Physios joined trained clinical exercise physiologists to deliver successful long Covid programme
An online programme of physical and mental health rehabilitation delivered by specially trained clinical exercise physiologists or physiotherapists can improve the quality of life for adults with long Covid, according to an article published in The BMJ today (8 February). The eight-week REGAIN programme, which was delivered in online group sessions, led to sustained improvements in fatigue, pain, and depression compared with usual care.
The article’s lead author is Gordon McGregor, who is professor of clinical exercise physiology and rehabilitation in the department of cardiopulmonary rehabilitation at the Centre for Exercise and Health, University Hospitals Coventry and Warwickshire NHS Trust.
Professor McGregor and his colleagues who conducted the study – all of whom are based in England – say this accessible, resource-efficient programme can be delivered at scale and will assist clinicians in treating people with this complex condition.
Programme of physical and mental health rehab delivered online
People with post-Covid-19 condition – commonly known as long Covid – have symptoms persisting or new symptoms appearing more than four weeks after an initial infection. As of March 2023, 1.9 million people in the UK reported having Covid-19 symptoms that had persisted beyond 12 weeks, 1.3 million beyond one year, and over 750,000 beyond two years.
Symptoms include extreme tiredness (fatigue), shortness of breath, memory loss and muscle aches, all of which can affect quality of life, social interaction, and economic productivity.
It’s been suggested that rehabilitation programmes may help people with long Covid, but there are no trial data to indicate benefit or harm. Professor McGregor and his colleagues set out to evaluate whether a structured, online, supervised, group physical and mental health rehabilitation programme improved health related quality of life compared with usual care for adults with post-Covid-19 condition.
More than 500 adults participated
The trial was funded by the UK National Institute for Health and Care Research Health Technology Assessment Programme. It involved 585 adults (52 per cent of whom were female with an average age of 56 years) who had been discharged from hospital at least three months earlier after a Covid-19 infection and who reported substantial lasting effects that they attributed to the virus.
After providing information on a range of health and lifestyle factors, 287 participants were randomised to usual care (a single online session of advice and support with a trained practitioner) and 298 to the REGAIN intervention (weekly home based, live, supervised, group exercise and psychological support sessions delivered online over eight weeks).
REGAIN is an accessible, resource efficient programme that can be delivered at scale, contributing to a reduction in the global burden of post-covid-19 condition [Gordon McGregor et al]
The results show that the REGAIN intervention was well tolerated and led to sustained improvements in health-related quality of life at three and 12 months compared with usual care, driven mostly by improved fatigue, pain, and depression.
At three months, 17 per cent of the intervention group reported that their overall health was ‘much better now’ compared with 8 per cent in the usual care group. Of 21 serious adverse events, only one (fainting with vomiting 24 hours after a live exercise session) was possibly related to the intervention, suggesting that it is acceptable and safe.
The researchers acknowledge some limitations, such as the inability of trial participants or REGAIN practitioners to be masked to treatment allocation and only 11 per cent of the trial participants being defined as 'non-White'.
Nevertheless, they say the REGAIN trial provides the first high quality randomised controlled trial evidence confirming the clinical benefit, and lack of harm, of online physical and mental health rehabilitation for post-Covid-19 condition, which will assist clinicians in the treatment of this complex condition.
'Among adults with post-covid-19 condition at least three months after hospital discharge for covid-19, an individualised online, group physical and mental health rehabilitation intervention improved overall heath related quality of life more than usual care at three and 12 months post-randomisation. REGAIN is an accessible, resource efficient programme that can be delivered at scale, contributing to a reduction in the global burden of post-covid-19 condition,' they conclude.
Who delivered the training?
Clinical exercise physiologists or physiotherapists trained in the REGAIN intervention and supported by health psychologists delivered the interventions exclusively online from a central trial hub.
The hub was based at Atrium Health, a non-profit rehabilitation centre, subcontracted to University Hospitals of Coventry and Warwickshire NHS Trust. Intervention staff included NHS and Atrium Health employees, with some delivering both intervention and usual care treatments.
The interventions were informed by a rapid review of existing literature relating to rehabilitation programmes for people affected by chronic obstructive pulmonary disease, chronic fatigue syndrome and the 2003 severe acute respiratory distress syndrome pandemic.
To read the full version of the article – titled Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN): multicentre randomised controlled trial doi: 10.1136/bmj-2023-076506 – click
Leading Australia-based physios respond
Findings from this trial have important clinical implications, say two Australia-based academics with physiotherapy backgrounds in a linked editorial. They are Rana Hinman, professor of physiotherapy in the department of physiotherapy at the School of Health Sciences, University of Melbourne, and Chris Maher, who is a professor at the Sydney School of Public Health, University of Sydney.
Professors Hinman and Maher argue that rehabilitation programmes for people diagnosed with post-Covid-19 condition should target symptoms such as fatigue, pain, and depression.
From a workforce perspective, scalable methods are needed to train clinicians to competently deliver rehabilitation for post-covid-19 condition [Rana Hinman and Chris Maher]
However, they suggest that there are challenges in rolling out novel complex rehabilitation therapies, such as REGAIN. These include whether the findings can be generalised to patients with milder infections and whether online delivery options will be acceptable to people living with post-Covid-19 condition.
‘From a workforce perspective, scalable methods are needed to train clinicians to competently deliver rehabilitation for post-covid-19 condition,’ the editorial notes. Professors Hinman and Maher say that health service providers must also consider whether they will support delivery of new treatments,' they add. The planned REGAIN economic evaluation, which is not yet published, will provide useful data in this regard.
To read the full version of the editorial – titled Rehabilitation for post-covid-19 condition doi: 10.1136/bmj.q20 – clickAuthor: I A McMillan