The impact of physiotherapy on symptoms and quality of life in working aged adults with long COVID: a systematic review

Abstract

Background Current evidence regarding the management of and functional recovery from long COVID suggests there is no standardised, universally accepted, evidence-based physiotherapy protocol specifically tailored to long COVID patients. Objective To assess the impact of physiotherapy, either group or individualised, on symptoms and quality of life (QoL) in working aged adults with long COVID symptoms following mild COVID-19. Methods MEDLINE via Ovid, Embase via Ovid, Scopus, PubMed, World Health Organisation Database, CINAHL via Ebsco, and Web of Science were searched from inception up to 27th of June 2024. The protocol was registered with PROSPERO (registration number CRD42023392999). Results Twelve studies involving 508 individuals were included. The three main categories of interventions identified were respiratory physiotherapy rehabilitation (n = 3), virtual and telerehabilitation (n = 5), and case reports with varied physical interventions (n = 4). Primary outcomes showed an improvement in the 6-min walk test following intervention (p < 0.001 in three studies, and one case study). Improvement in fatigue and breathlessness as demonstrated by modified Medical Research Council dyspnoea scale (p < 0.001), the 15-item King’s Brief Interstitial Lung Disease (KBILD) (p < 0.05) and fatigue severity scale (FSS) (p < 0.05). Secondary outcome benefits of perceived wellbeing were detected in all the studies that included QoL measures. Conclusions Physiotherapy can be an effective intervention to mitigate the most commonly reported long COVID symptoms. Some studies also show improved patient perceived wellbeing. Post-exertional symptom exacerbation (PESE) was considered in only three rehabilitation interventions for long COVID sufferers. The varied interventions employed for long COVID symptom management reflect the wide-ranging and varying symptoms described in these populations. The different categories of interventions used highlight that the rehabilitation services need to be equally wide-ranging and individualized regarding exercise planning, length and frequency of treatment sessions and overall intervention duration.