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

<h2>ABSTRACT</h2><h3>Background</h3> 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. <h3>Methods</h3> 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). <h3>Results</h3> 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]). <h3>Conclusions</h3> 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.