To evaluate the feasibility and effectiveness of a personalised multimodal physical therapy (PMPT) intervention, which includes both tailored physiotherapy and nutritional counselling, in improving physical performance and reducing fatigue in individuals with long COVID, compared to standard physiotherapy alone.
This pilot randomised controlled trial included 65 participants with long COVID, randomised to receive either standard physiotherapy or PMPT. The PMPT intervention focused on an individualized, symptom-contingent pacing physiotherapy regimen designed to optimize physical performance and minimize post-exertional malaise. The regimen was supplemented by nutritional counselling, which aimed to support physical rehabilitation through optimal energy and protein intake based on indirect calorimetry and nutritional assessments. Primary feasibility outcomes included participant recruitment, retention, and adherence. Secondary outcomes, specifically targeting physical function, included the 1-minute sit-to-stand test (1-MSTS) and the 6-minute walk test (6-MWT), with fatigue levels assessed using the Multidimensional Fatigue Inventory (MFI-20) at baseline, 6, 12, and 18 weeks. Descriptive statistics and sample size calculations for a fully powered RCT were performed.
The study demonstrated strong feasibility, with high retention and adherence rates. Both groups showed improvements in physical performance, but the PMPT group achieved greater gains in 6-MWT scores (Mean Difference (MD) -23.99m, 95% confidence interval (CI) [-59.03, 11.04] and 1-MSTS (MD -2.14 steps, 95%CI [-5.54, 1.26] at 18 weeks compared to the standard physiotherapy group . The PMPT group also reported lower levels of physical fatigue (MD 2.21 95%CI [0.13, 4.29]). Trajectory analysis suggested an increasing effect size for physical function over time in the PMPT group, indicating a sustained impact of the intervention. To confirm these findings, a future randomised controlled trial with 181 participants is recommended.
This pilot study suggests that a personalised multimodal physical therapy approach, which integrates symptom-contingent pacing strategies with nutritional support, is feasible and potentially more effective than standard physiotherapy alone in enhancing physical function and reducing fatigue in individuals with long COVID. A larger-scale trial is warranted to establish robust evidence for its effectiveness and to further optimize physiotherapy strategies for this population.
This pilot study suggests that incorporating symptom-contingent pacing into physiotherapy, along with nutritional support, may enhance physical recovery and reduce fatigue in individuals with long COVID. While these preliminary findings are promising, the limited sample size calls for further research to confirm their effectiveness. The study also emphasizes the benefit of interprofessional collaboration between physiotherapists and dietitians. Integrating these strategies into physiotherapy curricula could better equip clinicians to manage long COVID. If validated in larger trials, these insights may guide health policy for rehabilitation pathways in long COVID care.
Symptom pacing
Nutritional counseling
