Return to Work with Long COVID: A Rapid Review of Support and Challenges
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Objective
To explore existing evidence for the provision of support for return to work (RTW) in long COVID (LC) patients, and the barriers and facilitators to taking up this support.
Methods
A rapid review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Searches were completed in June 2024 and included MEDLINE, Embase, American Psychological Association (APA) PsycINFO, evidence based medicine (EBM) Reviews (including the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews), Health Management Information Consortium, Web of Science and Google Scholar. This review included studies on LC symptoms lasting over 12 weeks, focusing on 1) non-workplace- and workplace-based support for RTW in LC patients, and/or 2) barriers and facilitators to RTW in LC patients. A quality assessment was conducted using the JBI Systematic Reviews critical appraisal tool. The data were summarised in tabular format and a narrative summary. This study was pre-registered (PROSPERO-ID: CRD42023478126).
Results
Twenty-five studies were included. While many studies demonstrated rigorous methodologies and low risk of bias levels, some had high and medium risk levels. Non-workplace-based support was mostly measured quantitatively and included interdisciplinary healthcare programmes, clinical interventions, and rehabilitation programmes focusing on pacing and breathing strategies. Compensation and insurance schemes were important funders of these interventions.
Workplace-based support was mostly measured qualitatively. Barriers to the provision of support at organisational level included lack of understanding of LC symptoms, insufficient workplace guidance, and educational gaps among managers. Individual barriers included threat of income loss, remote working and disconnection from the workplace. Facilitators for support included recognition and validation of LC and its symptoms, and eligibility for disability benefits associated with work.
Conclusions
RTW is an important outcome of health related absence and should be systematically recorded in studies of people with long COVID (PwLC). The heterogeneity and unpredictability of LC symptoms create challenges for supporting working age populations. Further research is crucial to better understand the specific RTW needs for PwLC and address potential barriers and facilitators to effective support. Consistent guidelines on LC’s definition, and disability status may facilitate the provision of support and the development of interventions.
Prospero registration number
CRD42023478126
Article Summary
Strengths and limitations of this study
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Offers an in-depth examination of workplace and non-workplace-based support for return to work (RTW) for patients with long COVID (LC), including clinical interventions, multidisciplinary rehabilitation programmes, workplace support, and self-developed strategies.
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Comprehensive literature search of major electronic databases across disciplines and reporting as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
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The search was limited to English language, likely excluding relevant studies.
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While many studies had a low risk of bias, some studies had selection bias, unvalidated outcome measures or lacked control of confounders, limiting result accuracy.
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The focus on work-related outcomes excluded alternative support measures that might impact RTW, and the strict definition of LC omitted studies on overlapping conditions like chronic fatigue syndrome.
