PROTOTYPING A LONG-COVID STUDY WITHIN A PRACTICE-BASED SETTING, TESTING PROCEDURAL STEPS, OUTCOME MEASURES, AND PATIENT RESPONSE TO CARE
Main Article Content
Keywords
Long-COVID, Post-Viral Syndrome, Post-Acute Covid-19 Syndrome
Abstract
Purpose: To prototype the procedural steps, assessment methodologies, and participant response to care in a long-COVID research study conducted within a chiropractic practice.
Methods: Following a single-arm trial design, participants experiencing protracted COVID-19 symptoms for greater than 90 days were recruited through healthcare referrals, social media, and emails to existing patients of the participating chiropractor. Participants received 8 to12 weeks of Axial Stability Method (ASM) chiropractic care and participated in 4 assessment time points. Participant response to care and baseline assessments included participant self-reports, CareTaker Medical physiologic responses, spirometry, and balance.
Results: Recruitment resulted in 30 individuals indicating interest in the study; most individuals responded to recruitment efforts following implementation of Facebook advertisements (n=21). Seven participants were enrolled in the study. Five of the 7 participants were female and the average age was 46. Study procedures were tolerated well within the clinic, excepting spirometry. All participants either agreed or strongly agreed that the study organization, processes, staff, knowledge, and overall experience were appropriate. Overwhelmingly, participants experienced improvement in fatigue, long-Covid symptoms, and quality of life. For example, participant T-scores for the Functional Assessment of Chronic Illness Therapy – Fatigue Scale (FACIT-Fatigue) initially demonstrated that study participants were on average more fatigued than 76% (76th percentile) of the United States population, while at the end of the study participants were scoring in the 25th percentile. CareTaker Medical physiologic responses were consistent with previous chiropractic research. Unique physiologic response patterns based on initial presentation were observed for systolic blood pressure and heart rate variability (HRV) analysis using distribution entropy. Time domain analysis of HRV (root mean square of successive differences) demonstrated increased HRV response baseline to immediate post with a decrease in HRV over the course of care for most participants. Balance results were mixed.
Conclusion: Implementation of the study protocol was successful. Investigators accounted for challenges with recruitment, staffing, and scheduling. Participants reported improvement and often resolution of long-COVID symptoms, and physiologic marker responses to care were consistent with previous chiropractic research. Study design and small sample size limit response to care generalizability; findings need to be confirmed with properly powered clinical trial design.
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References
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15. Pinter A, Szatmari S Jr, Horvath T, et al. Cardiac dysautonomia in depression - heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat 2019;15:1287-1310. doi: 10.2147/NDT.S200360
16. McCraty R, Shaffer F. Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Glob Adv Health Med 2015;4(1):46-61. doi: 10.7453/gahmj.2014.073
17. Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health 2017;28(5):258. doi: 10.3389/fpubh.2017.00258
18. Lu G, Yang F, Taylor JA, Stein JF. A comparison of photoplethysmography and ECG recording to analyse heart rate variability in healthy subjects. J Med Eng Technol 2009;33(8):634-641. doi: 10.3109/03091900903150998
19. Goodman BP, Khoury JA, Blair JE, Grill MF. COVID-19 dysautonomia. Front Neurol 2021;12:624968. doi:10.3389/fneur.624968
20. Aranyo J, Bazan V, Llados G, et al. Inappropriate sinus tachycardia in post-COVID-19 syndrome. Sci Rep 2022;12:298. doi:10.10.1038/s41598-021-03831-6
21. Shah B, Kunal S, Bansal A, et al. Heart rate variability as a marker of cardiovascular dysautonomia in post-COVID-19 syndrome using artificial intelligence. Indian Pacing Electrophysiol 2022;22(2):70-76. doi: 10.1016/j.ipej.2022.01.004
22. Sakur FJ, Ward K, Khatri NN, Lau AYS. Self-care behaviors and technology used during COVID-19: systematic review. JMIR Hum Factors 2022;9(2):e35173. doi: 10.2196/35173
23. Paudyal V, Sun S, Hussain R, Abutaleb MH, Hedima EW. Complementary and alternative medicines use in COVID-19: A global perspective on practice, policy and research. Res Social Adm Pharm 2022;18(3):2524-2528. doi:10.1016/j.sapharm.2021.05.004
24. Quispe-Cañari JF, Fidel-Rosales E, Manrique D, et al. Self-medication practices during the COVID-19 pandemic among the adult population in Peru: a cross-sectional survey. Saudi Pharm J 2021;29(1):1-11. doi:10.1016/j.jsps.2020.12.001
25. 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(10):e0259164. doi: 10.1371/journal.pone.0259164
26. Nahin RL, Barnes PM, Stussman BJ. Expenditures on complementary health approaches: United States, 2012. Natl Health Stat Report 2016;95:1-11.
27. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-1012. Natl Health Stat Report 2015;(79):1-16.
28. WHO global report on traditional and complementary medicine 2019. Geneva (CH): World Health Organization; 2019. 226p. Report no.: CC BY-NC_SA 3.0 IGO
29. National Center for Complementary and Integrative Health. Spinal manipulation: what you need to know [Internet]. Bethesda (MD): National Center for Complementary and Integrative Health;2022 [updated 2022;cited 2022 May 24]. Available from: https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know
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Feb 8, 2023
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Knutson, L., Sullivan, S., Langeneggar, F., Massa, J., Drake, E., Hayes, K., & Herbert, M. (2023). PROTOTYPING A LONG-COVID STUDY WITHIN A PRACTICE-BASED SETTING, TESTING PROCEDURAL STEPS, OUTCOME MEASURES, AND PATIENT RESPONSE TO CARE. Journal of Contemporary Chiropractic, 6(1), 8–28. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/257 (Original work published February 7, 2023)
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