Longitudinal Evaluation of an Integrated Post-COVID-19/Long COVID Management Program Consisting of Digital Interventions and Personal Support: Randomized Controlled Trial.

BACKGROUND: The postacute COVID-19 syndrome (PACS) can be addressed with multidisciplinary approaches, including professional support and digital interventions. OBJECTIVE: This research aimed to test whether patients who received a health care facilitation program including medical internet support from human personal pilots and digital interventions (intervention group [IG] and active control group [ACG]) would experience fewer symptoms and have higher work ability and social participation than an untreated comparison group (CompG). The second objective was to compare the impact of a diagnostic assessment and digital interventions tailored to patients' personal capacity (IG) with that of only personal support and digital interventions targeting the main symptoms (ACG). METHODS: In total, 1020 patients with PACS were recruited. Using a randomized controlled trial design between the IG and the ACG, as well as propensity score matching to include the CompG, analyses were run with logistic regression and hierarchical-linear models. RESULTS: Symptoms decreased significantly in all groups over time (ßT1-T2=0.13, t549=5.67, P<.001; ßT2-T4=0.06, t549=2.83, P=.01), with a main effect of the group (ß=-.15, t549=-2.65, P=.01) and a more pronounced effect in the IG and ACG compared to the CompG (between groups: ßT1-T2=0.14, t549=4.31, P<.001; ßT2-T4=0.14, t549=4.57, P<.001). Work ability and social participation were lower in the CompG, but there was no significant interaction effect. There were no group differences between the IG and the ACG. CONCLUSIONS: Empowerment through personal pilots and digital interventions reduces symptoms but does not increase work ability and social participation. More longitudinal research is needed to evaluate the effects of a diagnostic assessment. Social support and digital interventions should be incorporated to facilitate health care interventions for PACS. TRIAL REGISTRATION: ClinicalTrials.gov NCT05238415; https://classic.clinicaltrials.gov/ct2/show/NCT05238415. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12879-022-07584-z.

Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review.

BACKGROUND: Patients with post-COVID/long-COVID symptoms need support, and health care professionals need to be able to provide evidence-based patient care. Digital interventions can meet these requirements, especially if personal contact is limited. OBJECTIVE: We reviewed evidence-based digital interventions that are currently available to help manage physical and mental health in patients with post-COVID/long-COVID symptoms. METHODS: A scoping review was carried out summarizing novel digital health interventions for treating post-COVID/long-COVID patients. Using the PICO (population, intervention, comparison, outcome) scheme, original studies were summarized, in which patients with post-COVID/long-COVID symptoms used digital interventions to help aid recovery. RESULTS: From all scanned articles, 8 original studies matched the inclusion criteria. Of the 8 studies, 3 were "pretest" studies, 3 described the implementation of a telerehabilitation program, 1 was a post-COVID/long-COVID program, and 1 described the results of qualitative interviews with patients who used an online peer-support group. Following the PICO scheme, we summarized previous studies. Studies varied in terms of participants (P), ranging from adults in different countries, such as former hospitalized patients with COVID-19, to individuals in disadvantaged communities in the United Kingdom, as well as health care workers. In addition, the studies included patients who had previously been infected with COVID-19 and who had ongoing symptoms. Some studies focused on individuals with specific symptoms, including those with either post-COVID-19 or long-term symptoms, while other studies included patients based on participation in online peer-support groups. The interventions (I) also varied. Most interventions used a combination of psychological and physical exercises, but they varied in duration, frequency, and social dimensions. The reviewed studies investigated the physical and mental health conditions of patients with post-COVID/long-COVID symptoms. Most studies had no control (C) group, and most studies reported outcomes (O) or improvements in physiological health perception, some physical conditions, fatigue, and some psychological aspects such as depression. However, some studies found no improvements in bowel or bladder problems, concentration, short-term memory, unpleasant dreams, physical ailments, perceived bodily pain, emotional ailments, and perceived mental health. CONCLUSIONS: More systematic research with larger sample sizes is required to overcome sampling bias and include health care professionals' perspectives, as well as help patients mobilize support from health care professionals and social network partners. The evidence so far suggests that patients should be provided with digital interventions to manage symptoms and reintegrate into everyday life, including work.

Patients' Post-/Long-COVID Symptoms, Vaccination and Functional Status-Findings from a State-Wide Online Screening Study.

(1) Background: Better understanding of post-/long-COVID and limitations in daily life due to the symptoms as well as the preventive potential of vaccinations is required. It is unclear whether the number of doses and timepoint interrelate with the trajectory of post-/long-COVID. Accordingly, we examined how many patients positively screened with post-/long-COVID were vaccinated and whether the vaccination status and the timepoint of vaccination in relation to the acute infection were related to post-/long-COVID symptom severity and patients' functional status (i.e., perceived symptom severity, social participation, workability, and life satisfaction) over time. (2) Methods: 235 patients suffering from post-/long-COVID were recruited into an online survey in Bavaria, Germany, and assessed at baseline (T1), after approximately three weeks (T2), and approximately four weeks (T3). (3) Results: 3.5% were not vaccinated, 2.3% were vaccinated once, 20% twice, and 53.3% three times. Overall, 20.9% did not indicate their vaccination status. The timepoint of vaccination was related to symptom severity at T1, and symptoms decreased significantly over time. Being vaccinated more often was associated with lower life satisfaction and workability at T2. (4) Conclusions: This study provides evidence to get vaccinated against SARS-CoV-2, as it has shown that symptom severity was lower in those patients who were vaccinated prior to the infection compared to those getting infected prior to or at the same time of the vaccination. However, the finding that being vaccinated against SARS-CoV-2 more often correlated with lower life satisfaction and workability requires more attention. There is still an urgent necessity for appropriate treatment for overcoming long-/post-COVID symptoms efficiently. Vaccination can be part of prevention measures, and there is still a need for a communication strategy providing objective information about the usefulness and risks of vaccinations.

The psychology of income wealth threshold estimations: A registered report.

How do people estimate the income that is needed to be rich? Two correlative survey studies (Study 1 and 2, N = 568) and one registered experimental study (Study 3, N = 500) examined the cognitive mechanisms that are used to derive an answer to this question. We tested whether individuals use their personal income (PI) as a self-generated anchor to derive an estimate of the income needed to be rich (= income wealth threshold estimation, IWTE). On a bivariate level, we found the expected positive relationship between one's PI and IWTE and, in line with previous findings, we found that people do not consider themselves rich. Furthermore, we predicted that individuals additionally use information about their social status within their social circles to make an IWTE. The findings from study 2 support this notion and show that only self-reported high-income individuals show different IWTEs depending on relative social status: Individuals in this group who self-reported a high status produced higher IWTEs than individuals who self-reported low status. The registered experimental study could not replicate this pattern robustly, although the results trended non-significantly in the same direction. Together, the findings revealed that the income of individuals as well as the social environment are used as sources of information to make IWTE judgements, although they are likely not the only important predictors.

Screening and assessment for post-acute COVID-19 syndrome (PACS), guidance by personal pilots and support with individual digital trainings within intersectoral care: a study protocol of a randomized controlled trial.

BACKGROUND: Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS. METHODS: This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated. DISCUSSION: This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population. Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

BACKGROUND: Individuals' physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation. AIM: This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health. DESIGN: A longitudinal design that included four time-point measurements across 15 months. SETTING: A medical rehabilitation center in Germany. POPULATION: Participants included 201 patients who were recruited from a medical rehabilitation center. METHODS: To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales. RESULTS: We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients' mental health over time. In addition, patients' physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment. CONCLUSIONS: This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment. CLINICAL REHABILITATION: More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants' mental health.

Cardiopulmonary capacity and psychological factors are related to return to work in orthopedic rehabilitation patients.

Health psychology sheds light on the process of returning to work after sick leave and subsequent medical rehabilitation. A 15-month longitudinal study with N = 201 orthopedic rehabilitation patients is reported. It examined whether and how both physiological health (e.g. body mass index and oxygen reabsorption) and psychological/social-cognitive factors (e.g. self-efficacy and social support) are related to returning to work. It was found that social-cognitive and physiological variables, such as oxygen consumption at anaerobic threshold, are important for returning to work. While physical activity was significantly correlated with social-cognitive variables, it was not significantly correlated directly with returning to work. Results suggest that self-efficacy and oxygen consumption at anaerobic threshold should be improved during medical rehabilitation.

Predictors for Loneliness Perceived by the Interviewer or the Individual: Findings from Limited Disability Pensioners and Medical Rehabilitation Patients / Predictores de Soledad Percibida por el Entrevistador o el Individuo: Hallazgos de Pensionados con Discapacidad Limitada y Pacientes de Rehabilitación Médica

Abstract Loneliness can be seen as indicator of social participation which is a major concern of the UN Convention on the Rights of Persons with Disabilities. Temporary disability pensioners and medical rehabilitants are persons with disabilities, whose rights should be empowered. Moreover, loneliness is a major burden for the individual and finding ways to overcome loneliness are accordingly required. Previous research has shown that different socio-demographic characteristics, life-satisfaction and social support interrelate with loneliness. The aim of the present study was to replicate findings with two computer-assisted telephone interview studies with individuals insured with a local pension fund. While study 1 recruited N = 453 disability pensioners (mean age=50.4 years, 53.5 % female) and assessed their loneliness with the typical self-report measured by directly asking, study 2 recruited N = 1,044 patients in a medical rehabilitation (mean age=49.5 years, 36 % female) and used the reports of their interviewers without asking the study participants directly about their loneliness. In both studies, more life-satisfaction was significantly associated with less loneliness (beta=-.41 and -.23). However, only in the interviewer-rated study, higher social support was related to less loneliness (beta=-.16). Sex differences were found in the interviewer-rated study (women were rated as lonelier, beta=.11), while an interrelation with age was only found if self-reports were used in terms of younger disability pensioners reported more loneliness (beta=-.24). The findings open options for counseling to also improve self-reported life-satisfaction. While interviewers rate female interviewees as lonelier than men, interventions should not forget about men as they report equal loneliness if controlled for other variables. The results replicate that health and life-satisfaction are imperative and addressable to decrease loneliness. This should be researched further and used for interventions.

Resumen La soledad puede ser vista como un indicador de la participación social, la cual es una preocupación importante para la Convención de las Naciones Unidas respecto a los derechos de personas con discapacidad. Los pensionados con discapacidad temporal y rehabilitantes médicos son personas con discapacidad, cuyos derechos deben ser empoderados. Aún más, la soledad es una carga significativa para el individuo y hallar maneras de sobreponerse a ésta es necesario. Investigaciones previas han mostrado que diferentes características sociodemográficas, la satisfacción con la vida y el apoyo social correlacionan con la soledad. El propósito del presente trabajo fue replicar hallazgos con dos entrevistas telefónicas apoyadas por computadora en individuos asegurados con un fondo local de pensión. El estudio 1 recolectó N = 453 pensionados con discapacidad (edad promedio = 50.4 años, 53.5% mujeres) y evaluó su soledad con una medida típica de auto-reporte que preguntaba de manera directa. El estudio 2 recolectó N = 1044 pacientes de rehabilitación médica (edad promedio = 49.5 años, 36% mujeres) y preguntó de manera indirecta a los participantes sobre su soledad. En ambos estudios, mayor satisfacción con la vida se asoció significativamente con menor soledad (beta = -.41 y -.23). Sin embargo, sólo en el estudio que trabajó con valoraciones del entrevistador se encontró que mayor apoyo social se asoció con menor soledad (beta = -.16). Se encontraron diferencias por sexo en el estudio con valoraciones del entrevistador (las mujeres fueron valoradas con mayor soledad, beta = .11), mientras que la interrelación con edad se encontró únicamente si los autoreportes se utilizaban en términos de pensionados más jóvenes y si estos reportaban mayor soledad (beta = -.24). Los hallazgos abren opciones para la consejería y para mejorar la satisfacción con la vida auto-reportada. Al tiempo que los entrevistadores describen a las mujeres entrevistadas como más solitarias que los hombres, las intervenciones no deben olvidar a los hombres ya que reportan niveles idénticos de soledad si se controlan otras variables. Los resultados replican que la salud y satisfacción con la vida son imperativas y deseables para disminuir la soledad. Esto debería investigarse más a fondo y ser utilizado para las intervenciones.