A comparison of allied healthcare versus no allied healthcare on participation, fatigue, physical functioning and health-related quality of life for patients with persistent complaints after a COVID-19 infection

To assess the effectiveness of allied healthcare versus no allied healthcare. Data from the ParaCOV cohort (allied healthcare, n = 1,451) and the LongCOVID cohort (no allied healthcare/control, n = 1427) were analyzed. Average treatment effects (ATEs) between groups were estimated using Targeted Maximum Likelihood Estimation adjusted for age, sex, body mass index, smoking status, comorbidities, and effect outcomes’ baseline values. A ≥ 10% between-group difference in improvement from baseline (BTGD) was considered clinically relevant for participation, fatigue, and physical functioning, and ≥0.062 for health-related quality of life. Patients receiving allied healthcare were older (49.2 vs. 41.2 years), less often female (63.3% vs. 70.1%), had higher BMI (28.2 vs. 26.1), smoked less frequently (5.0% vs. 9.0%), had more comorbidities (49.2% vs. 41.9%), and lower baseline anxiety and depression scores compared to those not receiving allied healthcare. For participation, ATEs after 6 and 12 months were respectively −2.62 (95%CI: −4.39; −0.86) and −1.68 (95%CI: −4.81;1.45), with BTGDs of 4.7% and 1.8% favoring the control. For fatigue, ATEs were 1.72 (95%CI: −0.14; 3.58) and 0.97 (95%CI: −1.48; 3.41), with BTGDs of 6.5% and 3.7% favoring the control. For physical functioning, ATEs were 5.75 (95% CI: 4.42; 7.09) and 6.36 (95%CI: 4.84; 7.88), with BTGDs of 1.4% and 2.2% favoring allied healthcare. For health-related quality of life, ATEs were 0.017 (95%CI: −0.008; 0.0044) and 0.033 (95%CI: 0.011; 0.054). Patients with persistent complaints after a COVID-19 infection showed significantly lower participation after 6 months, higher health-related quality of life after 12 months, and better physical functioning after 6 and 12 months of allied healthcare, however, BTGDs were not clinically relevant. Study limitations warrant cautious results interpretation. Although health-related quality of life and physical functioning improved in Long COVID patients, this cannot be definitively attributed to allied healthcare.The observed outcome differences between Long COVID patients with and without allied healthcare were not clinically relevant.More research is needed for tailored rehabilitation treatments for these patients. Although health-related quality of life and physical functioning improved in Long COVID patients, this cannot be definitively attributed to allied healthcare. The observed outcome differences between Long COVID patients with and without allied healthcare were not clinically relevant. More research is needed for tailored rehabilitation treatments for these patients.

为评估辅助医疗（allied healthcare）与无辅助医疗的临床效果差异。本研究分析了来自ParaCOV队列（接受辅助医疗，n=1451）及长新冠（LongCOVID）队列（未接受辅助医疗/对照组，n=1427）的数据。采用靶向最大似然估计（Targeted Maximum Likelihood Estimation）估算组间平均治疗效应（ATEs），校正因素包括年龄、性别、体重指数、吸烟状况、合并症及结局指标的基线水平。对于参与能力、疲劳感及躯体功能，组间自基线改善差值（BTGD）≥10%被视为具有临床意义；对于健康相关生命质量，该阈值为≥0.062。与未接受辅助医疗的患者相比，接受辅助医疗的患者年龄更大（49.2岁 vs 41.2岁），女性占比更低（63.3% vs 70.1%），体重指数更高（28.2 vs 26.1），吸烟率更低（5.0% vs 9.0%），合并症发生率更高（49.2% vs 41.9%），且基线焦虑及抑郁评分更低。
就参与能力而言，干预后6个月及12个月的平均治疗效应分别为-2.62（95%置信区间：-4.39；-0.86）和-1.68（95%置信区间：-4.81；1.45），对应的BTGD分别为4.7%和1.8%，均提示对照组更优。
针对疲劳感，干预后6个月及12个月的平均治疗效应分别为1.72（95%置信区间：-0.14；3.58）和0.97（95%置信区间：-1.48；3.41），BTGD分别为6.5%和3.7%，同样以对照组更优。
对于躯体功能，干预后6个月及12个月的平均治疗效应分别为5.75（95%置信区间：4.42；7.09）和6.36（95%置信区间：4.84；7.88），BTGD分别为1.4%和2.2%，更倾向于辅助医疗组。
在健康相关生命质量方面，干预后6个月及12个月的平均治疗效应分别为0.017（95%置信区间：-0.008；0.0044）和0.033（95%置信区间：0.011；0.054）。
新冠感染后存在持续性不适的患者，接受辅助医疗后6个月时参与能力显著更低，12个月时健康相关生命质量更高，且6个月及12个月时躯体功能更好，但上述BTGD均未达到临床意义阈值。
本研究存在局限性，故对结果解读需谨慎。尽管长新冠患者的健康相关生命质量及躯体功能有所改善，但该改善并不能明确归因于辅助医疗。观察到的接受与未接受辅助医疗的长新冠患者间的结局差异并无临床意义。仍需针对此类患者开展个体化康复治疗的相关研究。尽管长新冠患者的健康相关生命质量及躯体功能有所改善，但该改善并不能明确归因于辅助医疗。观察到的接受与未接受辅助医疗的长新冠患者间的结局差异并无临床意义。仍需针对此类患者开展个体化康复治疗的相关研究。