Non-pharmacological therapies for postviral syndromes, including Long COVID: a systematic review and meta-analysis protocol

Abstract

IntroductionPostviral syndromes (PVS) describe the sustained presence of symptoms following an acute viral infection, for months or even years. Exposure to the SARS-CoV-2 virus and subsequent development of COVID-19 has shown to have similar effects with individuals continuing to exhibit symptoms for greater than 12 weeks. The sustained presence of symptoms is variably referred to as ‘post COVID-19 syndrome’, ‘post-COVID condition’ or more commonly ‘Long COVID’. Knowledge of the long-term health impacts and treatments for Long COVID are evolving. To minimise overlap with existing work in the field exploring treatments of Long COVID, we have only chosen to focus on non-pharmacological treatments.AimsThis review aims to summarise the effectiveness of non-pharmacological treatments for PVS, including Long COVID. A secondary aim is to summarise the symptoms and health impacts associated with PVS in individuals recruited to treatment studies.Methods and analysisPrimary electronic searches will be performed in bibliographic databases including: Embase, MEDLINE, PyscINFO, CINAHL and MedRxiv from 1 January 2001 to 29 October 2021. At least two independent reviewers will screen each study for inclusion and data will be extracted from all eligible studies onto a data extraction form. The quality of all included studies will be assessed using Cochrane risk of bias tools and the Newcastle-Ottawa grading system. Non-pharmacological treatments for PVS and Long COVID will be narratively summarised and effect estimates will be pooled using random effects meta-analysis where there is sufficient methodological homogeneity. The symptoms and health impacts reported in the included studies on non-pharmacological interventions will be extracted and narratively reported.Ethics and disseminationThis systematic review does not require ethical approval. The findings from this study will be submitted for peer-reviewed publication, shared at conference presentations and disseminated to both clinical and patient groups.PROSPERO registration numberThe review will adhere to this protocol which has also been registered with PROSPERO (CRD42021282074).

The Feasibility and Impact of Practising Online Forest Bathing to Improve Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study

“…In the meantime, some researchers have offered reviews of the post-viral syndrome literature to guide intervention development. For example, Chandan [ 11 ] found that pilates, telerehabilitation, resistance exercise, and neuromodulation showed some support in symptom management. In the few published intervention studies with Long-COVID patients, physical rehabilitation has been a focus.…”

What interventions or best practice are there to support people with Long COVID, or similar post-viral conditions or conditions characterised by fatigue, to return to normal activities: a rapid review

“…The study was not adequately powered; therefore, further work may be necessary to assess efficacy (Chandan et al, 2022).…”

“…Two SRs indicated that non-pharmaceutical interventions for patients with Long COVID or CFS could help improve function for activities of daily life (Fowler-Davis et al, 2021; Larun et al, 2019). However, the third and most recent SR concluded that there is a lack of robust evidence for non-pharmaceutical interventions (Chandan et al, 2022).…”

“…part-time hours, working from home, or hybrid working). Two SRs indicated that non-pharmaceutical interventions for patients with Long COVID or CFS could help improve function for activities of daily life (Fowler-Davis et al, 2021; Larun et al, 2019). However, the third and most recent SR concluded that there is a lack of robust evidence for non-pharmaceutical interventions (Chandan et al, 2022). Long COVID fatigue management by exercise therapy, electrical nerve stimulation, sleep and touch therapy, and behavioural self-management may be beneficial when: physical and psychological support is delivered in groups, people can plan their functional response to fatigue, strengthening rather than endurance is used to prevent deconditioning, fatigue is regarded in the context of an individual’s lifestyle and home-based activities are used (Fowler-Davis et al 2021).…”

“…Long COVID fatigue management by exercise therapy, electrical nerve stimulation, sleep and touch therapy, and behavioural self-management may be beneficial when: physical and psychological support is delivered in groups, people can plan their functional response to fatigue, strengthening rather than endurance is used to prevent deconditioning, fatigue is regarded in the context of an individual’s lifestyle and home-based activities are used (Fowler-Davis et al 2021). One SR (Chandan et al 2022) reported work capability as an outcome however they did not find any studies which evaluated the impact of interventions on return to work/ normal life. One primary study concentrated on individuals with CFS (Nyland et al, 2014). Nyland et al (2014) described a written self-management programme featuring active coping (with CFS) strategies for daily life.…”