Systematic review of post-COVID-19 syndrome rehabilitation guidelines

Tess Marshall-Andon; Sebastian Walsh; Tara Berger-Gillam; Anees Ahmed Abdul Pari

doi:10.1136/ihj-2021-000100

Systematic review of post-COVID-19 syndrome rehabilitation guidelines

Integr Healthc J. 2023 Feb 14;4(1):e000100. doi: 10.1136/ihj-2021-000100. eCollection 2022.

Authors

Tess Marshall-Andon^{1

2}, Sebastian Walsh^{1

3}, Tara Berger-Gillam^{1

4}, Anees Ahmed Abdul Pari^{1

5}

Affiliations

¹ Public Health, Public Health England East of England, Cambridge, UK.
² University of Cambridge Department of Public Health and Primary Care, Cambridge, UK.
³ University of Cambridge, Cambridge, UK.
⁴ University of East Anglia, Norwich, UK.
⁵ NHS England and NHS Improvement East of England, Cambridge, UK.

Abstract

Introduction: Post-COVID-19 syndrome is associated with significant health and potential socioeconomic burden. Due to its novel nature, there is a lack of clarity over best practice for the rehabilitation of patients with ongoing or new symptoms following acute COVID-19 infection. We conducted a systematic review of clinical and service guidelines for post-COVID-19 syndrome rehabilitation.

Methods: This review was registered on PROSPERO and is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included guidelines formally published or endorsed by a recognised professional body, covering rehabilitation of people with symptoms following resolution of acute COVID-19 infection. We searched Medline, Embase, PsycINFO, CINAHL, Web of Science, NHS Evidence, MedRxiv, PsyArXiv and Google for terms related to COVID-19, rehabilitation and guideline. Two reviewers independently screened articles for inclusion, data extracted and quality assessed using the AGREE II and AGREE-REX tools for clinical guidelines and the AGREE-HS tool for service guidelines. We included guidelines of sufficient quality in a narrative synthesis.

Results: We identified 12 790 articles, of which 37 guidelines (19 clinical only, 7 service only and 11 combined clinical and service) were included. Guidelines covered a range of countries, rehabilitation types, populations and rehabilitation settings. Synthesis of clinical guidelines (n=4) was structured following the patient pathway, from identification, to assessment, treatment and discharge, with consideration of specific patient groups. Synthesis of service guidelines (n=8) was structured according to the Donabedian framework.

Discussion: Though the available post-COVID-19 syndrome rehabilitation guidelines were generally of poor quality, there was a high degree of consensus regarding the breadth of symptoms, the need for holistic assessment by a broad multidisciplinary team and person-centred care. There was less clarity on management options, measuring outcomes and discharge criteria.

Prospero registration number: CRD42021236049.

Keywords: COVID-19; Clinical practice guidelines; Rehabilitation.

Publication types

Review