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Dalichau S, Kordy H, Klüver J, Brinkmeier W, Rathmann N, Yorke L, Kleefmann J, Möller T. [The Significance of Chronic Fatigue in the Post-Covid Consultation and its Consequences for Outpatient Rehabilitation in the Context of Statutory Accident Insurance]. Psychother Psychosom Med Psychol 2024; 74:265-275. [PMID: 38492566 DOI: 10.1055/a-2266-3441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE The post-COVID consultation (PCC) is offered as part of a comprehensive range of treatment services provided by the statutory accident insurance for post-COVID patients to determine individual recommendations for further care. The aim of the study was to record the main symptoms and the associated restrictions on social and occupational participation in order to derive consequences for outpatient rehabilitation. METHOD In addition to a medical examination and a psychological consil, numerous assessments were carried out to evaluate the biopsychosocial state of health. 373 female (82.2%) and 81 male patients aged between 40 and 60 years from the professions of health and care services, education and pedagogy participated in the PCC since April 2021. RESULTS Nearly all patients (98.2%) reported fatigue as a cardinal symptom of their post-COVID complaints, in combination with subjectively experienced limitations in brain functioning in over 73% of cases. The duration of the symptomatology persisted for an average of 14-15 months in both female and male insured persons. Thus, over 85% of the total sample can be classified as cases of chronic fatigue (Fatigue Scale). The severity of fatigue also proportionally affects quality of life (SF-36), feelings of anxiety and depression (HADS), psychological resilience (RS-13), and motor parameters such as maximum grip strength and endurance capacity. 54.3% of the patients also received a suspected mental diagnosis and 38.1% a recommendation for further neuropsychological diagnostics. CONCLUSION For further treatment of the leading symptom of chronic fatigue, a multimodal and interdisciplinary outpatient rehabilitation is recommended, which should be oriented towards the treatment of the diagnosis of chronic fatigue syndrome (ME/CFS) and thus in particular towards a psychoeducational and rather than a curative therapeutic approach, and should consider aftercare strategies. Confirmed mental disorders and neuropsychological deficits are to be treated in addition.
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Affiliation(s)
- Stefan Dalichau
- Rehabilitation und Versorgungsforschung, BG Ambulanz Bremen, Bremen
| | - Henrike Kordy
- Abteilung Psychologische Psychotherapie, BG Ambulanz Bremen, Bremen
| | - Janna Klüver
- Abteilung Sporttherapie, BG Ambulanz Bremen, Bremen
| | | | - Nadine Rathmann
- Abteilung Gesundheitswissenschaften, BG Ambulanz Bremen, Bremen
| | - Lacy Yorke
- Abteilung Gesundheitswissenschaften, BG Ambulanz Bremen, Bremen
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Gloeckl R, Leitl D, Schneeberger T, Jarosch I, Koczulla AR. Rehabilitative interventions in patients with persistent post COVID-19 symptoms-a review of recent advances and future perspectives. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01631-9. [PMID: 37326700 DOI: 10.1007/s00406-023-01631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
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.
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Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany.
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany.
| | - Daniela Leitl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
- Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
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Fowler-Davis S, Platts K, Thelwell M, Woodward A, Harrop D. A mixed-methods systematic review of post-viral fatigue interventions: Are there lessons for long Covid? PLoS One 2021; 16:e0259533. [PMID: 34752489 PMCID: PMC8577752 DOI: 10.1371/journal.pone.0259533] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Fatigue syndromes have been widely observed following post-viral infection and are being recognised because of Covid19. Interventions used to treat and manage fatigue have been widely researched and this study aims to synthesise the literature associated with fatigue interventions to investigate the outcomes that may be applicable to 'long Covid'. METHOD The study was registered with PROSPERO (CRD42020214209) in October 2020 and five electronic databases were searched. Papers were screened, critically appraised and data extracted from studies that reported outcomes of fatigue interventions for post-viral syndromes. The narrative synthesis includes statistical analysis associated with effectiveness and then identifies the characteristics of the interventions, including identification of transferable learning for the treatment of fatigue in long Covid. An expert panel supported critical appraisal and data synthesis. RESULTS Over 7,000 research papers revealed a diverse range of interventions and fatigue outcome measures. Forty papers were selected for data extraction after final screening. The effectiveness of all interventions was assessed according to mean differences (MD) in measured fatigue severity between each experimental group and a control following the intervention, as well as standardised mean differences as an overall measure of effect size. Analyses identified a range of effects-from most effective MD -39.0 [95% CI -51.8 to -26.2] to least effective MD 42.28 [95% CI 33.23 to 51.34]-across a range of interventions implemented with people suffering varying levels of fatigue severity. Interventions were multimodal with a range of supportive therapeutic methods and varied in intensity and requirements of the participants. Those in western medical systems tended to be based on self- management and education principles (i.e., group cognitive behavioural therapy (CBT). CONCLUSION Findings suggest that the research is highly focussed on a narrow participant demographic and relatively few methods are effective in managing fatigue symptoms. Selected literature reported complex interventions using self-rating fatigue scales that report effect. Synthesis suggests that long Covid fatigue management may be beneficial when a) physical and psychological support, is delivered in groups where people can plan their functional response to fatigue; and b) where strengthening rather than endurance is used to prevent deconditioning; and c) where fatigue is regarded in the context of an individual's lifestyle and home-based activities are used.
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Affiliation(s)
- Sally Fowler-Davis
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Katharine Platts
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Michael Thelwell
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Amie Woodward
- Department of Health Sciences, University of York, York, United Kingdom
| | - Deborah Harrop
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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