The concept of “evidence relevant to” in the rehabilitation field: post COVID-19 condition mapping for the World Health Organization Guidance
Stefano Negrini, University of Milan - IRCCS Istituto Ortopedico Galeazzi, Milan
2IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
3IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
4Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate (VA), Italy
5School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ and Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
6Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, Milan, Italy
7IRCCS MultiMedica, Milan, Italy
Background: In the current absence of direct “evidence on” rehabilitation interventions for people with symptoms of post COVID-19 condition (PCC), we can search and synthesize the indirect “evidence relevant to” coming from interventions effective for these symptoms in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in their Guidelines. So, we defined “evidence relevant to” as the synthesis of evidence focusing on the rehabilitative management of impairments, activity limitations and participation restrictions, informed by different health conditions presenting with similar symptoms.
Objectives: We were asked by WHO to synthesize the Cochrane evidence relevant to rehabilitation for PCC-related symptoms: fatigue, post-exertional malaise, orthostatic intolerance dyspnea, arthralgia, dysphagia, dysphonia, olfactory disease, cognitive impairment, anxiety and depression.
Methods: We searched the last five years’ Cochrane Systematic Review (CSRs) using specific terms for each symptom, “rehabilitation” and their synonyms in Cochrane Library. We extracted the available evidence and summarized it using maps. We grouped the included CSRs for health conditions and interventions, indicating the effect and the certainty of evidence.
Results: Out of 5734 CSRs, we found 32 for fatigue, 4 for exercise intolerance, 10 for arthralgia, 15 for dyspnea, 1 for dysphagia, 17 for cognitive impairment and 37 for anxiety and depression, published between 2016 and 2021. They provided data from several health conditions, such as cancer, chronic respiratory diseases, osteoarthritis, and neurological disorders. Effective interventions for fatigue, exercise intolerance, dyspnea and arthralgia included exercise training and physical activities, telerehabilitation, multicomponent and educational interventions. Dysphagia was mainly treated with swallowing therapy, while cognitive aspects were managed with exercise, cognitive training and educational programs. The overall certainty of evidence was low to very-low and moderate/high in a few cases. We did not identify CSRs that specifically addressed post-exertional malaise, orthostatic intolerance, dysphonia and olfactory disease.
Conclusions: The current findings served as the basis for the recommendations on treatments for PCC symptoms published in the current WHO Guidelines for clinical practice. These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. Patient involvement: NA