Principal Findings
neurocognitive symptoms, ’ symptom reduction, fatigue
The aim of this study was to develop and evaluate an interdisciplinary health care facilitation program based on professional support and digital interventions by increasing the self-management of patients with PACS. Within the ASAP project, the IG received a diagnostic assessment in a clinic, accordingly tailored digital interventions, and support from a human personal pilot. The ACG received the digital interventions and personal support but no assessment and no interventions tailored to the assessment results.Our first hypothesis was that both groups receiving interventions would benefit when compared to the passive CompG. Regarding symptom severity, there was a larger reduction in both the IG and the ACG compared to the CompG. Furthermore, work ability and social participation were higher in both treatment groups (IG and ACG). Our second hypothesis was that patients in the IG would benefit more than patients in the ACG as they received a diagnostic assessment that could potentially lead to more tailored treatment in the long run and also received a more tailored digital intervention program than patients in the ACG. However, based on the inferential statistics, this hypothesis failed to hold true. Both groups showed a similar level of symptom reduction and an increase in their work ability over time. Third, we hypothesized that patients’ symptom reduction over the course of the intervention program would predict their work ability and social participation at follow-up. This was only the case for social participation but not work ability as the It is common in PACS that symptoms change and decrease over time without any intervention [The specific intervention approaches included support from personal pilots, who helped manage the health care system via regular, scheduled phone calls and on-demand meetings. The personal pilots helped the patients manage 3 different challenges: their daily life with their symptoms, the difficult process of finding individual diagnostic and treatment options, and taking part in a study. Although the personal pilots were not all trained as therapists, they provided vital support that was recognized by the patients, who perceived them as important partners in their recovery process. Earlier studies have also found that a supportive relationship and therapeutic companionship can be established through online platforms [Another intervention in this study was the use of digital interventions through a digital rehabilitation platform, including physical exercises, mindfulness training, and sensory as well as functional training. This intervention was delivered without a physical therapist. In general, patients describe web-based interventions as useful and satisfactory when they are delivered by a therapist [Based on the feedback of patients as well as earlier research [Despite the likelihood that the interventions introduced in this study had positive effects on the patients’ symptoms, these effects in self-reported symptom severity could also be attributed (partly) to the placebo effect [The results regarding social participation and work ability showed a different pattern. Although the interaction term indicating group differences between the treatment groups and the CompG was significant for symptom reduction, there was no such advantage of the treatment regarding these constructs that are crucial for the quality of life of patients with PACS [Concerning work ability, Zwerenz et al [Finally, the 2 treatment groups did not differ from each other over time concerning any outcome measure. This would suggest that the 3-day diagnostic assessment seems to have failed to create long-term advantages in the IG despite a comprehensive diagnostic program assessing physical, respiratory, neurological, and neuropsychological functions. The ACG consisted of shared decision-making of the personal pilots, together with patients, regarding digital interventions focusing on fatigue, neurocognitive symptoms, or cardiorespiratory symptoms. This approach managed to guide individualized digital treatment decisions in an easy and cost-effective way, so no advantages of the IG with digital interventions tailored to the diagnostic assessment could be detected. Nevertheless, there are several reasons to assume that the clinical assessment could have positive effects on symptom reduction and social participation in the long run: Patients especially valued the comprehensive (neuro)psychological diagnostics and the associated contact with a therapist. A lot of patients with PACS disclosed that they had not felt understood and validated in their symptoms and concerns before [After the assessment, patients were followed up over the course of approximately 3 months. Despite clear recommendations for medical rehabilitation provided in the diagnostic assessment, there are several health care–associated challenges as well as personal barriers that were not sufficiently considered in this study. Thus, the uptake or completion of a subsequent rehabilitative intervention might not have been possible during the time frame that was covered by the study’s outcome assessments. Another study demonstrated that 80% of all rehabilitation patients return to work within 2 years postrehabilitation, indicating a positive effect of rehabilitation tailored to individual needs. Nevertheless, further studies need to clarify whether this is also the case for patients with PACS [