| Dalbosco-Salas et al.(12) |
To analyze whether the telerehabilitation program is effective in improving physical capacity, quality of life and symptoms in adult post-Covid patients. |
Prospective observational study |
Physical capacity, physical limitations, bodily pain, general health perceptions, vitality, social functioning, emotional limitations and mental health improved after the intervention in most patients. At the same time, there was a significant recovery in fatigue and dyspnea. Between individuals who had been admitted to the ICU and individuals who had not been admitted to the ICU, all aspects showed improvement, with the exception of bodily pain, general health perceptions, emotional limitations and mental health. |
Telerehabilitation (offering physical exercises accompanied by professionals). |
| Daynes et al.(13) |
To assess whether there are improvements in the variables fatigue, respiratory difficulty, exercise capacity and cognition after physical intervention, among individuals with Long Covid. |
Observational study |
The study indicated a decrease in exercise capacity and health-related quality of life compared to healthy controls, although anxiety, depression and cognition were preserved. The results indicate an improvement in fatigue, with an increase in the incremental and endurance walking test, Functional Assessment of Chronic Disease Treatment Fatigue Scale, EuroQual 5 domains (EQ5D) and Montreal Cognitive Assessment and a decrease in the Hospital Anxiety and Depression Scale |
Continuous clinical monitoring. However, there is a lack of a specific rehabilitation protocol for patients with Long Covid-19. |
| Jimeno-Almazán et al.(14) |
To compare the results of patients with Long Covid undergoing supervised therapeutic exercise intervention or following the WHO (World Health Organization) self-management rehabilitation leaflet. |
Randomized clinical trial |
A routine of simultaneous training sessions was carried out three days a week. Based on the prevalent symptoms (common to the condition, such as dyspnea and low-grade fever), the following variables were assessed: lung function, body composition (fat and lean body mass), quality of life and fatigue, anxiety and depression, cardiovascular health and muscle strength. After 8 weeks of physical exercise, there was a reduction in signs and symptoms, especially with regard to dyspnea. There was also a general improvement in all the variables; however, some of the results reported by the patients in the fatigue and quality of life variables did not show significant improvements compared to the control group, even though there was a partial improvement in dyspnea and lung functionality. |
Physical fitness exercise interventions, with a focus on supervised and monitored physical rehabilitation. |
| Koliadenko et al.(15) |
To study the clinical manifestations of psychopathological symptoms in Covid-19 survivors and develop a conceptual model to provide them with medical care in telemedicine. |
Retrospective study |
As far as mental health is concerned, none of the individuals studied had any indication of mental health or behavioral disorders prior to Covid-19. Around 98 patients (76% of all patients) had memory impairment. All the individuals assessed (with the exception of one) had considerable levels of anxiety, stress and depression at the time of the study, mainly as a result of the negative situation brought about by the Covid-19 pandemic. Hypochondriacal symptoms were also identified, resulting from low indicators of well-being, activity and mood. The treatment, based on the cognitive-behavioral approach and associated with the use of antidepressants and non-benzodiazepine tranquilizers, emphasized an improvement in levels of stress, anxiety and depression. |
Cognitive Behavioral Therapy, with psychotherapeutic assistance provided through telemedicine, drug treatment and prolonged and continuous follow-up, with monitoring during and after the therapeutic intervention. |
| Nopp et al.(16) |
To evaluate the efficacy and safety of outpatient pulmonary rehabilitation for patients who continue to have persistent or progressing respiratory and/or functional limitations after contracting Covid-19. |
Prospective study |
The change in the 6-minute walk distance increased (from the beginning to the end of rehabilitation). After 6 weeks of the rehabilitation program, the post-Covid-19 functional status scale decreased. Similarly, dyspnea measured with the mMRC scale decreased. In addition, patients improved in maximum workload and endurance capacity, and quality of life increased. Changes in lung function and respiratory muscle strength were explored after the initial data analysis: at the start of the study, the patients had impaired lung function in relation to age, gender and height-specific expected value, with a significant improvement by the end of the study. In addition, maximum inspiratory mouth pressure increased by 28%. |
6-minute walk test, according to the guidelines of the European Respiratory Society. |
| O’Hare et al.(17) |
To understand how physicians at the Department of Veterans Affairs (VA) handled the diagnosis of Long Covid and provided care to patients with suspected or confirmed Long Covid present in electronic health records (EHRs). |
Cohort study |
During the management of Long Covid, clinical uncertainty and fragmentation of care were observed. Clinical uncertainty refers to medical hesitation in diagnosing specific signs and symptoms of Long Covid. This is mainly due to the multiple etiologies of the post-Covid condition, the dynamics of the treatments received by patients, adverse health events that are not related to Covid-19, the lack of medical confidence in the patient’s clinical condition and the difficulty in monitoring patients affected by Long Covid. As for the fragmentation of care, the assistance offered to patients is isolated and poorly coordinated. This is due to the approach that gives little importance to comprehensiveness and patient concerns, the difficulty of multidisciplinary action and clinical recommendations that can be seen as undesirable or burdensome for patients. |
The study does not mention the strategies commonly used, but highlights the practices that favor the fragmentation of care and the difficulties in diagnosing Long Covid. |
| Reis et al.(18) |
To identify the aspects/components to be considered when planning and implementing telerehabilitation interventions that guarantee transitional care for people with Long Covid after hospitalization and to identify the positive aspects of telerehabilitation. |
Descriptive study |
In the study, the participating nurses brought up aspects of Long Covid-19 management that they considered relevant. Regarding coordination between the levels of care, the study participants emphasized the importance of maintaining continuity of care, but with transitional care, maintaining empathetic listening in order to identify the health needs of the community and help individuals participate in their health-disease process. Telerehabilitation favors this transitional care, as it is still possible to ensure all interventions in an e-health modality, however, face-to-face moments are pertinent to evaluate respiratory and motor rehabilitation programs, which should be carried out with exercises that increase ventilatory capacity, chest expansion, diaphragm performance, control of associated symptoms (cough, dyspnea and expectoration) and tolerance to exertion. Motor rehabilitation, on the other hand, should encourage muscle strength, flexibility, joint range of motion, improved walking ability and quality. In addition, telerehabilitation has proved to be important in terms of moving individuals around, since it is possible to manage health conditions in one’s own home, with the help of the health team. |
Coordination of integration between Specialized Care and Primary Care. Addressing multidisciplinarity and telerehabilitation. |
| Romanet et al.(19) |
To evaluate the effectiveness of physical training on dyspnea and health-related quality of life in individuals with Long Covid. |
Randomized controlled trial |
The average Multidimensional Dyspnea Profile (MDP) score after physical training rehabilitation was 42% lower than after standard physical therapy. In addition, significant reductions were observed in the MDP subcategories: respiratory discomfort, sensory dimension and emotional response. Thus, the results suggest that physical training rehabilitation had positive effects on dyspnea and quality of life compared to standard physiotherapy in patients previously hospitalized with acute respiratory distress syndrome due to Covid-19. |
Specific physical training (walking and resistance and muscle strength training) and standard physiotherapy. |
| Schrimpf et al.(20) |
Evaluate the current number of patients with Long Covid (patients with symptoms between 4 and 12 weeks and more than 12 weeks) treated by general practitioners, as well as the symptoms most frequently observed in patients with acute Covid-19 and Long Covid by these physicians. |
Descriptive study |
Regarding the management of Long Covid-19, 97.2% of the health professionals interviewed had already treated a case of persistent symptoms between 4 and 12 weeks of Covid-19. The ability to diagnose these patients was determined to be 62.8%, while therapeutic options are rated at around 47.4%. Around 79.6% of professionals claim to have had contact with patients who have had symptoms for more than 12 weeks, with diagnostic capacity at 40.7% and therapeutic options at 54.9%. Professionals reported that around 18.3% of all Covid-19 patients need a certificate because they are unable to work, and approximately 3.7% of patients have access to rehabilitation centers. Among the treatments discussed, there are drug options, non-drug options (such as physiotherapy) and/or referrals to specialized services. |
Drug and non-drug therapies, physical rehabilitation and referrals to specialized services. |
| Nurek et al.(21) |
To provide a quick expert guide to doctors and clinical services in Long Covid, starting with the development of a list of recommendations. |
Descriptive study |
Among the results, we highlight the importance of clinical knowledge about the etiology, making the diagnosis based on pre-established criteria, individualized investigations, considering that each individual has their own health needs, appropriate referrals to specialty centers, complete evaluations, with specific tests for each case and rehabilitation activities for the management of signs and symptoms, which include educating the patient about their health condition, encouraging them to participate in their own health-disease process and make use of therapeutic options (alternative or not), such as physiotherapy, drugs, etc. |
Multiprofessional and interprofessional approach, referrals to specialized services, considering the physiological, psychological and social aspects of recovery. |
| Ladds et al.(22) |
To develop a model for the management of Long Covid, based on the experiences of health professionals. |
Qualitative study in which participants were asked to choose between an individual narrative interview or participation in an online focus group |
In this study, we developed a suggested model for improving the character of care at Long Covid, which addresses referral criteria, referral from the family doctor or hospitalization team, telephone screening, with investigations that consider systemic factors, guaranteeing integrality, and offer care from different medical specialties and the development of monitoring, follow-up and cognitive stimuli. |
Multidisciplinarity, with continuing education practices and integration between services and continuity of care, with therapeutic and clinical follow-up. |
| Jimeno-Almazán et al.(23) |
To determine the effectiveness of physical exercise, respiratory muscle training and the World Health Organization (WHO) recommendations leaflet on the recovery of physical fitness, quality of life and symptom status in people with post-Covid-19 syndrome. |
Cohort study with randomized clinical trial |
After 8 weeks of intervention, which consisted of a supervised concurrent training program (with or without inspiratory muscle training), there was a significant improvement among all the participants in the study. There was a decrease in individuals who reported having moderate and severe symptoms, especially among individuals who performed physical exercise (compared to those who only performed breathing training and the controls). There was a low decrease in the control group (except for the dyspnea factor, which increased), but there was a considerable improvement in symptoms in the group that participated in physical exercise and a median improvement in the groups that performed respiratory muscle training (associated or not with physical exercise). |
Practicing physical exercise. |
| Humphreys et al.(24) |
Explore the lived experience of Long Covid, focusing on the role of physical activity. |
Qualitative study using semi-structured interviews |
For some participants, prolonged physical disability had an emotional impact on them, causing low self-esteem, frustration and guilt at not being able to carry out daily activities. Participants had varying expectations of how the health system could assist them with physical activities, with many feeling unassisted by their medical professional and seeking information online. In addition, as physical or cognitive activities resulted in the onset of fatigue, participants reported a loss of freedom to engage in everyday activities. Thus, when performing physical exercise, these individuals reported relapses, which held a small perceived improvement in baseline function, because it was considered a price worth paying for the sense of normality, control and positive effect the activity provided, for fear of adverse effects or on medical advice. Most participants established personal strategies for managing physical activity and many expressed a desire for better monitoring and support to manage physical activity. Most were unable to resume activities that were once central to their core identity, so any activity that provides a sense of normality helps to refute the idea that this altered identity is permanent. |
Adoption of physical activity with individualized care and continuous monitoring, as well as emotional support to help with the impact of daily functions. |
Health care for patients with long COVID: a scoping review
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