Group rehabilitation found to improve quality of life for people with long COVID

An online program of physical and mental health rehabilitation can improve quality of life for adults with long COVID, finds a trial published by The BMJ today.

The eight-week REGAIN program, delivered in online group sessions, led to sustained improvements in fatigue, pain, and depression compared with usual care. The researchers say this accessible, resource-efficient program can be delivered at scale and will assist clinicians in the treatment of this complex condition.

Post-COVID-19 condition (commonly known as long COVID) is defined as symptoms persisting or new symptoms appearing more than four weeks after initial infection. As of March 2023, 1.9 million people in the UK reported COVID-19 symptoms persisting 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 programs may help people with long COVID, but there are no trial data to indicate benefit or harm. So researchers set out to evaluate whether a structured, online, supervised, group physical and mental health rehabilitation program improved health-related quality of life compared with usual care for adults with post-COVID-19 condition.

The trial involved 585 adults (52% female; average age 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 randomized 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).

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% of the intervention group reported that their overall health was "much better now" compared with 8% 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% of the trial participants being non-white.

Nevertheless, they say the REGAIN trial provides the first high-quality randomized 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.

Findings from this trial have important clinical implications, say researchers in a linked editorial. For example, they suggest that rehabilitation programs for post-COVID-19 condition should target fatigue, pain, and depression. However, challenges in rolling out novel complex rehabilitation therapies such as REGAIN exist, including whether findings can be generalized to patients with milder infection and if online delivery is 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, while health service providers also need to 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.