Self-reported physical usefulness is higher for patients with long COVID after a brief outpatient program based on cognitive behavioral therapy, a pragmatic trial in Norway demonstrated.
Scores on the Short-Form Health Survey 36 Physical Function Subscale (SF-36-PFS) — a 100-point scale with higher scores reflecting better physical functioning — improved in the intervention group compared with usual care (difference 9.2 points, 95% CI 4.3-14.2, P<0.001; Cohen d = 0.43), reported Tom Farmen Nerli, MD, of Vestfold Hospital Trust in Tønsberg, Norway, and co-authors.
The difference between the teams is almost the same at long-term follow-up (12 months after enrollment), indicating a long-lasting effect, Nerli and colleagues wrote in JAMA Network Open.
Most other measures of functional ability and symptom scores showed greater improvement in the intervention organization. The adverse events in the intervention organization were less than in the same previous care.
“Patients can recover from their post-COVID state,” Nerli said. “This intervention is effective and safe. The remedy is brief, but it is vital to give patients an explanation that they can relate to (an explanation of their symptoms),” he told MedPage TodayArray.
For more than a decade, Nerli and his team have treated patients with persistent physical symptoms (mainly fatigue and pain) with this procedure.
“For us, it is about fostering confidence that the body has the ability to adapt and that positive adaptation towards a general state of physical fitness requires the active performance of physical and intellectual activities that are individualized, adapted, achievable and fun” , ” He says: “We are very different from others in the way we work, but our experience over the years has given us confidence. “
The findings add to an emerging framework of evidence suggesting that cognitive behavioral treatment (CBT) and rehabilitation can prolong COVID symptoms and functioning in the long term, noted Trudie Chalder, PhD, MSc, of King’s College London in England. In the Netherlands, for example, CBT detects symptoms in patients with long COVID and severe fatigue.
“Over the last few decades, really extensive evidence has accumulated on the effectiveness of CBT for treating symptoms in the context of somatic conditions, chronic fatigue syndrome,” Chalder wrote in an accompanying editorial.
“Cognitive behavioral treatment is only definitively related to immunological parameters, such as pro-inflammatory cytokines and immune cell counts, in patients with physical conditions, but it also outperforms pharmacological treatments, such as infliximab [Remicade], in that the effects last more,” he said.
Long COVID includes fluctuating symptoms such as post-exertional malaise, fatigue, mental confusion, or other manifestations that persist for at least 3 months after SARS-CoV-2 infection. Recent knowledge from the CDC suggests that 6. 4% of US adults have long COVID, with about one in five reporting primary limitations in performance activities.
In their trial, Nerli and co-authors randomized 314 patients with mild to moderate long COVID to a rehabilitation program or usual care at a single referral center in Norway. They followed up with participants after treatment completion and 12 months after enrollment, collecting data from February 2022 to April 2024.
Overall, 231 people completed an SF-36-PFS evaluation, which was the primary endpoint. Primary outcome data were analyzed on an intention-to-treat basis.
Participants had an average age of 43 years and 72% were women. Fatigue, cognitive difficulties, and post-exertional malaise were the most prevalent long-term symptoms of COVID.
The rehabilitation program involved two to eight outpatient visits spaced approximately 2 to 6 weeks apart with the overall goal of restoring physical function. The intervention involved doctors and physiotherapists and was based on the theory of cognitive activation of stress, which states that any stressful occasion requires an adaptive response.
“Cognitive factors, such as subconscious expectancies, are key determinants of the degree and duration of the adaptive response and are themselves shaped by individual learning history,” Nerli and colleagues noted.
Another nine people in the intervention group reported a decline in physical performance from baseline to first outcome, compared with another 25 people in the same usual care group. Fourteen other people in the intervention group reported an increase in post-exertional discomfort from baseline to outcome number one, compared to the other 31 people who got the same usual care.
Study limitations included the single-center design of the trial and its lack of blinding. Objective measures of physical and social function — such as steps per day or work attendance — were not reported in the study.
Judy George covers neurology and neuroscience news for MedPage Today and writes about brain aging, Alzheimer’s disease, dementia, multiple sclerosis, rare diseases, epilepsy, autism, headaches, strokes, Parkinson’s, ALS, concussions, CTE, sleep, and more. Follow
This trial won from the Vestfold Hospital Trust, Akershus University Hospital and the Norwegian Institute of Public Health.
Nerli and co-authors had no disclosures.
Chalder said he has won grants from GSST Charity, the U. K. ‘s National Institute for Health and Care Research and Research and Innovation; serve on the National Institute for Health and Care Excellence committee for COVID-19 guidelines; receive private rates from NHS England, BABCP and the American Thoracic Society; and get South London Salary and Maudsley NHS Trust.