Post COVID-19 – effective treatment and rehabilitation

Living review

SBU Policy support

identifies and presents available scientific evidence to support policy and decision making, including the development of national guidelines, at other government agencies. In consultation with professional experts, SBU staff generates supporting documentation to address the various questions that have been posed.

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Background

SBU has been commissioned by the Swedish Government to evaluate the scientific evidence for care for patients with post COVID-19 (long-term symptoms or sequelae of the disease COVID-19).

The aim is to summarize published scientific articles addressing the following research question:

  • Which treatments are effective for post COVID-19?

Result

See all studies and tables

Flow diagram for article screening

Study flowchart 22 934 records identified through database searches. After screening, we have included 6 studies with low or moderate risk for bias and 7 studies with high risk of bias.

Published: 8/25/2021 Revised: 5/18/2022 Report no: 328 Registration no: 2021/137 https://www.sbu.se/328e

Evidence map

The articles in the evidence map are presented based on included population and intervention. You can filter which articles are displayed by making selections in the menu above the table. Below the table are functions for exporting the selection as an Excel file or image.

Evidence map: Post COVID-19 – effective treatment and rehabilitation

Filtrera
Population
Treatment/Rehabilitation
Symtom categories
Depression/Anxiety
1
Studies with moderate risk of bias
Fever
Palpitations/POTS*
Mental fatigue/Cognitive impairment
1
Studies with high risk of bias
Chronic obstructive pulmonary disease/Asthma
Smell/Taste
2
Studies with moderate risk of bias
Lung function/Breathing
1
Studies with low risk of bias
1
Studies with moderate risk of bias
3
Studies with high risk of bias
Neurological difficulties
Kidney problems
Pneumonia
Pain
Sleeping problems
Dizziness/Nausea
Other
1
Studies with moderate risk of bias
3
Studies with high risk of bias
*Postural Orthostatic Tachycardia Syndrome (POTS)

Method

Inclusion criteria

  • Population – 1. Patients with post COVID-19 condition accoring to WHO´s definition (individuals with persistent or new symptoms after 3 months from the initial onset of COVID-19 that last for at least 2 months and cannot be explained by an alternative diagnosis). 2. Patients who did not meet the critera according to WHO´s definition (but had early symptoms, treatment started after infection clearance and were followed up at least three months).
  • Interventions – Treatment or rehabilitation for long-term symptoms.
  • Comparison – No treatment or other treatment.
  • Outcomes – All outcomes related to post COVID-19 (long-term symptoms or sequelae of the disease COVID-19).
  • Study design – RCT and non-randomized controlled trials. Observational and qualitative studies, as well as case studies, will be excluded.

Literature search

Every week, an information specialist searches the database Medline (OvidSP) via Alerts. Every month, five additional databases are searched: Cinahl (Ebsco), PsycINFO (Ebsco), Cochrane Library (Wiley), Embase (embase.com) and WHO: Global literature on coronavirus disease. Reference lists and citations for relevant primary studies and reviews are also screened.

See appendix for the complete search strategies.

The project group also continuously track the following COVID-19 specific resources:

Selection and assessement of identified articles

First, abstracts are screened independently by two reviewers to identify studies that meet the inclusion criteria.

Second, the full text of potentially relevant studies are then retrieved and assessed for relevance.

Third, all included studies are assessed for risk of bias for the outcomes of interest by two independent reviewers with the Cochrane risk of bias tools RoB 2 and Robins-I. Studies assessed with an overall high risk of bias are excluded.

Disagreements between the reviewers are resolved by discussion, when necessary with involvement of a third reviewer.

Protocol

A protocol for the living review is published in PROSPERO (International prospective register of systematic reviews) with registration number CRD42021276717.

Project group

Experts

  • Alison Godbolt, Danderyd Hospital
  • Judith Bruchfeld, Karolinska University Hospital
  • Jörgen Månsson, University of Gothenburg
  • Kristina Hedman, Sundsvall Regional Hospital
  • Marcus Ståhlberg, Karolinska University Hospital
  • Michael Runold, Karolinska University Hospital
  • Olof Hertting, Astrid Lindgren Children's Hospital

From SBU

  • Elizabeth Åhsberg, Project Manager
  • Nathalie Peira, Assistant Project Manager
  • Idha Kurtsdotter, biträdande projektledare (from April 2022)
  • Jessica Dagerhamn, Assistan Project Manager (from November 2021 to April 2022)
  • André Sjöberg, Assistant Project Manager (up to December 2022)
  • Maria Ahlberg, Project Administrator
  • Carl Gornitzki, Information Specialist (up to November 2021)
  • Hanna Olofsson, Information Specialist (from December 2021)
  • Pernilla Östlund, Head of Department
  • Susanne Eksell, Web Project Manager

Updates

All numbers are deduplicated to previous searches.

2022-05-16

Weekly update (Medline via Alert). Studies to be assessed for relevance: 65.

2022-05-12

One relevant studie identified (Glynne 2022) but excluded due to high risk of bias.

2022-05-10

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 754.

2022-05-09

Weekly update (Medline via Alert). Studies to be assessed for relevance: 93.

2022-05-02

Weekly update (Medline via Alert). Studies to be assessed for relevance: 105.

2022-05-02

One relevant studie identified (Hawkins 2022) but excluded due to high risk of bias.

2022-04-25

Weekly update (Medline via Alert). Studies to be assessed for relevance: 146.

2022-04-18

Weekly update (Medline via Alert). Studies to be assessed for relevance: 105.

2022-05-15

One relevant studie identified (Wisnivesky 2022) but excluded due to high risk of bias.

2022-04-14

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 1 608

2022-04-13

New study identified and assessed for risk of bias: Chen 2021 (moderate risk). Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 1 608.

2022-04-11

Weekly update (Medline via Alert). Studies to be assessed for relevance: 81.

2022-04-04

Weekly update (Medline via Alert). Studies to be assessed for relevance: 110.

2022-03-28

Weekly update (Medline via Alert). Studies to be assessed for relevance: 109.

2022-03-21

Weekly update (Medline via Alert). Studies to be assessed for relevance: 81.

2022-03-14

Weekly update (Medline via Alert). Studies to be assessed for relevance: 106.

2022-03-08

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 1 603.

2022-03-07

Weekly update (Medline via Alert). Studies to be assessed for relevance: 131.

2022-02-28

Weekly update (Medline via Alert). Studies to be assessed for relevance: 106.

2022-02-21

Weekly update (Medline via Alert). Studies to be assessed for relevance: 105.

2022-02-14

Weekly update (Medline via Alert). Studies to be assessed for relevance: 133.

2022-02-08

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 1 640.

2022-02-07

Weekly update (Medline via Alert). Studies to be assessed for relevance: 95.

2022-02-01

One relevant studie identified (Scherlinger 2022) but excluded due to high risk of bias.

2022-01-31

Weekly update (Medline via Alert). Studies to be assessed for relevance: 99.

2022-01-28

Study Tran 2021 was removed due to preprint.

2022-01-24

Weekly update (Medline via Alert). Studies to be assessed for relevance: 100.

2022-01-17

New study identified and assessed for risk of bias: Tran 2021 (moderate risk). 

2022-01-17

Weekly update (Medline via Alert). Studies to be assessed for relevance: 97.

2022-01-11

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 2 275.

2022-01-10

Weekly update (Medline via Alert). Studies to be assessed for relevance: 69.

2022-01-03

Weekly update (Medline via Alert). Studies to be assessed for relevance: 89.

2021-12-27

Weekly update (Medline via Alert). Studies to be assessed for relevance: 69.

2021-12-20

Weekly update (Medline via Alert). Studies to be assessed for relevance: 127.

2021-12-13

Weekly update (Medline via Alert). Studies to be assessed for relevance: 97.

2021-12-08

New study identified and assessed for risk of bias: Chen 2021 (moderate risk). 

2021-12-08

One relevant studie identified (Dun 2021) but excluded due to high risk of bias.

2021-12-07

Monthly update all databases (Medline via Alert). Studies to be assessed for relevance: 1 344.

2021-12-06

Weekly update (Medline via Alert). Studies to be assessed for relevance: 144.

2021-11-29

Weekly update (Medline via Alert). Studies to be assessed for relevance: 61.

2021-11-25

New study identified and assessed for risk of bias: Le Bon 2021 (moderate risk).

2021-11-23

Weekly update (Medline via Alert). Studies to be assessed for relevance: 93.

2021-11-15

Weekly update (Medline via Alert). Studies to be assessed for relevance: 98.

2021-11-09

Monthly update in all databases (Medline separately via Alert). Studies to be assessed for relevance: 1 019.

2021-11-08

Weekly update (Medline via Alert). Studies to be assessed for relevance: 57.

2021-11-01

Weekly update (Medline via Alert). Studies to be assessed for relevance: 148.

2021-10-26

Weekly update (Medline via Alert). Studies to be assessed for relevance: 48.

2021-10-18

Weekly update (Medline via Alert). Studies to be assessed for relevance: 80.

2021-10-11

Weekly update (Medline via Alert). Studies to be assessed for relevance: 53.

2021-10-05

Monthly update in all databases. Medline also included due to updated search strategy, version 2, and all search hits retrospectively included from year 2021. Studies to be assessed for relevance: 3 301.

2021-10-04

Weekly update (Medline via Alert). Studies to be assessed for relevance: 120.

2021-09-27

Weekly update (Medline via Alert). Studies to be assessed for relevance: 116.

2021-09-20

Three relevant studies identified (Belcaro 2021; Catalan 2021; Mayer 2021) but excluded due to high risk of bias.

2021-09-20

Weekly update (Medline via Alert). Studies to be assessed for relevance: 165.

2021-09-13

Updated search strategy (version 2) launched. Replaces search strategy 1 from this date onwards.

2021-09-13

Weekly update (Medline via Alert). Studies to be assessed for relevance: 56.

2021-09-06

Monthly update in all databases (Medline separately via Alert). Studies to be assessed for relevance: 445.

2021-09-06

Weekly update (Medline via Alert). Studies to be assessed for relevance: 46.

2021-08-30

Weekly update (Medline via Alert). Studies to be assessed for relevance: 45.

2021-08-25

The web site for the living review Post COVID-19 – effective treatment and rehabilitation is launched on SBU.se.

2021-08-24

New study identified and assessed for risk of bias: Li 2021 (low risk).

2021-08-23

Weekly update (Medline via Alert). Studies to be assessed for relevance: 48.

2021-08-23

Decision to exclude previous included studies (Liu 2020; Abdelalim 2021; Hameed 2021) after modified PICO/inclusion criteria for population:

  • Previous – Individuals diagnosed with postcovid.
  • Current – Individuals diagnosed with postcovid (symptoms 3 months or longer).

2021-08-20

Citation search (Abdelalim 2021) in Scopus. Studies to be assessed for relevance: 10.

2021-08-20

New relevant studies identified and assessed for risk of bias: D'Ascanio 2021 (moderate risk) and Fan 2021 (moderate risk).

2021-08-16

Weekly update (Medline via Alert). Studies to be assessed for relevance: 33.

2021-08-10

Monthly update in all databases (Medline separately via Alert). Studies to be assessed for relevance: 507.

2021-08-09

Weekly update (Medline via Alert). Studies to be assessed for relevance: 47.

2021-08-02

Weekly update (Medline via Alert). Studies to be assessed for relevance: 55.

2021-07-26

Weekly update (Medline via Alert). Studies to be assessed for relevance: 50.

2021-07-19

Weekly update (Medline via Alert). Studies to be assessed for relevance: 41.

2021-07-12

Weekly update (Medline via Alert). Studies to be assessed for relevance: 40.

2021-07-05

Weekly update (Medline via Alert). Studies to be assessed for relevance: 50.

2021-07-02

Monthly update in all databases (Medline separately via Alert). Studies to be assessed for relevance: 569.

2021-06-28

Referens and citation search of two relevant reviews: Demeco 2020 and Yong 2021. Studies to be assessed for relevance: 211.

2021-06-28

Weekly update (Medline via Alert). Studies to be assessed for relevance: 37.

2021-06-21

Weekly update (Medline via Alert). Studies to be assessed for relevance: 50.

2021-06-18

New relevant study identified (Martins 2021) but excluded due to high risk of bias.

2021-06-14

Weekly update (Medline via Alert). Studies to be assessed for relevance: 51.

2021-06-11

New relevant study identified: Abodonya 2021 (low risk for bias).

2021-06-07

Weekly update (Medline via Alert). Studies to be assessed for relevance: 53.

2021-06-01

Monthly update in all databases (Medline separately via Alert). Studies to be assessed for relevance: 343.

2021-05-31

Weekly update (Medline via Alert). Studies to be assessed for relevance: 60.

2021-05-31

Complementary search in the database WHO COVID-19: Global literature on coronavirus disease. Studies to be assessed for relevance: 507.

2021-05-27

Citation search (Liu 2020) in Scopus. Studies to be assessed for relevance: 71.

2021-05-24

Weekly update (Medline via Alert). Studies to be assessed for relevance: 59.

2021-05-17

Weekly update (Medline via Alert). Studies to be assessed for relevance: 80.

2021-05-10

Weekly update (Medline via Alert). Studies to be assessed for relevance: 80.

2021-05-03

Weekly update (Medline via Alert). Studies to be assessed for relevance: 151.

2021-05

Three relevant studies identified and assessed for risk of bias: Liu 2020 (moderate risk); Abdelalim 2021 (moderate risk); Hameed 2021 (high risk).

2021-04-26

Initial literature search from 2019 onwards. Studies to be assessed for relevance: 3 009.

More on the subject

SBU and COVID-19

3D-bild av virus

SBU closely monitors what actions other countries are taking to meet the needs of decision- and policymakers to respond to the COVID-19 pandemic. Via the International organisation of HTA, INAHTA, SBU shares and exchanges information to support staff and decision-makers in health care and social services.

SBU is also in contact with the other Swedish agencies within the national health care sector who currently are working intensively to support both the health care services as well as care homes.

Ongoing work on COVID-19 at SBU

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