Fatigue in long COVID: An exploratory pragmatic randomized trial of osteopathic care plus physical therapy versus physical therapy alone

Background This study assessed whether osteopathic care (OC) combined with physical therapy (PT) is more effective than PT alone in reducing fatigue and functional limitations in adults with long COVID. Methods Two-arm, assessor-blinded, pragmatic randomized controlled trial. The PT group received standard care including motor and respiratory exercises for cardiorespiratory and skeletal muscle functions. The OC+PT group received PT plus OC. The PT group attending up to 2 sessions per week and the OC+PT group receiving up to 7 OC sessions. Primary outcomes were fatigue and functional limitations, measured at 2 months using the Fatigue Severity Scale (FSS) and the Post-COVID Functional State (PCFS) scale. Secondary outcomes included fatigue and functional limitations at 3 months and perceived change post-treatment using the Perceived Change Scale (PCS-patient). Results Of the 104 participants planned, 73 were recruited and 28 (26.9%) were randomized into OC+PT (n=14) or PT alone (n=14). The OC+PT group showed lower FSS scores at 2 months (MD [95%CI]) (−10.41 [−14.47; −6.35]) and 3 months (−12.25 [−16.52; −7.98]). The PCFS score was lower for the OC+PT group at 2 months (−0.70 [−1.11; −0.29]) but not at 3 months (−0.26 [−0.69; 0.16]). Perceived improvement was similar between groups at both 2 months (5.28 [−0.84; 11.40]) and 3 months (3.10 [−3.10; 9.30]). Conclusions This exploratory trial suggests potential benefits of combining OC with PT over PT alone in reducing fatigue and improving functional status in long COVID patients over 2 months. Larger, fully-powered studies are needed to confirm these preliminary results.