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A systematic review published in the BMJ looks at interventions such as Cognitive Behavioural Therapy (CBT) and rehabilitation for long Covid management.
Prof Trudie Chalder, Professor of Cognitive Behavioural Psychotherapy, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, said:
“This gold standard review of clinical trials investigated the effectiveness of inventions for Long Covid. The only approaches that moderately helped were cognitive behaviour therapy (CBT) or physical and mental health rehabilitation. This provides much needed hope to patients who can be empowered to improve.”
Dr Janet Scott, Consultant in Acute & Research Medicine, NHS Highlands Long COVID service; and Affiliate Senior Clinical Lecturer, MRC-University of Glasgow Centre for Virus Research, University of Glasgow, said:
“While the evidence supports CBT and rehabilitation programs for long COVID, patients need more than just exercise and counselling – they need a holistic and individualized management approach including full medical assessment. We have no magic bullet yet.
“This review shows we’re still in the early stages of understanding long COVID treatment, with only 24 trials published but 239 more in progress. The current focus on understanding the condition’s mechanisms makes sense – we need to know what causes long COVID to develop targeted treatments.
“More detailed thoughts:
“This rigorous review highlights an important tension in long COVID research. While relatively few clinical trials of treatments have been published so far, this likely reflects the complexity of studying a condition we’re still trying to understand. The current focus on observational and mechanistic studies makes sense – we need to understand what causes long COVID to develop targeted treatments.
“The review’s main conclusion – that cognitive behavioural therapy probably reduces fatigue and improves cognitive function, and that physical and mental health rehabilitation likely increases recovery – is important. However, it’s crucial to understand what this evidence doesn’t tell us. Long COVID patients don’t only need light exercise and counselling – they need a holistic and individualized management approach including a full medical appraisal to optimize their health. In clinical practice, we see patients with complex medical needs who benefit from comprehensive medical assessment and established treatments for their symptoms. Many of our patients have underlying health conditions that, while not explaining all their long COVID symptoms, need proper medical attention to ensure the best possible outcomes. We have no magic bullet yet, but we regularly use proven symptomatic treatments that won’t appear in long COVID trials precisely because they’re already standard medical care.
“With 239 trials registered but not yet reported, we’re likely to see much more evidence about potential treatments emerging soon. In the meantime, we’ve learned that some approaches, like carefully supervised rehabilitation programs, can help patients cope with symptoms while we work to understand the underlying causes. The key challenge now is finding the right balance between understanding the condition and testing treatments, while ensuring patients receive comprehensive clinical care that addresses all aspects of their health.
“What’s clear is that we urgently need more well-designed clinical trials of promising treatments. The research community needs to reprioritize its focus toward interventional studies that can directly inform patient care.”
Dr Daniel Munblit, Reader in Paediatrics, Division of Care in Long Term Conditions, King’s College London; and Visiting Reader in the Department of Infectious Disease, Imperial College London, said:
“An evidence synthesis conducted by Zeraatkar and colleagues from McMaster University examined the effectiveness of various interventions for managing long covid, including drug and non-drug treatment options. The authors are to be praised for addressing this important and complex topic. This is top-quality research following state-of-the-art methodology and authors did their best to account for limitations.
“The manuscript concludes that there is moderate certainty evidence supporting the effectiveness of Cognitive Behavioural Therapy (CBT) and combined physical and mental health rehabilitation programs in improving symptoms of long covid, probably reducing fatigue and improving concentration, which are among main long covid symptoms. Combined physical and mental health rehabilitation programs probably increase the proportion of patients experiencing recovery or significant improvement, reduce depressive symptoms, and improve quality of life.
“Most importantly, the research did not find compelling evidence to support other interventions, including various medications (vortioxetine, leronlimab), dietary supplements (synbiotics, coenzyme Q10), and other therapies (amygdala and insula retraining, transcranial direct current stimulation, hyperbaric oxygen).
“This living systematic review acknowledges several limitations, with heterogeneity of long covid being a key limitation. Despite limitations, this research offers very valuable insights for clinical practice. It suggests that offering CBT and physical and mental health rehabilitation programs to long covid patients is reasonable, as they are likely to improve symptoms, at least in some individuals.
“The work also underscores the importance of addressing patient concerns and scepticism surrounding CBT and rehabilitation, particularly the misconception that their effectiveness implies a purely “psychological” basis for long covid. Open communication and patient education are absolutely critical for ensuring treatment acceptance and adherence.”
‘Interventions for the management of long covid (post-covid condition): living systematic review’ by Dena Zeraatkar et al. was published in the BMJ at 23:30 UK time on Wednesday 24 November 2024.
DOI: 10.1136/bmj-2024-081318
Declared interests
Prof Trudie Chalder: “TC is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King’s College London. She has grants from Guy’s St Thomas Charity Grants, NIHR and UKRI for post COVID syndromes.
She has received travel expenses, accommodation costs, and honorarium for several lectures in Europe and has received travel expenses and accommodation costs for attending American Thoracic Society Conference. She was on the Expert Advisory Panel for Covid-19 Rapid Guidelines.
She has written articles with at least one of the authors of this study: White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys AML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry. 2023 Dec;94(12):1056-1063. doi: 10.1136/jnnp-2022-330463. Epub 2023 Jul 10. PMID: 37434321.”
Dr Janet Scott: “About me: Dr Janet Scott, Long COVID physician for NHS Highlands and NRS Fellow specialising in post-viral conditions
Conflicts of interest: I am Principal Investigator for STIMULATE-ICP and have a pending grant application with Pfizer.”
Dr Daniel Munblit: “I have no commercial conflicts of interest and the only conflict I can think of is that I am a member of the WHO Guideline Development Group for clinical management of post COVID-19 condition: https://www.who.int/docs/default-source/coronaviruse/biographies-of-experts-in-who-guideline-development-group-for-post-covid-19-condition.pdf?sfvrsn=8347953f_2).”