Ambulante Rehabilitative Versorgung von Patienten mit Long-COVID – eine leitlinienorientierte klinisch-praktische Handlungsempfehlung

Zusammenfassung

Hintergrund Auch über Wochen und Monate anhaltende und neu auftretende Symptome nach einer SARS-CoV-2 Infektion sind verbreitet und führen teilweise zu einem bunten Bild an Einschränkungen und Defiziten. Wissenschaftliche Evidenz zu einzelnen therapeutischen Möglichkeiten ist nur begrenzt verfügbar. Das Ziel dieser Arbeit ist es daher pragmatische Be-handlungsempfehlungen analog der aktuellen Heilmittelrichtlinie aufzustellen.

MethodeNeben einer Suche in sechs elektronischen Datenbanken wurden auch die Erfahrungen aus der Behandlung von hunderten Betroffenen aus der Post-COVID-Sprechstunde sowie Patienten mit ähnlichen Symptomen bei anderen Erkrankungen herangezogen. Unter Einbeziehung aller Autoren erfolgte dann die Entwicklung der pragmatischen Handlungsempfehlungen für die Hauptsymptome im Rahmen ambulanter Therapiemaßnahmen. Eine Aufstellung von möglicher Diagnostik und funktionellen Assessments vor der Therapie wurde abschließend entwickelt.

Ergebnisse Für die Hauptsymptome Fatigue, Dyspnoe und kognitive Einschränkungen bietet der Heilmittelkatalog unter der Diagnose U09.9 weitreichende therapeutische Möglichkeiten. Die Zusammenstellung der Therapiepakete sollte individuell erfolgen und durch Reassesments an das Leistungsniveau angepasst werden. Eine Aufklärung des Patienten über mögliche Rückfälle und Verschlechterungen sowie Umgang mit diesen sollte Teil der Therapie sein. Diskussion Ambulante Heilmittel sollten im Rahmen des besonderen Verordnungsbedarfes zur Behandlung von Long-COVID eingesetzt werden. Hierbei ist es wichtig auch schwerwiegende Komplikationen nach der Erkrankung, wie beispielsweise das Post-intensive-Care-Syndrom zu erfassen und speziell zu behandeln. Eine regelmäßige Überprüfung wissenschaftlicher Arbeiten und Empfehlungen sollte auf Grund der schnellen Weiterentwicklung der Erkenntnisse erfolgen. Qualitativ hochwertige Interventionsstudien sind notwendig, um eine größere Evidenz auf diesem Gebiet zu erreichen.

Abstract

Background Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline.

Method In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed.

Results For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen.

Discussion Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

Schlüsselwörter

Rehabilitation - Therapieempfehlung - Physiotherapie - Funktionsstörungen - COVID-19, Physikalische und Rehabilitative Medizin, Rehabilitationsbedarf

Key words

Functional disorders - rehabilitation - therapy recommendation - physical therapy - COVID-19

Publication History

Received: 05 January 2022

Accepted after revision: 01 April 2022

Article published online:
31 May 2022

• Literatur

• 1 Lemhöfer C, Sturm C, Loudovici-Krug D. et al. The impact of Post-COVID-Syndrome on functioning – results from a community survey in patients after mild and moderate SARS-CoV-2-infections in Germany. J Occup Med Toxicol 2021; 16: 45 DOI: 10.1186/s12995-021-00337-9.
• 2 Décary S, Gaboury I, Poirier S. et al. Humility and Acceptance: Working Within Our Limits With Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Orthop Sports Phys Ther 2021; 51: 197-200 DOI: 10.2519/jospt.2021.0106.
• 3 Iwu CJ, Iwu CD, Wiysonge CS. The occurrence of long COVID: a rapid review. Pan Afr Med J 2021; 38: 65 DOI: 10.11604/pamj.2021.38.65.27366.
• 4 Orrù G, Bertelloni D, Diolaiuti F. et al. Long-COVID Syndrome? A Study on the Persistence of Neurological, Psychological and Physiological Symptoms. Healthcare (Basel) 2021; 9 DOI: 10.3390/healthcare9050575.
• 5 Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond) 2021; 53: 737-754 DOI: 10.1080/23744235.2021.1924397.
• 6 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232 DOI: 10.1016/S0140-6736(20)32656-8.
• 7 Barker-Davies RM, O’Sullivan O, Senaratne KPP. et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54: 949-959 DOI: 10.1136/bjsports-2020-102596.
• 8 Ceravolo MG, Arienti C, Sire Ade. et al. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Eur J Phys Rehabil Med 2020; 56: 642-651 DOI: 10.23736/S1973-9087.20.06501-6.
• 9 Duncan E, Cooper K, Cowie J. et al. A national survey of community rehabilitation service provision for people with long Covid in Scotland. F1000Res 2020; 9: 1416 DOI: 10.12688/f1000research.27894.2.
• 10 Ladds E, Rushforth A, Wieringa S. et al. Persistent symptoms after Covid-19: qualitative study of 114 “long Covid” patients and draft quality principles for services. BMC Health Serv Res 2020; 20: 1144 DOI: 10.1186/s12913-020-06001-y.
• 11 Ladds E, Rushforth A, Wieringa S. et al. Developing services for long COVID: lessons from a study of wounded healers. Clin Med (Lond) 2021; 21: 59-65 DOI: 10.7861/clinmed.2020-0962.
• 12 Jimeno-Almazán A, Pallarés JG, Buendía-Romero Á. et al. Post-COVID-19 Syndrome and the Potential Benefits of Exercise. Int J Environ Res Public Health 2021; 18 DOI: 10.3390/ijerph18105329.
• 13 Sisó-Almirall A, Brito-Zerón P, Conangla Ferrín L. et al. Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management. Int J Environ Res Public Health 2021; 18 DOI: 10.3390/ijerph18084350.
• 14 Bell ML, Catalfamo CJ, Farland LV. et al. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PLoS One 2021; 16: e0254347 DOI: 10.1371/journal.pone.0254347.
• 15 Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr 2021; 15: 869-875 DOI: 10.1016/j.dsx.2021.04.007.
• 16 National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Royal College of General Practitioners. COVID-19 rapid guideline: managing the long-term effects of COVID-19. Im Internet: https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742 Stand: 27.11.2021
• 17 Malik P, Patel K, Pinto C. et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis. J Med Virol 2022; 94: 253-262 DOI: 10.1002/jmv.27309.
• 18 Mandal S, Barnett J, Brill SE. et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax 2021; 76: 396-398 DOI: 10.1136/thoraxjnl-2020-215818.
• 19 D’Ascanio L, Vitelli F, Cingolani C. et al. Randomized clinical trial “olfactory dysfunction after COVID-19: olfactory rehabilitation therapy vs. intervention treatment with Palmitoylethanolamide and Luteolin”: preliminary results. Eur Rev Med Pharmacol Sci 2021; 25: 4156-4162 DOI: 10.26355/eurrev_202106_26059.
• 20 Lopez-Leon S, Wegman-Ostrosky T, Perelman C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11: 16144 DOI: 10.1038/s41598-021-95565-8.
• 21 World Health Organisation. A clinical case definition of post COVID-19 condition by a Delphi consensus. Im Internet: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 Stand: 27.11.2021
• 22 Davis HE, Assaf GS, McCorkell L. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 2021; 38: 101019 DOI: 10.1016/j.eclinm.2021.101019.
• 23 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)- Ständige Kommission Leitlinien. S1-Leitlinie Pst-COVID/Long-COVID. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/020-027l_S1_Post_COVID_Long_COVID_2021-07.pdf Stand: 15.08.2021
• 24 Fan Y, Shi Y, Zhang J. et al. The effects of narrative exposure therapy on COVID-19 patients with post-traumatic stress symptoms: A randomized controlled trial. J Affect Disord 2021; 293: 141-147 DOI: 10.1016/j.jad.2021.06.019.
• 25 Murray H, Grey N, Wild J. et al. Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. Cogn Behav Therap 2020; 13: e13 DOI: 10.1017/S1754470X2000015X.
• 26 Ramnarain D, Aupers E, Oudsten Bden. et al. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21: 1159-1177 DOI: 10.1080/14737175.2021.1981289.
• 27 Gardashkhani S, Ajri-Khameslou M, Heidarzadeh M. et al. Post-Intensive Care Syndrome in Covid-19 Patients Discharged From the Intensive Care Unit. J Hosp Palliat Nurs 2021; 23: 530-538 DOI: 10.1097/NJH.0000000000000789.
• 28 Nalbandian A, Sehgal K, Gupta A. et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27: 601-615 DOI: 10.1038/s41591-021-01283-z.
• 29 Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Res 2021; 52: 575-581 DOI: 10.1016/j.arcmed.2021.03.010.
• 30 Weinstock LB, Brook JB, Walters AS. et al. Mast cell activation symptoms are prevalent in Long-COVID. Int J Infect Dis 2021; 112: 217-226 DOI: 10.1016/j.ijid.2021.09.043.
• 31 Korompoki E, Gavriatopoulou M, Hicklen RS. et al. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. J Infect 2021; 83: 1-16 DOI: 10.1016/j.jinf.2021.05.004.
• 32 Ortelli P, Ferrazzoli D, Sebastianelli L. et al. Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom. J Neurol Sci 2021; 420: 117271 DOI: 10.1016/j.jns.2020.117271.
• 33 Oronsky B, Larson C, Hammond TC. et al. A Review of Persistent Post-COVID Syndrome (PPCS). Clin Rev Allergy Immunol 2021; DOI: 10.1007/s12016-021-08848-3.
• 34 Scherlinger M, Felten R, Gallais F. et al. Refining “Long-COVID” by a Prospective Multimodal Evaluation of Patients with Long-Term Symptoms Attributed to SARS-CoV-2 Infection. Infect Dis Ther 2021; 10: 1747-1763 DOI: 10.1007/s40121-021-00484-w.
• 35 Huang L, Yao Q, Gu X. et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet 2021; 398: 747-758 DOI: 10.1016/S0140-6736(21)01755-4.
• 36 Poudel AN, Zhu S, Cooper N. et al. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS One 2021; 16: e0259164 DOI: 10.1371/journal.pone.0259164.
• 37 August D, Stete K, Hilger H. et al. Persistierende Beschwerden 6 Monate nach COVID-19 – Erfahrungen aus der COVID-19-Nachsorgeambulanz des Universitätsklinikums Freiburg. Dtsch Med Wochenschr 2021; 146: e65-e73 DOI: 10.1055/a-1546-4291.
• 38 Miskowiak KW, Johnsen S, Sattler SM. et al. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. Eur Neuropsychopharmacol 2021; 46: 39-48 DOI: 10.1016/j.euroneuro.2021.03.019.
• 39 Lemhöfer C, Best N, Gutenbrunner C. et al. Gefühlte und reale Arbeitsfähigkeit von Patient*innen mit Post-COVID Symptomatik nach mildem Akutverlauf: eine Analyse des Rehabilitation Needs Questionnaire (RehabNeQ). Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021; DOI: 10.1055/a-1674-8044.
• 40 Gutenbrunner C, Nugraha B, Martin LT. Phase-Adapted Rehabilitation for Acute Coronavirus Disease-19 Patients and Patient With Long-term Sequelae of Coronavirus Disease-19. Am J Phys Med Rehabil 2021; 100: 533-538 DOI: 10.1097/PHM.0000000000001762.
• 41 Iqbal A, Iqbal K, Arshad Ali S. et al. The COVID-19 Sequelae: A Cross-Sectional Evaluation of Post-recovery Symptoms and the Need for Rehabilitation of COVID-19 Survivors. Cureus 2021; 13: e13080 DOI: 10.7759/cureus.13080.
• 42 Rooney S, Webster A, Paul L. Systematic Review of Changes and Recovery in Physical Function and Fitness After Severe Acute Respiratory Syndrome-Related Coronavirus Infection: Implications for COVID-19 Rehabilitation. Phys Ther 2020; 100: 1717-1729 DOI: 10.1093/ptj/pzaa129.
• 43 Lemhöfer C, Best N, Bökel A. et al. Zufriedenheit COVID-19-Erkrankter mit den Akteuren des Gesundheitssystems und der rehabilitativen Therapieversorgung unter Verwendung des COVID-19-Rehabilitation Needs Questionnaire (C19-RehabNeQ) in Bayern. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021; DOI: 10.1055/a-1528-1667.
• 44 Aiyegbusi OL, Hughes SE, Turner G. et al. Symptoms, complications and management of long COVID: a review. J R Soc Med 2021; 114: 428-442 DOI: 10.1177/01410768211032850.
• 45 Becker PM. Overview of sleep management during COVID-19. Sleep Med 2021; DOI: 10.1016/j.sleep.2021.04.024.
• 46 Burges Watson DL, Campbell M, Hopkins C. et al. Altered smell and taste: Anosmia, parosmia and the impact of long Covid-19. PLoS One 2021; 16: e0256998 DOI: 10.1371/journal.pone.0256998.
• 47 Chow N, Hogg-Johnson S, Mior S. et al. Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes: A Systematic Review. JAMA Netw Open 2021; 4: e215493 DOI: 10.1001/jamanetworkopen.2021.5493.
• 48 Dani M, Dirksen A, Taraborrelli P. et al. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clin Med (Lond) 2021; 21: e63-e67 DOI: 10.7861/clinmed.2020-0896.
• 49 Delbressine JM, Machado FVC, Goërtz YMJ. et al. The Impact of Post-COVID-19 Syndrome on Self-Reported Physical Activity. Int J Environ Res Public Health 2021; 18 DOI: 10.3390/ijerph18116017.
• 50 Frank U, Frank K. COVID-19 – neue Herausforderungen in der Dysphagie- und Atemtherapie. Nervenarzt 2021; DOI: 10.1007/s00115-021-01162-5.
• 51 Funke-Chambour M, Bridevaux P-O, Clarenbach CF. et al. Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID. Respiration 2021; 100: 826-841 DOI: 10.1159/000517255.
• 52 Gloeckl R, Leitl D, Jarosch I. et al. Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study. ERJ Open Res 2021; 7 DOI: 10.1183/23120541.00108-2021.
• 53 He J, Yang L, Pang J. et al. Efficacy of simplified-cognitive behavioral therapy for insomnia(S-CBTI) among female COVID-19 patients with insomnia symptom in Wuhan mobile cabin hospital. Sleep Breath 2021; 25: 2213-2219 DOI: 10.1007/s11325-021-02350-y.
• 54 Humphreys H, Kilby L, Kudiersky N. et al. Long COVID and the role of physical activity: a qualitative study. BMJ Open 2021; 11: e047632 DOI: 10.1136/bmjopen-2020-047632.
• 55 Johnsen S, Sattler SM, Miskowiak KW. et al. Descriptive analysis of long COVID sequelae identified in a multidisciplinary clinic serving hospitalised and non-hospitalised patients. ERJ Open Res 2021; 7 DOI: 10.1183/23120541.00205-2021.
• 56 Lagadinou M, Kostopoulou E, Karatza A. et al. The prolonged effects of COVID-19. A new “threat”?. Eur Rev Med Pharmacol Sci 2021; 25: 4611-4615 DOI: 10.26355/eurrev_202107_26253.
• 57 Li J, Li X, Jiang J. et al. The Effect of Cognitive Behavioral Therapy on Depression, Anxiety, and Stress in Patients With COVID-19: A Randomized Controlled Trial. Front Psychiatry 2020; 11: 580827 DOI: 10.3389/fpsyt.2020.580827.
• 58 Liu Z, Qiao D, Xu Y. et al. The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial. J Med Internet Res 2021; 23: e26883 DOI: 10.2196/26883.
• 59 Mahase E. Covid-19: What do we know about “long covid”?. BMJ 2020; 370: m2815 DOI: 10.1136/bmj.m2815.
• 60 Martelletti P, Bentivegna E, Spuntarelli V. et al. Long-COVID Headache. SN Compr Clin Med 2021; 1-3 DOI: 10.1007/s42399-021-00964-7.
• 61 Mayer KP, Steele AK, Soper MK. et al. Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report. Phys Ther 2021; 101 DOI: 10.1093/ptj/pzab098.
• 62 Mohamed AA, Alawna M. Role of increasing the aerobic capacity on improving the function of immune and respiratory systems in patients with coronavirus (COVID-19): A review. Diabetes Metab Syndr 2020; 14: 489-496 DOI: 10.1016/j.dsx.2020.04.038.
• 63 National COVID-19 Clinical Evidence Taskforc. Australian guidelines for the clinical care of people with COVID-19 -. Im Internet: https://files.magicapp.org/guideline/8fba21d0-d32a-4b93-9e69-d05a5f5ea9bc/published_guideline_5790-47_0.pdf Stand: 27.11.2021
• 64 Raman B, Cassar MP, Tunnicliffe EM. et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine 2021; 31: 100683 DOI: 10.1016/j.eclinm.2020.100683.
• 65 Sigfrid L, Drake TM, Pauley E. et al. Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. Lancet Reg Health Eur 2021; 8: 100186 DOI: 10.1016/j.lanepe.2021.100186.
• 66 Royal Dutch Society for Physical Therapy. Recommendations for physiotherapy in patients with COVID-19 https://www.kngf2.nl/binaries/content/assets/kennisplatform/onbeveiligd/guidelines/recommendations-for-physiotherapy-in-patients-with-covid-19---kngf.pdf Stand: 21.12.2021
• 67 Simon N, Robertson L, Lewis C. et al. Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2021; 5: CD011710 DOI: 10.1002/14651858.CD011710.pub3.
• 68 Tran V-T, Riveros C, Clepier B. et al. Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients’ lived experience. Clin Infect Dis 2021; DOI: 10.1093/cid/ciab352.
• 69 Vaes AW, Goërtz YMJ, van Herck M. et al. Recovery from COVID-19: a sprint or marathon? 6-month follow-up data from online long COVID-19 support group members. ERJ Open Res 2021; 7 DOI: 10.1183/23120541.00141-2021.
• 70 Vink M, Vink-Niese A. Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome. Healthcare (Basel) 2020; 8 DOI: 10.3390/healthcare8040552.
• 71 Vollbracht C, Kraft K. Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Nutrients 2021; 13 DOI: 10.3390/nu13041154.
• 72 Webster KE, O’Byrne L, MacKeith S. et al. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7: CD013877 DOI: 10.1002/14651858.CD013877.pub2.
• 73 Zheng Y, Wang L, Zhu Y. et al. Efficacy of cognitive behavioral therapy on mood and quality of life for patients with COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100: e25512 DOI: 10.1097/MD.0000000000025512.
• 74 Zeile T. Versorgung älterer Patienten nach dem Krankenhausaufenthalt. MMW Fortschr Med 2021; 163: 48-50 DOI: 10.1007/s15006-021-0017-2.
• 75 Mendelson M, Nel J, Blumberg L. et al. Long-COVID: An evolving problem with an extensive impact. S Afr Med J 2020; 111: 10-12 DOI: 10.7196/SAMJ.2020.v111i11.15433.
• 76 Elkan M, Dvir A, Zaidenstein R. et al. Patient-Reported Outcome Measures After Hospitalization During the COVID-19 Pandemic: A Survey Among COVID-19 and Non-COVID-19 Patients. Int J Gen Med 2021; 14: 4829-4836 DOI: 10.2147/IJGM.S323316.
• 77 Cochrane Rehabilitation . Rehabilitation – COVID-19 Evidence-based Response action. Im Internet: https://rehabilitation.cochrane.org/resources/cochrane-rehabilitation-versus-covid-19Stand: 27.11.2021
• 78 Gemeinsamer Bundesausschuss. Heilmittelrichtlinie (in Kraft getreten 01.Juli 2021). Im Internet: https://www.g-ba.de/downloads/62-492-2506/HeilM-RL_2021-03-18_iK-2021-07-01.pdfStand: 27.11.2021
• 79 Lemhöfer C, Gutenbrunner C, Schiller J. et al. Assessment of rehabilitation needs in patients after COVID-19: Development of the COVID-19-rehabilitation needs survey. J Rehabil Med 2021; 53 jrm00183 DOI: 10.2340/16501977-2818.
• 80 Farr E, Wolfe AR, Deshmukh S. et al. Diaphragm dysfunction in severe COVID-19 as determined by neuromuscular ultrasound. Ann Clin Transl Neurol 2021; 8: 1745-1749 DOI: 10.1002/acn3.51416.
• 81 Elmer N, Reißhauer A, Liebl ME. Stille Hypoxie nach COVID-19 – gefährliche Unbekannte für die Rehabilitation. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021; DOI: 10.1055/a-1494-3374.
• 82 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)- Ständige Kommission Leitlinien. Komplementärmedizin in der Behandlung von onkologischen PatientInnen. Im Internet: https://www.awmf.org/leitlinien/detail/ll/032-055OL.htmlStand: 03.12.2021
• 83 Kröz M, Reif M, Quittel F. et al. Langzeitwirkung einer multimodalen und kombiniert multimodal-aeroben Intervention bei rezidivfreien Frauen mit Brustkrebs und Cancer-related Fatigue. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2018; 28: 245 DOI: 10.1055/s-0038-1668277.
• 84 Weise A, Hersche R. atigue aktiv entgegenwirken Energiemanagement-Schulung (EMS) bei Multipler Sklerose. Energiemanagement-Schulung (EMS) bei Multipler Skleros. Ergotherapie und. Rehabilitation 2019; 58: 16-20
• 85 Isenmann S, Haehner A, Hummel T. Störungen der Chemosensorik bei Covid-19: Pathomechanismen und klinische Relevanz. Fortschr Neurol Psychiatr 2021; 89: 281-288 DOI: 10.1055/a-1375-0761.
• 86 Cochrane Library. Coronavirus (COVID-19): evidence relevant to clinical rehabilitation. Im Internet: https://www.cochranelibrary.com/collections/doi/SC000047/full Stand: 29.12.2021
• 87 Belsher BE, Beech E, Evatt D. et al. Present-centered therapy (PCT) for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2019; 2019 DOI: 10.1002/14651858.CD012898.pub2.
• 88 Olthuis JV, Watt MC, Bailey K. et al. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2016; 3: CD011565 DOI: 10.1002/14651858.CD011565.pub2.