Uswatte Gitendra, Taub Edward, Ball Karlene, Mitchell Brandon S, Blake Jason A, McKay Staci, Biney Fedora, Iosipchuk Olesya, Hempfling Piper, Harris Elise, Dickerson Anne, Lokken Kristine, Knight Amy J, Mark Victor W, Agnihotri Shruti, Cutter Gary
Department of Psychology, University of Alabama at Birmingham.
Department of Physical Therapy, University of Alabama at Birmingham.
medRxiv. 2024 Aug 12:2024.07.04.24309908. doi: 10.1101/2024.07.04.24309908.
Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study's objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae.
Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a) ≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed.
Fourteen completed Immediate-CICT (=7) or TAU (=7); two withdrew from TAU before their second testing session. Completers were [ (S)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (=3.7 points, p<.001, =2.6) and brain fog (=-4 points, p<.001, =-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, =.048.
CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.
新冠后长期脑雾常常使人丧失能力。然而，目前尚无经实证支持的治疗方法。本研究的目的是初步评估一种新的康复方法——约束诱导认知疗法（CICT）对新冠后认知后遗症的可行性和疗效。
招募了16名新冠感染后3个月以上、有轻度认知障碍且日常生活工具性活动（IADL）功能障碍的社区居民。参与者被随机分为立即接受CICT组或常规治疗（TAU）组，后者可交叉接受CICT。CICT将从约束诱导运动疗法修改而来的行为改变技术与处理速度训练（一种计算机化认知训练程序）相结合。如果满足以下条件，则认为CICT是可行的：（a）≥80%的参与者完成治疗；（b）同样发现治疗非常令人满意且难度至多为中等；（c）发生<2起与研究相关的严重不良事件。主要结局是日常生活中的IADL表现（加拿大职业表现量表）。还评估了就业状况和脑雾（精神混乱量表）。
14人完成了立即接受CICT（=7）或TAU（=7）治疗；2人在第二次测试前退出了TAU组。完成治疗者的情况为：新冠感染后[（S）]：10（7）个月；年龄51（13）岁；女性10人，男性4人；非裔美国人1人，欧洲裔美国人13人。所有可行性基准均得到满足。与TAU相比，立即接受CICT使IADL表现有非常大的改善（=3.7分，p<.001，=2.6），脑雾也有改善（=-4分，p<.001，=-2.9）。5名未退休的立即接受CICT治疗的参与者中有4人在治疗后重返工作岗位；TAU组参与者无人重返工作岗位，=0.048。
CICT有望减轻新冠后长期脑雾、改善IADL并促进成年患者重返工作岗位。研究结果值得开展一项有积极对照组的大规模随机对照试验。
