Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition.
Chiara Arienti, Claudio Cordani, Stefano G Lazzarini and 3 others
PMID 36472558WHAT IT FOUND
Cochrane reviews show exercise and education can reduce fatigue in other chronic diseases, but evidence is very low to moderate.
No reviews exist for post-exertional malaise or orthostatic intolerance. Apply treatments cautiously, ruling out cardiac issues first.
Key findings
01Exercise and physical activity interventions showed benefits for fatigue in conditions like cancer and fibromyalgia, but the evidence quality was very low to moderate.
02No Cochrane reviews were found that specifically addressed post-exertional malaise or orthostatic intolerance.
03Neuromuscular electrical stimulation plus exercise showed some benefit for endurance in stable COPD, but with very low-quality evidence.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The evidence is indirect. The reviews are from other health conditions (cancer, COPD, etc.), not Post-COVID-19 Condition (PCC) itself. Most evidence was of very low or low quality, with only a few reviews providing moderate-quality evidence. No Cochrane reviews were found for post-exertional malaise or orthostatic intolerance, leaving significant gaps for these specific PCC symptoms. The review only included Cochrane Systematic Reviews, excluding other potentially relevant high-quality systematic reviews from non-Cochrane sources.
Declared interests
The study was developed by Cochrane Rehabilitation for the World Health Organization Rehabilitation Program. No specific financial conflicts of interest are listed in the provided text, but the collaboration with WHO indicates a public health organizational context.
The easy way to misread this
Do not interpret these findings as direct evidence for treating Post-COVID-19 Condition. The interventions were tested in other diseases, and the quality of evidence is very low to moderate. Applying them to PCC patients requires careful screening for contraindications, especially cardiac issues and post-exertional malaise.