Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Identification Data Sources and Search Strategy
2.2. Study Selection
- Patients:
- Intervention:
- Comparison:
- Outcomes:
- Study Design:
2.3. Data Extraction
2.4. Evaluation of Methodological Quality and Risk of Bias
2.5. Data Synthesis and Analysis
3. Results
3.1. Risk of Bias and Methodological Quality
3.2. Characteristics of the Included Trials
3.2.1. Interventions
3.2.2. Outcomes
3.2.3. Results of Articles
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Database | Search Terms |
---|---|
MEDLINE (n = 1648); PeDro (n = 2); Trip database (n = 0); Cochrane (n = 28) Google Schollar (n = 3); Embase (n = 6); CINAHL/EBSCO (n = 1); Scopus (n = 5) NICE (n = 0) Prospero (n = 0) | (“Long COVID” or “post COVID-19” or “persistent COVID syndrome”) AND (“Telemedicine” OR “Telerehabilitation” OR Digital Physiotherapy Practice”) |
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Jian’an Li et al., 2022 [37] | Keir E J Philip et al., 2022 [38] | Teixeira do Amaral V et al., 2022 [39] | Del Corral T et al., 2022 [40] | P. Sharma et al., 2022 [41] | Jian’an Li et al., 2021 [42] | |
---|---|---|---|---|---|---|
Eligibility criteria | Y | Y | Y | Y | Y | Y |
Randomization | Y | Y | Y | Y | Y | Y |
Allocation concealed | Y | Y | N | Y | N | Y |
Baseline comparability | Y | Y | Y | Y | N | Y |
Subject blinding | N | N | N | Y | N | N |
Therapist blinding | N | N | N | Y | N | N |
Evaluator blinding | Y | Y | Y | Y | Y | Y |
Adequate follow-up | Y | Y | N | Y | N | N |
Intention to treat | Y | Y | N | Y | N | Y |
Comparison between groups | Y | Y | Y | Y | N | Y |
Point estimates and variability | Y | Y | Y | Y | N | Y |
Total PeDro Score | 8 | 8 | 5 | 9 | 2 | 7 |
Author [Year] | Population | Participants [n], Type of Evidence | PeDro Score, Risk of Bias | Intervention | Outcome Measure | Intervention Duration [Weeks] | Follow-Up [Month] | Results |
---|---|---|---|---|---|---|---|---|
Jian’an Li et al., 2022 [37] | Long COVID Patients |
| 8/10—Low |
|
| 6 | 28 | TERECO program was superior to control group with regard to functional exercise capacity, LMS and physical HRQOL. The effects could be maintained for a period of 7 months. No differentiation was found in pulmonary function. Improvements were found in the physical component of the SF-12 scale, with effects at post-treatment and follow-up. |
Keir E J Philip et al., 2022 [38] | Long COVID Patients |
| 8/10—Low |
|
| 6 | -- | Improvements in the MHC of quality of life were observed compared to usual care. VAS for breathlessness (running) favored ENO Breathe participation. In the secondary outcomes, no statistically significant differences were observed between the groups. Thematic analysis of participants’ perceptions of the intervention identified three key themes: (1) symptom improvement; (2) the sense that the program complemented standard care; and (3) the particular suitability of singing and music to address their needs. Mind, body, and music-focused practices could influence participants’ recovery. |
Teixeira do Amaral V et al., 2022 [39] | Long COVID Patients |
| 5/10—Some Concerns |
|
| 12 | -- | Both the intervention and control groups increased (p < 0.001) forced vital capacity (absolute and % of predicted), forced expiratory volume in the first second (absolute and % of predicted) and hand grip strength during follow-up. However, only the intervention group reduced carotid–femoral pulse wave velocity and increased (p < 0.05) resting oxygen saturation, mean inspiratory pressure, mean expiratory pressure and % of predicted mean expiratory pressure during follow-up. No significant changes were observed in any other variable during follow-up. |
| ||||||||
Del Corral T et al., 2022 [40] | Long COVID Patients |
| 9/10—Low |
|
| 8 | -- | Statistically significant improvement in quality of life, but not in exercise tolerance, in the two training groups compared to the sham groups. The two training groups developed a large statistically significant increase in inspiratory muscle strength and endurance and lower extremity muscle strength compared to the two sham groups. Expiratory muscle strength and peak expiratory flow showed a large, statistically significant increase in the training group. |
| ||||||||
P. Sharma et al., 2022 [41] | Long COVID Patients |
| 2/10—High |
|
| 6 | -- | Results showed that there was a statistically significant difference between IG (MBDS) and CG (MBDS) (p = 0.005605 and p = 0.01121) and statistically significant difference was found between IG (VAS-F) and CG (VAS-F) (p = 0.01818 and p = 0.036359). |
| ||||||||
Jian’an Li et al., 2021 [42] | Long COVID Patients |
| 7/10—Low |
|
| 6 | 28 | The adjusted between-group difference in change in 6-MWD from baseline was 65.45 m at post-treatment and 68.62 m at follow-up. Treatment effects for LMS were 20.12 s post-treatment and 22.23 s at follow-up. No group differences were found for lung function apart from post-treatment MVV. Increase in SF-12 PCS was greater in the TERECO group, with treatment effects estimated at 3.79 at post-treatment and 2.69 at follow-up. No significant between-group differences were found for improvements in SF-12 in mental component. At post-treatment, 90.4% endorsed a favorable outcome for mMRC dyspnea in the TERECO group vs. 61.7% in control. |
Intervention | Authors and References | Number of Articles | Participants (n), | Low Risk of Bias (% of Total Articles by Intervention) | Risk of Bias: Some Concerns (% of Total Articles by Intervention) | High Risk of Bias (% of Total Articles by Intervention) |
---|---|---|---|---|---|---|
Tele-supervised home-based exercise training | Jian’an Li et al., 2022 [37]/Keir E J Philip et al., 2022 [38]/Teixeira do Amaral V et al., 2022 [39]/Del Corral T et al., 2022 [40] | 4 | 233 | 3 (75%) | 1 (25%) | - |
Unsupervised home-based program | Jian’an Li et al., 2021 [42]/P. Sharma et al., 2022 [41] | 2 | 74 | 1 (50%) | - | 1 (50%) |
Short educationalinstructions | Jian’an Li et al., 2022 [37]/Jian’an Li et al., 2021 [42] | 2 | 121 | 2 (100%) | - | - |
Usual care | Keir E J Philip et al., 2022 [38]/Teixeira do Amaral V et al., 2022 [39]/P. Sharma et al., 2022 [41] | 3 | 111 | 1 (33.33%) | 1 (33.33%) | 1 (33.33%) |
Outcomes | Authors and References | Number of Articles | Participants (n) | Low Risk of Bias (% of Total Articles by Outcome) | Risk of Bias: Some Concerns (% of Total Articles by Outcome) | High Risk of Bias (% of Total Articles by Outcome) |
---|---|---|---|---|---|---|
Pulmonary capacity | Jian’an Li et al., 2022 [37]/Keir E J Philip et al., 2022 [38]/Teixeira do Amaral V et al., 2022 [39]/Del Corral T et al., 2022 [40]/Jian’an Li et al., 2021 [42] | 5 | 510 | 4 (80%) | 1 (20%) | - |
HRQoL (Quality of Life) | Jian’an Li et al., 2022 [37]/Keir E J Philip et al., 2022 [38]/Del Corral T et al., 2022 [40]/Jian’an Li et al., 2021 [42] | 4 | 478 | 4 (100%) | - | - |
Dyspnea | Jian’an Li et al., 2022 [37]/Keir E J Philip et al., 2022 [38]/P. Sharma et al., 2022 [41]/Jian’an Li et al., 2021 [42] | 4 | 420 | 3 (75%) | - | 1 (25%) |
Functional capacity | Jian’an Li et al., 2022 [37]/Teixeira do Amaral V et al., 2022 [39]/Del Corral T et al., 2022 [40]/Jian’an Li et al., 2021 [42] | 4 | 358 | 3 (75%) | 1 (25%) | - |
Cognitive and psychological status | Keir E J Philip et al., 2022 [38]/Del Corral T et al., 2022 [40] | 2 | 238 | 2 (100%) | - | - |
Fatigue | P. Sharma et al., 2022 [41] | 1 | 30 | - | - | 1 (100%) |
Exercise Tolerance | Del Corral T et al., 2022 [40] | 1 | 88 | 1 (100%) | - | - |
Participants’ experiences | Keir E J Philip et al., 2022 [38] | 1 | 150 | 1 (100%) | - | - |
Jian’an Li et al., 2022 [37] | Keir E J Philip et al., 2022 [38] | Teixeira do Amaral V et al., 2022 [39] | Del Corral T et al., 2022 [40] | P. Sharma et al., 2022 [41] | Jian’an Li et al., 2021 [42] | |
---|---|---|---|---|---|---|
Pulmonary capacity | (+) | (++) | (++) | (++) | (+) | |
HRQoL (Quality of Life) P (Physical component) M (Mental component) | (++P) (+M) | (+P) (++M) | (++) | (++P) (+M) | ||
Dyspnea | (+) | (+) | (++) | (+) | ||
Functional capacity | (++) | (+) | (++) | (++) | ||
Cognitive and psychological status | (+) | (+) | ||||
Fatigue | (++) | |||||
Exercise Tolerance | (+) | |||||
Cardiovascular function | (++) | |||||
Participants’ experiences | (+) |
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Estebanez-Pérez, M.-J.; Martín-Valero, R.; Vinolo-Gil, M.J.; Pastora-Bernal, J.-M. Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review. Healthcare 2023, 11, 1970. https://doi.org/10.3390/healthcare11131970
Estebanez-Pérez M-J, Martín-Valero R, Vinolo-Gil MJ, Pastora-Bernal J-M. Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review. Healthcare. 2023; 11(13):1970. https://doi.org/10.3390/healthcare11131970
Chicago/Turabian StyleEstebanez-Pérez, María-José, Rocío Martín-Valero, Maria Jesus Vinolo-Gil, and José-Manuel Pastora-Bernal. 2023. "Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review" Healthcare 11, no. 13: 1970. https://doi.org/10.3390/healthcare11131970