Dimitra Pouliopoulou, Myranda Hawthorne, Joy MacDermid, Kieran Quinn, Erin Miller, Nicole Billias, Simon Décary, Fahad Razak, Angela Cheung, Panagis Galiatsatos, Tiago Pereira, Pavlos Bobos
Purpose:
We sought to provide a more comprehensive analysis of PEM in individuals with PCC. More specifically, the objectives of our study were to assess the prevalence of PEM in adults living with PCC and investigate the change in prevalence of PEM following rehabilitation interventions that include a prescribed exercise component.
Methods:
We searched MEDLINE, Embase, Central, CINAHL, PsychINFO and Clinical Trial Registries from inception until January 12th, 2024. We included observational studies that measured the prevalence of PEM in adults with PCC and interventional studies that measured the change in prevalence of PEM following rehabilitation interventions in adults with PCC. We performed a single-arm proportional meta-analysis to synthesise prevalence estimates using logit transformation. We conducted a sensitivity analysis using multilevel-mixed-effects logistic regression.
Results:
The prevalence of PEM in community-dwelling adults living with PCC was 36% (95% CI: 0.19 to 0.57; 2,263 participants). Two of the included studies (61 patients) found a decrease in the frequency and intensity of PEM episodes in adults with PCC following a tailored rehabilitation program centred on integrating pacing approaches. None of the included studies reported an increase of PEM symptoms’ frequency and intensity following an individually tailored rehabilitation program with a therapeutic exercise component (5 studies; 892 patients).
Conclusion(s):
Our study confirms that there is a large proportion of people with PCC experiencing PEM-related symptoms and suggests that there is an urgent need for effective treatment pathways for people living with both conditions. There is a subgroup of patients with PCC that do not have PEM, and the current evidence suggests that individually tailored, symptom-titrated rehabilitation interventions with active exercise components may be well tolerated in this sub-population without triggering a new onset of PEM-related symptoms. Our results are limited by the limited reporting of the percentage of PEM in the baseline before enrolling patients in the rehabilitation programs, and the large number of studies using non-validated, unstandardized tools to measure PEM in people with PCC, hence there is an urgent need to strengthen the methods of future trials.
Implications:
Understanding and estimating the prevalence of PEM in adults with PCC is crucial for the planning and development of new health resources on a societal scale. When governments are required to allocate resources to health expenditure, they must undertake significant investigation and one of the first considerations for any new decision made is the assessment of population needs. A cardiopulmonary assessment of the patient before starting the rehabilitation program and constant monitoring patient’s physiological parameters and consistent monitoring of perceived exertion may be considered to effectively personalized these interventions and allow for exercise bellow exertion triggering thresholds.
Funding acknowledgements:
No funding was received for this project.
Keywords:
Post-COVID-19 Condition
Post-Exertional Malaise
Rehabilitation Interventions
Post-Exertional Malaise
Rehabilitation Interventions
Primary topic:
Musculoskeletal
Second topic:
Community based rehabilitation
Third topic:
Primary health care
Did this work require ethics approval?:
No
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No
