Effects of Rehabilitation Interventions for Old Adults with Long COVID: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Overview

Journal J Glob Health

Specialties Health Services
Public Health

Date 2024 Sep 6

PMID 39238359

Authors

Jie Deng

Chenyuan Qin

Minjung Lee

Yubin Lee

Myoungsoon You

Jue Liu

Affiliations

Soon will be listed here.

Abstract

Background: There is limited evidence on the effectiveness of the existing rehabilitation interventions for old adults with long coronavirus disease (COVID), which is of particular concern among old adults.

Methods: We systematically searched studies published in PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases from their inception to 15 November 2023. Randomised controlled trials (RCTs) compared rehabilitation interventions with other controls in old adults (mean/median age of 60 or older) with long COVID were included. We performed a meta-analysis to compare the effects of the rehabilitation interventions with the common control group. Mean difference (MD) or standardised mean difference (SMD) with its 95% confidence intervals (CI) were used as summary statistics. Moreover, subgroup analyses based on the intervention programmes, the severity of acute infection, and the age of participants were carried out.

Results: A total of 11 RCTs involving 832 participants (64.37 ± 7.94 years, 52.2% were men) were included in the analysis. Compared with the control groups, rehabilitation interventions significantly improved 6-minute walking test (6 MWT; MD = 15.77 metres (m), 95% CI = 5.40, 26.13, P < 0.01), 30-second sit-to-stand test (MD = 4.11 number of stands (n), 95% CI = 2.46, 5.76, P < 0.001), all aspects of quality of life, independence in activities of daily living (SMD = 0.31, 95% CI = 0.14, 0.48, P < 0.001), and relieved fatigue (SMD = -0.66, 95% CI = -1.13, -0.19, P < 0.01), depression (SMD = -0.89, 95% CI = -1.76, -0.02, P < 0.05) and anxiety (SMD = -0.81, 95% CI = -1.58, -0.05, P < 0.05). However, the improvement of hand grip strength and pulmonary function was not statistically significant (P > 0.05). Subgroup analyses showed that improvements in 6 MWT, fatigue, anxiety, and depression were more pronounced in old patients who received exercise training, while those who received respiratory rehabilitation had more pronounced improvements in pulmonary function and quality of life.

Conclusions: Old adults with long COVID who underwent rehabilitation interventions experienced significant improvement in functional capacity, fatigue, quality of life, independence in activities of daily living, and mental health outcomes compared with usual/standard care. These findings suggest that screening, management, and rehabilitation interventions for long COVID in older adults should be strengthened to improve their complete health status and functional status, thereby reducing the long-term disease burden caused by long COVID and fostering healthy aging during the post-pandemic era.

References

van Haastregt J, Everink I, Schols J, Grund S, Gordon A, Poot E . Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance. Eur Geriatr Med. 2021; 13(1):291-304. PMC: 8605452. DOI: 10.1007/s41999-021-00575-4. View

Li G, Hilgenfeld R, Whitley R, De Clercq E . Therapeutic strategies for COVID-19: progress and lessons learned. Nat Rev Drug Discov. 2023; 22(6):449-475. PMC: 10113999. DOI: 10.1038/s41573-023-00672-y. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Krupp L, Larocca N, Steinberg A . The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989; 46(10):1121-3. DOI: 10.1001/archneur.1989.00520460115022. View

Soriano J, Murthy S, Marshall J, Relan P, Diaz J . A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22(4):e102-e107. PMC: 8691845. DOI: 10.1016/S1473-3099(21)00703-9. View

Grishechkina I, Lobanov A, Andronov S, Rachin A, Fesyun A, Ivanova E . Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study. Eur J Transl Myol. 2023; 33(2). PMC: 10388602. DOI: 10.4081/ejtm.2023.11063. View

Yang G, Li Z, Li Z, Huang L, Liang P, Liu L . Meta-analysis of the impact of physical activity on the recovery of physical function in COVID-19 patients. Heliyon. 2023; 9(9):e19339. PMC: 10469390. DOI: 10.1016/j.heliyon.2023.e19339. View

Ware Jr J, Sherbourne C . The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6):473-83. View

Kleinitz P, Sabariego C, Llewellyn G, Taloafiri E, Mangar A, Baskota R . Integrating rehabilitation into health systems: A comparative study of nine middle-income countries using WHO's Systematic Assessment of Rehabilitation Situation (STARS). PLoS One. 2024; 19(2):e0297109. PMC: 10843154. DOI: 10.1371/journal.pone.0297109. View

10.

Shahin W, Kennedy G, Stupans I . The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence. 2019; 13:1019-1035. PMC: 6611718. DOI: 10.2147/PPA.S212046. View

11.

Jarrott B, Head R, Pringle K, Lumbers E, Martin J . "LONG COVID"-A hypothesis for understanding the biological basis and pharmacological treatment strategy. Pharmacol Res Perspect. 2022; 10(1):e00911. PMC: 8929332. DOI: 10.1002/prp2.911. View

12.

Longobardi I, Goessler K, de Oliveira Junior G, DO Prado D, Santos J, Meletti M . Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial. Br J Sports Med. 2023; 57(20):1295-1303. DOI: 10.1136/bjsports-2022-106681. View

13.

ZUNG W . A SELF-RATING DEPRESSION SCALE. Arch Gen Psychiatry. 1965; 12:63-70. DOI: 10.1001/archpsyc.1965.01720310065008. View

14.

Omarova I, Akanova A, Kurmanova A, Kurmanova G, Glushkova N, Seidanova A . Acupuncture as an Additional Method of Rehabilitation Post-COVID-19: a randomized controlled trial. J Pharmacopuncture. 2023; 26(3):238-246. PMC: 10547817. DOI: 10.3831/KPI.2023.26.3.238. View

15.

Calvache-Mateo A, Heredia-Ciuro A, Martin-Nunez J, Hernandez-Hernandez S, Reychler G, Lopez-Lopez L . Efficacy and Safety of Respiratory Telerehabilitation in Patients with Long COVID-19: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2023; 11(18). PMC: 10530340. DOI: 10.3390/healthcare11182519. View

16.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

17.

Like R . Culturally competent family medicine: transforming clinical practice and ourselves. Am Fam Physician. 2005; 72(11):2189-90. View

18.

Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y . Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020; 39:101166. PMC: 7118596. DOI: 10.1016/j.ctcp.2020.101166. View

19.

Araya-Quintanilla F, Sepulveda-Loyola W, Cuyul-Vasquez I, Alvarez-Bustos A, Gutierrez-Espinoza H, Probst V . Recommendations and Effects of Rehabilitation Programs in Older Adults After Hospitalization for COVID-19: A Scoping Review. Am J Phys Med Rehabil. 2023; 102(7):653-659. PMC: 10259172. DOI: 10.1097/PHM.0000000000002183. View

20.

Carvalho A, Moreira J, Cubelo P, Cantista P, Aguiar Branco C, Guimaraes B . Multidisciplinary rehabilitation in intensive care for COVID-19: randomised controlled trial. ERJ Open Res. 2023; 9(1). PMC: 9571162. DOI: 10.1183/23120541.00350-2022. View