Patient-Reported Outcomes (PROs) 3 und 6 Monate nach pneumologischer Post-COVID-Rehabilitation

Zusammenfassung

Ziel der Studie  Wenn teilhaberelevante COVID-19-Krankheitsfolgen auch die Atmungsorgane (mit-)betreffen, wird in nationalen und internationalen Leitlinien eine pneumologische Rehabilitation (PR) empfohlen. Bisher liegen jedoch aus Deutschland keine Studien über den Verlauf nach PR vor, ebenso wenig wie über mögliche Verlaufsunterschiede zwischen den beiden Long-Covid-Subgruppen „Fortwährend-symptomatische-COVID-19“ und “Post-COVID-Syndrom” (PCS).

Methodik  In einer prospektiven Beobachtungsstudie wurden Patient-Reported Outcomes (PROs) bezüglich Belastungsdyspnoe, Lebensqualität, Schmerz, Fatigue, Depressivität und Angst zu PR-Beginn (T1), PR-Ende (T2) sowie nach 3 (T3) und 6 Monaten (T4) erfasst. Die statistische Auswertung erfolgte mittels latenter Differenzenmodelle.

Ergebnisse  Es wurden 224 Rehabilitanden (M_Alter=54,4; SD_Alter=10,4; 42,0% weiblich) in die Studie eingeschlossen. Während der PR verbesserten sich alle PROs signifikant. Nach der PR blieben die Verbesserungen entweder mit großer Prä-Post-Effektstärke erhalten (Belastungsdyspnoe, Lebensqualität), verringerten sich leichtgradig auf kleine Prä-Post-Effektstärken (Depressivität, Fatigue) oder reduzierten sich auf Ausgangsniveau (Angst, Schmerzen). PCS-Patienten hatten zu T1 stärkere Belastungen in Depressivität, Fatigue und Schmerzen, unterschieden sich aber nicht in den Verläufen. Indikatoren der Schwere der vorausgegangenen akuten COVID-Phase (Sauerstofftherapie, Behandlung auf Intensivstation, Beatmung) waren zu T1 mit höheren Belastungen in Depressivität, Fatigue und Schmerzen assoziiert, aber nicht mit den Verläufen während und nach der PR. Patientinnen zeigten hingegen sowohl zu T1 höhere Belastungen in Depressivität und Fatigue als auch höhere Prä-Post-Effekte als männliche Patienten.

Schlussfolgerung  Verbesserungen in den PROs traten in beiden Subgruppen nur während der PR, nicht jedoch im Nachbeobachtungszeitraum auf. Dies legt nahe, dass die Veränderungen nicht durch den natürlichen Heilungsverlauf, sondern zumindest teilweise durch die PR bedingt sind. Überdies legen die Ergebnisse nahe, dass beide Patientengruppen von einer PR profitieren können. Verbesserungen hinsichtlich Belastungsdyspnoe und Lebensqualität sowie in einem reduzierten Ausmaß auch hinsichtlich Depressivität und Fatigue persistierten bis 6 Monate nach der PR, allerdings nicht hinsichtlich Schmerzen und Ängstlichkeit. Um diese Effekte aufrechtzuerhalten sind möglicherweise zusätzliche multimodale Interventionen erforderlich.

Abstract

Purpose If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups “Ongoing symptomatic COVID-19” and “Post-COVID-19 syndrome” (PCS).

Methods  In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models.

Results  There were 224 rehabilitation patients (M_Age=54.4; SD_Age=10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients.

Conclusion  The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.

Schlüsselwörter

COVID-19 - pneumologische Rehabilitation - Long-COVID - Post-COVID-Syndrom

Key words

COVID-19 - pulmonary rehabilitation - Long COVID - Post-COVID-19 syndrome

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