A review of interventions and support options for long COVID patients returning to work

By Dr. Chinta SidharthanFeb 2 2023Reviewed by Benedette Cuffari, M.Sc.

In a recent study posted to the medRxiv* preprint server, researchers review recent studies that discuss interventions and support for individuals with long coronavirus disease (long COVID) or other similar conditions involving fatigue that occur after viral infections to help them return to normal activity levels.

Study: What interventions or best practice are there to support people with Long COVID, or similar post-viral conditions or conditions characterized by fatigue, to return to normal activities: a rapid review. Image Credit: Drazen Zigic/Shutterstock

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Extensive research indicates that the symptoms of long COVID such as fatigue, dyspnea, myalgia, and cognitive impairment affect the quality of life of coronavirus disease 2019 (COVID-19) patients long after recovering from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Some systematic reviews have identified similarities between long COVID and other post-viral conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia, with common symptoms including fatigue, dizziness, chest pain, neurological and cognitive difficulties, as well as post-exertion malaise leading to reduced physical activity.

It is essential to understand how governments can provide support to patients with long COVID to ensure their rapid recovery and resumption of normal activities for their overall well-being, as well as for the economic growth of the country.

About the study

In the present study, researchers examine systematic reviews, clinical guidelines, qualitative studies, and cohort studies published between 2014 and 2022. This information was used to evaluate the intervention strategies and support needed to help patients with long COVID and similar post-viral infection conditions resume normal activities and work.

The researchers used the Population, Intervention, Comparison, and Outcome (PICO) framework to select the studies included in the review. These studies were conducted on adults suffering from long COVID or similar conditions who were receiving usual care for the condition. The examined outcomes included “return to work,” “absenteeism,” “employment,” and “life activities,” among others.

Key databases were searched for systematic reviews and clinical guidelines that considered non-pharmaceutical interventions (NPIs) for aiding long COVID patients to resume normal levels of daily activity. The data from these studies were extracted and their quality was appraised.

Study findings

The studies on long COVID suggested that individuals with this condition must be treated similarly to those with disabilities in terms of accommodations at the workplace, with care and support provided as needed. Suggested workplace accommodations included part-time working hours, a hybrid system of working, or opportunities to work from home.

While two systematic reviews indicated that NPIs were helpful for long COVID and Chronic Fatigue Syndrome (CFS) patients in improving their function and return to normal activity levels, another systematic review stated that there was a dearth of robust evidence on the success of NPIs.

One study suggested that methods such as behavioral self-management, electrical nerve stimulation, exercise therapy, as well as sleep and touch therapy could be effective. Some of the specific situations in which these methods would be applicable include home-based activities, as well as psychological and physical support groups. Regardless of the approach, the fatigue levels of each individual should be considered in the context of their lifestyles.

Although one systematic review considered work capability as one of the outcomes, no prior studies had evaluated the effect of interventions on the ability to return to work or normal levels of activity. However, one study that included CFS patients reported an 18% increase in employment among the patients after a written self-management program.

The characterization of long COVID as a post-viral condition is ongoing and further complicated by the myriad of symptoms experienced by these patients, as well as the varying severity and unpredictability of long COVID symptoms.

Self-management therapy, occupational therapy, and cognitive behavior therapy were some of the patient-centered intervention options proposed by the authors, many of which are similar to those offered for ME/CFS patients. Furthermore, the authors recommended that employers allow for certain accommodations, such as part-time or hybrid work options, for patients who are unable to return to work full-time.

Conclusions

Many studies have examined the impact of treatments and interventions for long COVID on outcomes such as work capacity and the ability to resume normal activities. Based on the studies evaluated in this review, the authors recommend a patient-centered and needs-based approach to provide support for long COVID patients, including occupational accommodations that help patients resume partial levels of activity at work.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.