International Postgraduate School, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Spain -
Physiotherapy and Orofacial Pain Working Group, Spanish Society of Craniomandibular Dysfunction and Orofacial Pain (SEDCYDO), Madrid, Spain -
Eur J Phys Rehabil Med. 2024 Oct;60(5):868-877. doi: 10.23736/S1973-9087.24.08540-X. Epub 2024 Sep 5.
Post COVID-19 condition (PCC) is characterized by the persistence of symptoms associated with COVID-19 infection for more than 12 weeks, with worsening quality of life and physical function deconditioning being among the most commonly reported persistent symptoms. Pulmonary rehabilitation has emerged as a safe and viable option for these patients. Administered either face-to-face (FTF) or telemedicine (TL), it has been shown to improve symptoms associated with PCC. However, little is known about which approach is best for this population. Therefore, we conducted a systematic review and network meta-analysis on the efficacy of FTF versus TL compared to usual care in improving physical function and quality of life (physical and mental) in patients with PCC.
A systematic search of PubMed, Cochrane Library, and Web of Science was performed from 2020 to January 5, 2024. Two independent reviewers performed study selection, data extraction, and risk of bias assessment; this selection included only randomized controlled trials. A network meta-analysis was performed to compare the effects of FTF and TL with usual care. Multivariate and univariate analysis were performed to evaluate the best intervention.
Data were extracted from 10 studies, five of which were treated with FTF and five of which were TL, involving 765 adults with PCC, ranging in age from 22 to 66 years. Interventions consisted of isolated or combined exercises (aerobic, resistance, breathing) and lasted between three and ten weeks in most of the included studies. Multivariate analysis found that FTF produced significant differences compared to TL or usual care with moderate quality of evidence. Univariate analysis found that significant differences were only found for physical function and mental domain of quality of life for TL vs. usual care, with moderate quality of evidence.
This study supports the use of FTF as a therapy to improve physical function and quality of life in patients with PCC. However, in the absence of differences between FTF and TL in the univariate model for any of the outcomes studied, the choice of the form of pulmonary rehabilitation administration should be individualized. Future studies should compare FTF with TL directly to clarify which is the best approach.
新冠后疾病（PCC）的特征是与新冠感染相关的症状持续超过 12 周，生活质量恶化和身体功能失调是最常报告的持续症状。肺康复已成为这些患者的一种安全可行的选择。无论是面对面（FTF）还是远程医疗（TL）进行管理，都已被证明可改善与 PCC 相关的症状。然而，对于这一人群，哪种方法最好尚不清楚。因此，我们对 FTF 与 TL 相对于常规护理在改善 PCC 患者身体功能和生活质量（身体和心理）方面的疗效进行了系统评价和网络荟萃分析。
从 2020 年到 2024 年 1 月 5 日，对 PubMed、Cochrane 图书馆和 Web of Science 进行了系统搜索。两名独立的审查员进行了研究选择、数据提取和偏倚风险评估；该选择仅包括随机对照试验。进行了网络荟萃分析以比较 FTF 和 TL 与常规护理的效果。进行了多变量和单变量分析以评估最佳干预措施。
从 10 项研究中提取数据，其中 5 项采用 FTF，5 项采用 TL，涉及 765 名患有 PCC 的成年人，年龄在 22 至 66 岁之间。干预措施包括孤立或联合运动（有氧运动、阻力运动、呼吸运动），大多数纳入的研究中持续时间为三至十周。多变量分析发现，与 TL 或常规护理相比，FTF 具有显著差异，具有中等质量的证据。单变量分析发现，TL 与常规护理相比，仅在身体功能和生活质量的心理领域发现差异具有中等质量的证据。
本研究支持使用 FTF 作为治疗方法来改善 PCC 患者的身体功能和生活质量。然而，在单变量模型中，FTF 与 TL 在任何研究结果方面均无差异，因此肺康复管理形式的选择应个体化。未来的研究应直接比较 FTF 与 TL，以明确哪种方法最好。
