If paramedical care helps, then that offers patients a perspective

People with Long COVID currently receive paramedical recovery care, such as physiotherapy, occupational therapy, exercise therapy, speech therapy or dietetics, which is covered by the basic health insurance package of the health insurer. However, does this paramedical recovery care in the case of Long COVID work and is it cost-effective? There is no evidence for this. We therefore set up a study to investigate this from July 2022 onwards and hope to complete the study in the summer of 2023. We can do that relatively quickly because we are conducting the research on the basis of two extant datasets

Progress, but limitations remain as well

The first dataset originates from the PARACOV study of Radboudumc. This cohort contains the anonymised data of about 1400 patients with Long COVID who have received paramedical recovery care. Did their health improve or not? The initial results – after six months – must still be assessed for publication, but the preprint is already online. Although patients continue to experience limitations in their daily functioning after six months, they have also made progress. The question is whether the differences in the scores are completely due to the paramedical rehabilitation care. Would the patients have started to feel better without the therapy as well.

We have created our own control group

To measure whether the health gain is genuinely the effect of paramedical recovery care, we are comparing the anonymised data from the PARACOV study with that of other anonymised data from a large Long COVID cohort from the National Institute for Public Health and the Environment (RIVM). The course of the symptoms has also been followed for those patients. This cohort includes patients that have made use of paramedical recovery care as well, but equally encompasses patients who have not done that, for whatever reason. We will be searching that last group of patients, selecting people who are as similar as possible to the patients from the PARACOV study. The most important difference is that they have not had any paramedical recovery care. This is how we will be creating our own control group.

Second choice

Ideally, you would conduct a randomised study for a comparative study, where the patient is randomly assigned to one of two groups. However, in this case, that is not considered to be ethical. People with Long COVID have a lot of symptoms and the government wants to offer them something, such as paramedical recovery care. Therefore, in this study, we are trying to mirror the design of a randomised study as accurately as possible.

Advanced econometric techniques

We use advanced econometric techniques for the selection to ensure that we do not compare apples and oranges by mistake. These techniques are being developed by our colleague Judith Bosmans, Professor of Methodology of Health Technology Assessment (VU Amsterdam). She compares – together with PhD student Anita Varga – different matching methods that have names like Propensity Score Matching, Genetic Matching and Targeted Maximum Likelihood Estimation. That study has almost been completed. We asked them about the mapping method which would be most suitable for our research and we will use that for our analyses. We will therefore be making use of state-of-the-art insights.

Unique collaboration

It is unique that we can make use of newly gained knowledge for such an important social issue. That is thanks to the intensive collaboration between Radboudumc, VU Amsterdam (Health Sciences Department) and the RIVM. Everybody recognised the need to collaborate and the three of us worked hard to realise that. Our approach was a dynamic one, and that continues to characterise our ongoing approach to research.

It is unique that we can make use of newly gained knowledge for such an important social issue. That is thanks to the intensive collaboration between Radboudumc, VU Amsterdam (Health Sciences Department) and the RIVM
Hanneke van Dongen
Assistant Professor, Amsterdam Public Health, APH - Methodology

Results will be published in June

This month we will be able to make statements about the results from the study. Then it will become clear to what extent people get better thanks to paramedical recovery care, or to what extent the health gain from the PARACOV study can be ascribed to the natural course of events. If it transpires that paramedical recovery care in the case of Long COVID is not cost-effective, then that will influence the care provided. It would make it easier for patients who don't experience any effects to decide to stop with exercise therapy. But if it proves to be cost-effective, then health insurers can decide to continue reimbursing this care.

Perspective for patients

I was pretty ill with COVID-19 and spent two weeks in bed. I had difficulty breathing. That was already back in the time of the Omicron variant, so not even during the first wave. It must be really annoying if you continue to suffer symptoms for a longer period of time. If paramedical recovery care proves to help, then that offers patients with long-term symptoms a perspective. And that is why this study is so important.

Author: Riëtte Duynstee
Photo: private collection Hanneke van Dongen