Acupressure and Qigong in post-infectious fatigue with impaired physical function: a randomized clinical trial

BACKGROUND: Post-COVID Syndrome (PCS) is characterized by a variety of symptoms including fatigue and impaired physical function. The aim of the ACUQiG-study was to investigate the therapeutic effects and safety of a self-care program combining acupressure and Qigong on physical function in PCS patients with post-infectious fatigue.

METHODS: In this two-arm, open-label randomized controlled study, patients with confirmed SARS-CoV-2 infection and persisting fatigue and ≥3 other typical PCS symptoms >12 weeks were enrolled. Patients were randomized to an intervention group receiving an 8-week daily self-applied acupressure regimen performed at home plus twice-weekly online Qigong sessions, or to a control group receiving no study intervention in the first 16 weeks. Both groups received written self-care advice on complementary medicine treatments and continued routine care. The primary outcome was physical function at 8 weeks measured via the SF-36 Physical Functioning Subscale (SF-36 PFS). Secondary outcomes included fatigue measured by the Chalder Fatigue Scale (CFS), responder analysis, and safety outcomes.

RESULTS: A total of 235 participants (85.1% women; mean age 42.1 years) were randomized (n = 118 intervention, n = 117 controls). At week 8, the adjusted between-group difference in SF-36 PFS was 4.2 points (95% CI −0.9 to 9.4; p = 0.109) with a mean of 55.4 (51.8–59.1) in the intervention group vs. 51.2 (47.6–54.9) in the control group. Responder analysis (≥10-point improvement) suggested a favorable trend for the intervention group (58.9% vs. 46.3%; odds ratio 1.69 (95% CI, 0.98 to 2.92, p = 0.058). The intervention group showed slightly greater improvements in Chalder Fatigue Scale scores [mean at week 8, 21.4 (95% CI 20.2–22.6) vs. 23.2 (95% CI 22.0–24.3), p = 0.040] compared to the control group. Overall, the self-applied study intervention was safe, but aggravation of preexisting symptoms occurred.

CONCLUSION: Both groups improved over time; the addition of acupressure and Qigong to a self-care advice leaflet did not provide a statistically significant or clinically relevant improvement in physical function compared to the leaflet alone. Further high-quality clinical trials are needed to investigate the effects of multimodal self-care programs for managing PCS-related fatigue and physical function.