluation, designed with input from people with lived experience of long COVID, and with a focus on outcomes that matter to patients.

As such, the researchers conclude: “Our findings suggest that offering patients with long-term COVID-19 a CBT program or a physical and mental rehabilitation program is likely to improve symptoms.”

These results will be updated as new evidence becomes available, they add.