An online programme of physical and mental health rehabilitation can improve quality of life for adults with long covid, finds a trial published by The BMJ today.
The eight week REGAIN programme, delivered in online group sessions, led to sustained improvements in fatigue, pain, and depression compared with usual care.
The researchers say this accessible, resource-efficient programme can be delivered at scale and will assist clinicians in the treatment of this complex condition.
Post-covid-19 condition (commonly known as long covid) is defined as symptoms persisting or new symptoms appearing more than four weeks after initial infection. As of March 2023, 1.9 million people in the UK reported covid-19 symptoms persisting beyond 12 weeks, 1.3 million beyond one year, and over 750,000 beyond two years.
Symptoms include extreme tiredness (fatigue), shortness of breath, memory loss and muscle aches, all of which can affect quality of life, social interaction, and economic productivity.
It’s been suggested that rehabilitation programmes may help people with long covid, but there are no trial data to indicate benefit or harm.
So researchers set out to evaluate whether a structured, online, supervised, group physical and mental health rehabilitation programme improved health related quality of life compared with usual care for adults with post-covid-19 condition.
The trial involved 585 adults (52% female; average age 56 years) who had been discharged from hospital at least 3 months earlier after a covid-19 infection and who reported substantial lasting effects that they attributed to the virus.
After providing information on a range of health and lifestyle factors, 287 participants were randomised to usual care (a single online session of advice and support with a trained practitioner) and 298 to the REGAIN intervention (weekly home based, live, supervised, group exercise and psychological support sessions delivered online over eight weeks).
The results show that the REGAIN intervention was well tolerated and led to sustained improvements in health related quality of life at three and 12 months compared with usual care, driven mostly by improved fatigue, pain, and depression.
At three months, 17% of the intervention group reported that their overall health was “much better now” compared with 8% in the usual care group.
Of 21 serious adverse events, only one (fainting with vomiting 24 hours after a live exercise session) was possibly related to the intervention, suggesting that it is acceptable and safe.
The researchers acknowledge some limitations, such as the inability of trial participants or REGAIN practitioners to be masked to treatment allocation and only 11% of the trial participants being non-White.
Nevertheless, they say the REGAIN trial provides the first high quality randomised controlled trial evidence confirming the clinical benefit, and lack of harm, of online physical and mental health rehabilitation for post-covid-19 condition, which will assist clinicians in the treatment of this complex condition.
Findings from this trial have important clinical implications, say researchers in a linked editorial. For example, they suggest that rehabilitation programmes for post-covid-19 condition should target fatigue, pain, and depression,
However, challenges in rolling out novel complex rehabilitation therapies, such as REGAIN, exist including whether findings can be generalised to patients with milder infection and if online delivery is acceptable to people living with post-covid-19 condition.
From a workforce perspective, scalable methods are needed to train clinicians to competently deliver rehabilitation for post-covid-19 condition, while health service providers also need to consider if they will support delivery of new treatments, they add. The planned REGAIN economic evaluation, which is not yet published, will provide useful data in this regard.
Method of Research
Randomized controlled/clinical trial
Subject of Research
Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN): multicentre randomised controlled trial
Article Publication Date
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. GM, MU, JB, HS, KS, and JY are chief investigators or co-investigators on multiple previous and current research grants from the UK National Institute for Health and Care Research. GM and SE are directors of Atrium Health, a non-profit cardiopulmonary rehabilitation provider, which provided the treatment hub for the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) trial. Both receive payment for their work as directors. HS and SP are directors of Health Psychology Services, a private health psychology provider. DM is a physiotherapist delivering post-intensive care unit rehabilitation for the NHS. MU is a current or recent co-investigator on Arthritis Research UK, Australian National Health and Medical Research Council, and Norwegian Medical Research Council grants; a director and shareholder of Clinvivo, which provides electronic data collection for health services research; part of an academic partnership with Serco, funded by the European Social Fund, related to return-towork initiatives, and a co-investigator on two current and one recent National Institute for Health and Care Research (NIHR) funded studies receiving additional support from Stryker. JB has received travel expenses for speaking at conferences from the professional organisations hosting these conferences. JY is an existing member of the NIHR Health Technology Assessment General Funding Committee. KS was a member of the NIHR Health and Social Care Delivery Research Board from 2010 to 2018