ZusammenfassungAktuell (Mitte März 2022) haben sich über 17 Mio. Menschen in Deutschland mit dem SARS-CoV-2-Virus infiziert. Es ist damit zu rechnen, dass 5–10% der Infizierten ein klinisch relevantes Post-COVID-Syndrom entwickeln. Häufigste Symptome sind Fatigue, Dyspnoe und kognitive Einschränkungen. Eine kausale Therapie steht aktuell nicht zur Verfügung, es mehren sich jedoch die Hinweise, dass ein multimodaler Behandlungsansatz mit psychotherapeutischen Elementen erfolgversprechend ist. Post-COVID stellt somit eine aktuelle Herausforderung für das Gesundheitssystem und speziell die Rehabilitation dar. In diesem Beitrag wird ein duales internistisch-psychosomatisches Rehabilitationskonzept beschrieben. Kernelemente sind eine verhaltenstherapeutisch orientierte störungsspezifische Psychotherapiegruppe sowie an die individuelle Leistungsfähigkeit angepasste und langsam aufbauende Bewegungstherapie. Ziele sind Unterstützung bei der Krankheitsverarbeitung und eine Verbesserung der Leistungsfähigkeit. Eingesetzt werden u. a. Interventionen basierend auf der ACT und dem Avoidance-Endurance-Konzept. Hinzu kommen indikativ Atemtherapie, kognitives Training sowie Ernährungs- und Sozialberatung. Die internistische Mitbetreuung gibt den Patienten die Sicherheit, sich auf das körperliche Trainingsprogramm einlassen zu können. Die bisherigen Erfahrungen zeigen, dass das Konzept von den Betroffenen gut akzeptiert wird und dass die angestrebten Behandlungsziele erreicht werden können.
BackgroundCOVID-19 is associated with various symptoms and psychological involvement in the long term. In view of the multifactorial triggering and maintenance of the post-COVID syndrome, a multimodal therapy with somatomedical and psychotherapeutic content is expedient. This paper compares the psychological stress of post-COVID patients and their course in rehabilitation to psychosomatic and psychocardiological patients.MethodObservational study with control-groups and clinical, standardized examination: psychological testing (BDI-II, HELATH-49), 6-MWT as somatic parameter, two measurement points (admission, discharge). Sample characteristics, including work related parameters, the general symptom-load and the course of symptoms during rehabilitation are evaluated.ResultsAt admission in all measures post-COVID patients were significantly affected, but less pronounced than psychosomatic or psychocardiological patients (BDI-II post-COVID = 19.29 ± 9.03, BDI-II psychosomatic = 28.93 ± 12.66, BDI-II psychocardiology = 24.47 ± 10.02). During rehabilitation, in all complaint domains and sub-groups, symptom severity was significantly reduced (effect sizes ranging from d = .34 to d = 1.22). Medium positive effects were seen on self-efficacy (d = .69) and large effects on activity and participation (d = 1.06) in post-COVID patients. In the 6-MWT, the walking distance improved by an average of 76.43 ± 63.58 meters (d = 1.22). Not a single patient deteriorated in walking distance, which would have been a possible sign of post exercise malaise (PEM).ConclusionPost-COVID patients have a slighter psychological burden as psychocardiological or psychosomatic patients. Although rehabilitation is not curative, post-COVID patients benefit significantly from the interventions and there were no signs of PEM.
Background In Patients suffering from post-COVID syndrome, in addition to physical limitations, cognitive limitations, fatigue, dyspnea as well as depression and anxiety disorders may also be present. Up to now (as of May 2022), approx. 514 million people worldwide have been infected with SARS-CoV-2, in Germany this affects approx. 25 million. In Germany, 2.5 million people could potentially be affected by post-COVID syndrome. Post-COVID is thus a highly relevant public health issue. So far, there is no specific causal therapy for the post-COVID syndrome, but with multimodal symptom-oriented rehabilitation, the course can be favourably influenced. However, there is no study yet that focuses on patients in different rehabilitation indications and compares the focal symptomatology and coping strategies as well as the patients' benefit per indication. Methods/design As first objective, pulmonal, cardiac, neurological, cognitive or/and psychological functional impairments in rehabilitation patients after COVID-19 disease will be described. The second objective is the differentiated review of the specific rehabilitation measures, in the short term and in the longer term for the purpose of future prognoses and optimisation of therapeutic interventions. This prospective, non-randomised, controlled longitudinal study, plus multi-group comparisons will take place in seven rehabilitation clinics of different specialisations: cardiological rehab, pneumological rehab, neurological rehab, psychosomatic rehab. Within 12 months, 1000 cases across all participating centres will be included. Somatic and psychological testing will be conducted at three measurement points: Admission (t0), discharge (t1), 6-montas Catamnesis (t2). The patients receive the usual care according to the respective rehabilitation priorities, adapted to the special challenges of post-COVID symptoms. Patients of the post-COVID outpatient clinic without rehabilitation will be used as a control group. Discussion This study will precisely assess the extent to which subclinical neurological or/and psychological impairments are present in post-COVID-19 rehabilitation and the results will help, developing, providing and evaluating appropriate treatment concepts. This may also have relevant implications for the improvement of physical ability and quality of life in post-COVID-19 patients and increase the probability of return to work. Trial registration Z-2022-1749-8, registered 03. February 2022, https://studienanmeldung.zks-regensburg.de
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