Post-Covid syndrome: Almost half return to work after rehab
20.06.2023 13:22
More than 80 percent of those affected by post-Covid syndrome benefit significantly, physically or mentally, from inpatient rehabilitation. This is the result of a new pilot study. “Overall, the rehabilitation worked somewhat better for those affected by post-Covid than for psychocardiological or psychosomatic patients,” explains study leader Professor Dr. med. Volker Köllner. The expert from the German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM) emphasizes that low-threshold outpatient programs are now also needed.
The study compared the effects of five weeks of inpatient rehabilitation on 50 psychocardiological patients, 49 psychosomatic patients and 52 post-Covid patients. Those affected post-Covid suffered from symptoms such as fatigue, shortness of breath, difficulty concentrating, diffuse pain, dizziness and headaches for more than three months since their infection. Their average age was 51 years, 76 percent were women, and almost 50 percent had a higher level of education. Half said they were already ill before the Covid infection; the other half felt in great shape before Covid illness.
The majority are not able to work
“Overall, these were typical post-Covid sufferers of medium severity, of which there are probably several hundred thousand,” explains Köllner about the pilot study that was published at the beginning of the year.1 Those affected can get dressed and eat breakfast themselves. “But they quickly become exhausted, and two thirds suffered from severe memory and concentration problems,” adds the head of the psychosomatic rehabilitation research group at the Charité – Universitätsmedizin Berlin. The majority of post-Covid patients were unable to work, 43 percent for longer than six months.
The post-Covid rehabilitation took place at the turn of the year 2021/2022 and was based on a new, multimodal concept, the components of which are also included in the guidelines for the treatment of Long-Covid.2 The modules included individually tailored movement training, breathing therapy, information and education, mindfulness exercises, cognitive training, yoga or Qi Gong as well as psychotherapeutic individual and group discussions. “At the end of the rehabilitation, medium to high effect sizes were evident with regard to physical complaints, activity and participation, depression, anxiety and physical fitness,” said Köllner, medical director and chief physician of the psychosomatics department at the Seehof Rehab Center. “In some cases, the effects were even slightly higher than in well-proven psychosomatic and psychocardiological rehabilitation.”
Walking distance improved by an average of 20 percent
The positive effects were particularly strong on depression. “When she was discharged, she was just below the threshold for mild depression,” reports Köllner. In addition, the effect sizes in terms of physical activity and participation were very high: When testing how much distance the patients could run within six minutes, those affected post-Covid increased their distance from an average of 420 to 500 meters. “In the end, this corresponds to almost normal physical resilience,” sums up Köllner. Accordingly, 47 percent were able to return to work immediately after rehabilitation, sometimes with the help of gradual reintegration.
The Teltow rehabilitation specialist sees the idea that rehabilitation could be too strenuous for post-Covid patients as invalidated. “Around 80 percent have improved, some have not benefited, but no one has worsened,” said Köllner. It is important to tailor the exercise program individually - and the group effect: "Those affected discuss the topic together for five weeks: How do I cope with post-Covid," reports Köllner. “This releases effects like those in a self-help group.” By August, more than 1,000 post-Covid sufferers will be included in a multicenter follow-up study (PoCoRe), with the results being tracked over two years.
Long-term professional reintegration is needed
“Outpatient follow-up care is now needed in order to maintain the positive effects,” emphasizes the DGPM expert. Longer-term programs for professional reintegration are also necessary. “Employers are also in demand here,” notes Köllner. Overall, the prognosis for post-Covid syndrome is positive, but recovery often takes more time than with other diseases.
Credentials:
1 Kupferschmitt A, Langheim E, Hülser H, Etzrodt F, Loew TH and Köllner V (2023): First results from post-COVID inpatient rehabilitation. Front. Rehabilitative. Sci. 3:1093871. doi: 10.3389/fresc.2022.1093871
2 Patient guidelines, February 2023: https://register.awmf.org/assets/guidelines/020-027p_S1_Post_COVID_Long_COVID_2023-02.pdf