Marshall-Andon Tess, Walsh Sebastian, Berger-Gillam Tara, Pari Anees Ahmed Abdul
Public Health, Public Health England East of England, Cambridge, UK.
University of Cambridge Department of Public Health and Primary Care, Cambridge, UK.
Integr Healthc J. 2023 Feb 14;4(1):e000100. doi: 10.1136/ihj-2021-000100. eCollection 2022.
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.
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.
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.
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.
CRD42021236049.
新冠后综合征与重大的健康问题及潜在的社会经济负担相关。由于其具有新颖性，对于急性新冠感染后仍有持续症状或出现新症状的患者，在康复的最佳实践方面缺乏明确认识。我们对新冠后综合征康复的临床和服务指南进行了系统评价。
本评价在国际前瞻性系统评价注册库（PROSPERO）进行了注册，并按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行报告。我们纳入了由认可的专业机构正式发布或认可的指南，涵盖急性新冠感染症状缓解后有症状患者的康复。我们在Medline、Embase、PsycINFO、CINAHL、科学引文索引（Web of Science）、英国国家医疗服务体系证据库（NHS Evidence）、MedRxiv、PsyArXiv和谷歌中搜索与新冠、康复和指南相关的术语。两名评审员独立筛选纳入的文章，使用临床指南的AGREE II和AGREE-REX工具以及服务指南的AGREE-HS工具提取数据并进行质量评估。我们将质量足够的指南纳入叙述性综合分析。
我们识别出12790篇文章，其中纳入了37项指南（19项仅为临床指南，7项仅为服务指南，11项为临床和服务相结合的指南）。指南涵盖了一系列国家、康复类型、人群和康复环境。临床指南（n = 4）的综合分析按照患者流程构建，从识别、评估、治疗到出院，并考虑了特定患者群体。服务指南（n = 8）的综合分析按照唐纳贝迪安框架构建。
尽管现有的新冠后综合征康复指南质量普遍较差，但在症状范围、由广泛的多学科团队进行全面评估的必要性以及以患者为中心的护理方面存在高度共识。在管理选项、测量结果和出院标准方面的清晰度较低。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42021236049。
