Does pulmonary rehabilitation improve fatigue in patients with post-COVID-19 syndrome? A metaanalysis of randomized clinical trials

Abstract

Purpose: To assess the efficacy of pulmonary rehabilitation (PR) on fatigue in patients with post-COVID-19 syndrome (PCS). Methods: A systematic review and a meta-analysis were performed until 21 October 2024 in 4 databases (CINAHL, Medline, Scopus and Web of Science). Inclusion criteria: Population: patients (≥18 years) with PCS; Intervention: PR; Comparison: control group (CG) vs. placebo; Outcome: fatigue assessed before and after the intervention; Study: randomized clinical trials. Methodological quality was assessed with Downs and Black scale and risk of bias with Cochrane risk-of-bias tool. Meta-analysis was conducted with RevMan 5.4. Results: Thirteen studies were included in the systematic review and 10 in the meta-analysis. The meta-analysis showed a moderate effect size (SMD=-0.59, 95% CI=-0.89, -0.28; p=0.0002, n=973) in favor of PR compared to CG for fatigue, with significant differences. Compared to CG, fatigue in patients with PCS was reduced to a greater extent in PR group (both center-based PR and home-based PR, and both <12 weeks of PR and ≥12 weeks of PR), with significant differences. Conclusion: This review demonstrates the efficacy of PR as a promising intervention for alleviating fatigue in patients with PCS, revealing a significantly greater reduction in fatigue in PR group compared to CG.