First results from post-COVID inpatient rehabilitation

[Psychosomatic Rehabilitation for Post-COVID]

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial

BACKGROUND

The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting.

METHODS

The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention.

RESULTS

The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33-0.49).

CONCLUSIONS

Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.

[The Significance of Chronic Fatigue in the Post-Covid Consultation and its Consequences for Outpatient Rehabilitation in the Context of Statutory Accident Insurance]

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.

[Pneumological Rehabilitation in Long COVID - A Comparative Exploratory Longitudinal Study of Long COVID and Asthma/COPD Rehabilitees]

BACKGROUND

For some COVID-19 patients, symptoms and health impairments persist for an extended period of time (long COVID). Long-term consequences of the disease can lead to permanent limitations in participatory life. In these cases, medical rehabilitation may be useful. Due to the novelty of the disease, little is known about the need for rehabilitation and therapy and the health benefits of specific rehabilitation interventions.

METHODS

A multicentre longitudinal observational study was conducted. Persons affected by long COVID (LC) between 18 and 65 years of age undergoing pulmonary rehabilitation were included. An age-matched comparison group (CG) consisted of rehabilitation patients with bronchial asthma and COPD. Written questionnaires were administered at the beginning and end of rehabilitation, as well as six and twelve months after rehabilitation. Outcomes included parameters of subjective health, occupational outcomes, contents of rehabilitation and rehabilitation aftercare.

RESULTS

The sample consisted of 305 participants, of whom 172 were classified as LC and 133 as CG. In the total sample, one third of the participants were male and the average age was 53 years. All rehabilitation participants had high health burdens, LC patients had statistically significantly higher impairments in almost all outcomes recorded. At the beginning of rehabilitation, one third of the respondents were on sick leave, more often in LC than in the CG. Twelve months after rehabilitation, both groups achieved significant health improvement, with LC showing greater improvements in most outcomes (interaction effect p<0.01). Despite success in most parameters, LC patients still showed persistent COVID symptoms at twelve months. One year after rehabilitation, 89% returned to work.

CONCLUSION

The majority of rehabilitation patients benefit greatly from pulmonary medical rehabilitation in terms of health and occupation. The content of pulmonary rehabilitation seems to be suitable for this indication group; however, there is an indication-specific use of therapy between CG and LC group. As a result, the LC group seems to need more and different therapies.

Psychobehavioral B-Criteria of Somatic Symptom Disorder Are Associated with Somatic Symptom Reporting in a Large Sample of Psychosomatic Outpatients

Introduction

Somatic symptom disorder (SSD) as introduced by the DSM-5 is characterized by chronic somatic symptoms not fully explained by underlying pathology and accompanied by psychological factors, the diagnostic B-criteria. These cognitive, affective, and behavioral disturbances are related to increased attention to somatic symptoms. However, there is a lack of empirical evidence regarding the association between the B-criteria and high symptom reporting in clinical settings.

Methods

This 12-year retrospective, cross-sectional, observational study examined 6,491 patients from a German psychosomatic outpatient center. The somatoform subscale of HEALTH-49 was used to evaluate somatic symptom reporting. Excessive health concerns and other potential criteria associated with symptom reporting were determined using the ICD-10-Symptom Rating and other HEALTH-49 subscales.

Results

Regression analysis revealed that the established B-criteria for SSD were the strongest factors associated with somatic symptom reporting, with a standardized beta-coefficient of β = 0.31 (R2 = 0.428, df = 24, F = 187.886). Other psychobehavioral factors were clearly less associated with somatic symptom reporting, such as depressive symptoms with β = 0.15 and impaired activity and participation with β = 0.12. Sociodemographic factors, such as age (β = 0.16) and gender (β = 0.12), were also independently associated with somatic symptom reporting.

Conclusion

This study provides evidence for the concept of SSD related to specific B-criteria associated with somatic symptom reporting, based on a large patient sample. These results point to an important role of psychological symptomatology in patients with somatic symptoms. The findings also suggest that additional factors contribute to the reporting of somatic symptoms. Our results may inform future diagnostic criteria for SSD.

[Rehabilitation for Post-COVID Syndrome covered by the German Pension Insurance in 2021]

AIM OF THE STUDY

The present work is intended to give an overview of rehabilitation of patients with post COVID-19 condition covered by the German Pension Insurance in 2021.

METHODS

Cross-sectional analysis of medical rehabilitation completed in 2021, in which COVID-19 sequelae were coded in first or second place in the uniform discharge report according to the International Statistical Classification of Diseases and Related Health Problems was carried out. The codes U08(.9), U09(.9) and U10(.9) as well as the corresponding codes from 2020 were taken into the evaluation as COVID-19-related diseases. Children's rehabilitation and oncological rehabilitation for pensioners and their relatives were excluded. Statistically, relative and absolute frequencies are given for nominal and ordinal variables, and median and quartiles for continuous, skewed distributed variables.

RESULTS

9,666 rehabilitations with one of the codes mentioned in first or second place remained. 54.8% of the patients were women and 43.2% men. The median age was 54 and 55 years (women/men). In all, 64.4% of the rehabilitations were carried out in the pulmonary medicine department. Owing to somatic indications, almost 50% of these patients in rehabilitation remained in the clinic beyond the regular approval period. The most common other diagnoses were diseases of the respiratory system. In 80.7% of those affected, the treating physicians considered the post-COVID-19 condition-associated symptoms as improved through rehabilitation. Furthermore, employment was subject to social security contributions for 88.0% of these patients, and 30.5% were employed in the fields of health, social affairs, teaching, and education. Of those affected, 63.8% were on sick leave when they were admitted, 63.0% when they were discharged. With regard to performance in the last job or on the general job market, over 90.0% received a prognosis for 6 hours and more.

CONCLUSION

The importance of post-COVID-19 condition in the context of medical rehabilitation increased significantly over the course of 2021. The disease causes long periods of disability. With regard to performance, the available analyses give a positive picture; only 6.5% of those individuals undergoing rehabilitation were assessed as having a reduced capacity to earn of less than 3 hours on the general labor market.

Attention deficits and depressive symptoms improve differentially after rehabilitation of post-COVID condition - A prospective cohort study

BACKGROUND

Depressive and cognitive symptoms like fatigue, loss of energy or sleep disorders characterise the post-COVID condition. Post-COVID psychosomatic rehabilitation should focus on both symptom groups. The current prospective cohort study addresses the change in these symptoms in the context of a psychosomatic rehabilitation.

METHOD

N = 80 patients with post-COVID symptoms underwent psychological testing on admission and discharge: PHQ-9 questionnaire for depression, TAP - test battery for the attention test with the sub-tests working memory, sustained attention, divided attention and alertness. Sample characteristics, including health-related and work-related parameters, the general symptom load and the course of symptoms during the five weeks of rehabilitation were evaluated.

RESULTS

On admission, the PHQ-9 indicated the presence of depressive symptoms in post-COVID patients (PHQ-9 = 15.15 ± 5.11). Over the course of rehabilitation, the depressive symptoms decreased to a sub-clinical level (PHQ-9 = 8.80 ± 4.61), suggesting a strong effect of post-COVID inpatient rehabilitation (Cohen's d = 1.57). At the same time, post-COVID patients showed clinically relevant impairments in attention and working memory that persisted throughout the rehabilitation period despite multimodal post-COVID treatment.

CONCLUSION

Over the course of post-COVID rehabilitation, depressive symptoms appear to be significantly reduced. With regard to cognitive impairment, a comparable effect within the short period of 5 weeks is not evident. Our results suggest the need for specific treatment of persistent neuropsychological deficits following post-COVID rehabilitation.

The Impact of Comprehensive Rehabilitation on the Exercise Capacity of Patients after COVID-19

Coronavirus Disease 2019 (COVID-19) is a complex disease that affects multiple body systems, including the respiratory, cardiovascular, neurological, and muscular systems. It is estimated that approximately half of the patients after the treatment for COVID-19 experience persistent symptoms that lead to a decreased physical capacity. Scientific recommendations suggest that cardiovascular and respiratory rehabilitation programs should be implemented in patients who have completed treatment for COVID-19. Therefore, the objective of this study was to evaluate the impact of comprehensive rehabilitation on the exercise capacity of patients after COVID-19 treatment. The study included 146 patients after the treatment for COVID-19 who were eligible for therapeutic rehabilitation. The exercise capacity was assessed using the 6-minute walk test (6MWT). The results showed that patients who underwent rehabilitation had an average increase of 23.83% in their 6MWT score compared to the baseline. A comprehensive rehabilitation program including breathing exercises, aerobic training, and strength and endurance exercises is an effective intervention that can improve the physical capacity of patients after COVID-19 treatment.

S2k-Guideline SARS-CoV-2, COVID-19 and (early) rehabilitation - a consensus-based guideline for Germany

The consensus-based guideline "SARS-CoV-2, COVID-19 and (early) rehabilitation" for Germany has two sections: In the first part, the guideline addresses infection protection-related procedures during the COVID-19 pandemic. In the second part, it provides practice recommendations for rehabilitation after COVID-19. The specific recommendations for rehabilitation after COVID-19 as issued by 13 German medical societies and two patient-representative organizations are presented together with general background information for their development.