Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section)

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Abstract

Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician’s professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician’s role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient’s age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.

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Most cited references 91

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Long COVID: major findings, mechanisms and recommendations

Hannah E. Davis, Lisa McCorkell, Julia Moore Vogel … (2023)

Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations. Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process. Long COVID is an often debilitating illness of severe symptoms that can develop during or following COVID-19. In this Review, Davis, McCorkell, Vogel and Topol explore our knowledge of long COVID and highlight key findings, including potential mechanisms, the overlap with other conditions and potential treatments. They also discuss challenges and recommendations for long COVID research and care.

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A clinical case definition of post-COVID-19 condition by a Delphi consensus

Joan B Soriano, Srinivas Murthy, John C Marshall … (2021)

People with COVID-19 might have sustained postinfection sequelae. Known by a variety of names, including long COVID or long-haul COVID, and listed in the ICD-10 classification as post-COVID-19 condition since September, 2020, this occurrence is variable in its expression and its impact. The absence of a globally standardised and agreed-upon definition hampers progress in characterisation of its epidemiology and the development of candidate treatments. In a WHO-led Delphi process, we engaged with an international panel of 265 patients, clinicians, researchers, and WHO staff to develop a consensus definition for this condition. 14 domains and 45 items were evaluated in two rounds of the Delphi process to create a final consensus definition for adults: post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction, and generally have an impact on everyday functioning. Symptoms might be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms might also fluctuate or relapse over time. A separate definition might be applicable for children. Although the consensus definition is likely to change as knowledge increases, this common framework provides a foundation for ongoing and future studies of epidemiology, risk factors, clinical characteristics, and therapy.

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Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review

Chen Chen, Spencer Haupert, Lauren Zimmermann … (2022)

Abstract Introduction This study aims to examine the worldwide prevalence of post COVID-19 condition, through a systematic review and meta-analysis. Methods PubMed, Embase, and iSearch were searched on July 5, 2021 with verification extending to March 13, 2022. Using a random effects framework with DerSimonian-Laird estimator, we meta-analyzed post COVID-19 condition prevalence at 28+ days from infection. Results 50 studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post COVID-19 condition was 0.43 (95% CI: 0.39,0.46). Hospitalized and non-hospitalized patients have estimates of 0.54 (95% CI: 0.44,0.63) and 0.34 (95% CI: 0.25,0.46), respectively. Regional prevalence estimates were Asia— 0.51 (95% CI: 0.37,0.65), Europe— 0.44 (95% CI: 0.32,0.56), and North America— 0.31 (95% CI: 0.21,0.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI: 0.26,0.49), 0.25 (95% CI: 0.15,0.38), 0.32 (95% CI: 0.14,0.57) and 0.49 (95% CI: 0.40,0.59), respectively. Fatigue was the most common symptom reported with a prevalence of 0.23 (95% CI: 0.17,0.30), followed by memory problems (0.14 [95% CI: 0.10,0.19]). Discussion This study finds post COVID-19 condition prevalence is substantial; the health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Phys Rehabil Med

Journal ID (iso-abbrev): Eur J Phys Rehabil Med

Journal ID (publisher-id): EJPRM

Title: European Journal of Physical and Rehabilitation Medicine

Publisher: Edizioni Minerva Medica

ISSN (Print): 1973-9087

ISSN (Electronic): 1973-9095

Publication date (Electronic): 11 January 2024

Publication date Collection: December 2023

Volume: 59

Issue: 6

Pages: 789-799

Affiliations

deptDepartment of Experimental and Clinical Medicine , Politecnica delle Marche University , Ancona, Italy; deptDepartment of Rehabilitation Medicine, Addenbrooke’s Hospital , Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK; Oxford University Hospitals NHS Foundation Trust , Oxford, UK; deptLeeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary , University of Leeds , Leeds, UK; IRCCS Istituto Ortopedico Galeazzi , Milan, Italy; deptDepartment of Rehabilitation , Hospital of Foligno , USL Umbria 2, Perugia, Italy

Author notes

[* ]Corresponding author: Elisa Andrenelli, Department of Experimental and Clinical Medicine, Politecnica delle Marche University, 60126 Ancona, Italy. E-mail: e.andrenelli@ 123456univpm.it

Authors’ contributions: Maria G. Ceravolo and Fahim Anwar equally contributed as first authors. Maria G. Ceravolo and Fahim Anwar conceived and designed the manuscript; Elisa Andrenelli, Cynthia Udensi, and Jawaria Qureshi performed data search and screening. All authors analyzed and interpreted the data. Maria G. Ceravolo, Fahim Anwar, Elisa Andrenelli, Cynthia Udensi and Jawaria Qureshi drafted the manuscript; Manoj Sivan, Carlotte Kiekens, Mauro Zampolini revised it critically. All authors read and approved the final version of the manuscript.

Article

Publisher ID: 8315

DOI: 10.23736/S1973-9087.23.08315-6

PMC ID: 10792869

PubMed ID: 38214046

SO-VID: a56b63bc-a1dc-4542-acc7-ceeabdd08345

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.

History

Date accepted : 14 November 2023

Date received : 05 November 2023

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