Ambulante rehabilitative Versorgung von Patienten mit Long-COVID – eine leitlinienorientierte klinisch-praktische Handlungsempfehlung

Zusammenfassung

Hintergrund Auch über Wochen und Monate anhaltende und neu auftretende Symptome nach einer SARS-CoV-2 Infektion sind verbreitet und führen teilweise zu einem bunten Bild an Einschränkungen und Defiziten. Wissenschaftliche Evidenz zu einzelnen therapeutischen Möglichkeiten ist nur begrenzt verfügbar. Das Ziel dieser Arbeit ist es daher, pragmatische Behandlungsempfehlungen analog der aktuellen Heilmittelrichtlinie aufzustellen.

Methode Neben einer Suche in sechs elektronischen Datenbanken wurden auch die Erfahrungen aus der Behandlung von hunderten Betroffenen aus der Post-COVID-Sprechstunde sowie Patienten mit ähnlichen Symptomen bei anderen Erkrankungen herangezogen. Unter Einbeziehung aller Autoren erfolgte dann die Entwicklung der pragmatischen Handlungsempfehlungen für die Hauptsymptome im Rahmen ambulanter Therapiemaßnahmen. Eine Aufstellung von möglicher Diagnostik und funktionellen Assessments vor der Therapie wurde abschließend entwickelt.

Ergebnisse Für die Hauptsymptome Fatigue, Dyspnoe und kognitive Einschränkungen bietet der Heilmittelkatalog unter der Diagnose U09.9 weitreichende therapeutische Möglichkeiten. Die Zusammenstellung der Therapiepakete sollte individuell erfolgen und durch Reassesments an das Leistungsniveau angepasst werden. Eine Aufklärung des Patienten über mögliche Rückfälle und Verschlechterungen sowie Umgang mit diesen sollte Teil der Therapie sein.

Diskussion Ambulante Heilmittel sollten im Rahmen des besonderen Verordnungsbedarfes zur Behandlung von Long-COVID eingesetzt werden. Hierbei ist es wichtig, auch schwerwiegende Komplikationen nach der Erkrankung, wie beispielsweise das Post-intensive-Care-Syndrom, zu erfassen und speziell zu behandeln. Eine regelmäßige Überprüfung wissenschaftlicher Arbeiten und Empfehlungen sollte auf Grund der schnellen Weiterentwicklung der Erkenntnisse erfolgen. Qualitativ hochwertige Interventionsstudien sind notwendig, um eine größere Evidenz auf diesem Gebiet zu erreichen.

Abstract

Background Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline.

Method In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed.

Results For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen.

Discussion Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

Schlüsselwörter

Rehabilitation - Therapieempfehlung - Physiotherapie - Funktionsstörungen - COVID-19 - Functional disorders - rehabilitation - therapy recommendation - physical therapy - COVID-19

Publication History

Received: 05 January 2022

Accepted after revision: 01 April 2022

Article published online:
02 May 2023

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