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. 2023 Feb 16;20(4):3477.
doi: 10.3390/ijerph20043477.

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review

Joht Singh Chandan  1 , Kirsty R Brown  1   2 , Nikita Simms-Williams  1 , Nasir Z Bashir  3 , Jenny Camaradou  4 , Dominic Heining  5 , Grace M Turner  1   6 , Samantha Cruz Rivera  1   6   7 , Richard Hotham  1 , Sonica Minhas  1 , Krishnarajah Nirantharakumar  1   8 , Manoj Sivan  9 , Kamlesh Khunti  10 , Devan Raindi  11 , Steven Marwaha  12   13 , Sarah E Hughes  1   6   7   14 , Christel McMullan  1   6 , Tom Marshall  1 , Melanie J Calvert  1   6   7   14   15   16 , Shamil Haroon  1 , Olalekan Lee Aiyegbusi  1   6   7   14 ; TLC Study
Affiliations

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review

Joht Singh Chandan et al. Int J Environ Res Public Health. .

Abstract

Background: Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS.

Methods: We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively.

Findings: Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients.

Interpretation: In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS.

Registration: The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.

Keywords: COVID-19; Long COVID; PVS; non-pharmacological intervention; post-COVID-19 condition; post-acute sequelae of SARS-CoV-2 infection (PASC); post-viral syndromes; rehabilitation; systematic review.

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Conflict of interest statement

There are no conflict of interest among the authors relevant to this study. For note, J.C. is a member of the UK NICE COVID-10 expert panel, COVID-END evidence synthesis network and a member of European Academy of Neurology working group on autonomic disorders as a patient representative.

Figures

Figure 1
Figure 1
PRISMA study selection [15].
Figure 2
Figure 2
Risk of bias [13,90,91,92,93] (Legend: +: Low risk, -: High risk & ?: Unclear risk).
See this image and copyright information in PMC

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