# Effectiveness of two interventions to optimize expectations in psychosomatic rehabilitation of post-COVID patients: study protocol for an integrative approach

## TL;DR

This study tests two interventions to improve expectations in post-COVID rehabilitation, aiming to enhance recovery and work ability.

## Contribution

The study introduces two expectation-focused interventions for post-COVID rehabilitation, emphasizing their potential for broader therapeutic application.

## Key findings

- The interventions aim to improve rehabilitation outcomes by focusing on positive expectations.
- The study uses the Work Ability Index as a primary outcome to assess earning capacity improvements.
- The approach supports the development of more effective, integrative therapies for post-COVID syndrome.

## Abstract

Most prevalent symptoms of post-COVID syndrome (PCS) are fatigue, shortness of breath, cognitive impairment, and pain. Comorbidities such as depression and anxiety are common. The diagnosis PCS is confirmed if symptoms persist for longer than 3 months and are not better explained by another medical condition. About half of the patients are still not fit for work after psychosomatic rehabilitation. From psychotherapeutic research, it is known that a relationship-based approach is decisive for treatment efficacy. Here, the patient’s expectation that the treatment will help is one central pathway that contributes to symptom reduction and an increase in quality of life. Using positive expectations, respectively, the placebo effect in medical settings has already been proven to be beneficial.

Evaluation of two expectation-focused interventions for patients with PCS to optimize the rehabilitation process. The interventions aim to focus on positive expectations and imaginations. Thus, the project should lead to further improvement in the rehabilitation of patients with PCS.

The study implements a 3-arm, parallel group, longitudinal non-randomized controlled, sequential cohort design. The trial is designed to estimate the effect of 1) a 3-session psychotherapeutic expectation-focused integrative, manualized intervention, and 2) a brief intervention where patients are asked to write down their expectations on their own in a journal, compared to 3) a treatment-as-usual-only control condition (usual treatment in rehabilitation, no study intervention). Since the predominant symptoms in PCS patients vary a lot, the Work Ability Index (WAI) is considered as a proxy for earning capacity as primary outcomes.

The analysis will provide insights into the extent to which the interventions improve PCS. This approach was chosen to enable a larger number of practitioners to provide more specific therapeutic support for patients with PCS. The study serves as proof of principle for further research and development of more effective therapies. It emphasizes the urgent need for interdisciplinary, integrative treatment and research to better understand and manage PCS.

German Clinical Trials Register https://drks.de/search/en, DRKS00034671.