Beneficial effects of face-to-face pulmonary rehabilitation in patients with Long Covid: a systematic review with meta-analysis

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Background: Outpatient pulmonary rehabilitation (OPR) is recommended for patients with Long Covid (LC) even though the protocols used were not specific to the disease. Objective: To evaluate the effects of OPR on dyspnea (D) and exercise functional capacity (EFC) outcomes in patients with LC. Method: The registered systematic review (PROSPERO 2023 CRD42023389365) was conducted according to PRISMA and identified randomized clinical trials (RCTs) and observational cohort studies (OCS) in the electronic databases Medline/PubMed, Web of Science, Physiotherapy Evidence Database (PEDro) and EMBASE, from November 2019 to November 2024. The inclusion criteria were patients (≥ 18 years) with Long Covid (symptoms >12 weeks) undergoing OPR from 4 weeks in duration, with face-to-face physical training as an essential component. Results: 9 studies totaling 477 patients were included in 2 RCTs and 7 OCS. In the RCTs subgroup, the meta-analysis showed a reduction in dyspnea at rest, assessed by the modified Medical Research Council scale (mMRC) (MD: 0.82, 95%, CI 1.38-0.25, I2=58%, p=0.12). In the OCS subgroup, the meta-analysis showed improved performance in the 6-minute walk test (6MWT) (MD: 50.65, 95%, CI 45.68-55.61, I2=0%, p=0.89). Conclusion: Patients with CL benefit from OPR adapted for other lung diseases, with improvement in EFC as well as dyspnea. Further controlled studies are needed to guide the implementation of specific protocols that can provide better quality evidence.

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