van Berkel et al. (2025)
- Authors: J. van Berkel, R. C. Lalieu, D. Joseph, M. Hellemons, C. A. Lansdorp
- Institutes: Eurocept Clinics, Amersfoort/Rotterdam, The Netherlands; Hyperbaric Medical Center (HGC), Rijswijk, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Publisher: Scientific Reports
- Link: DOI
Summary
This real-world study provides a mixed and cautious outlook on hyperbaric oxygen therapy (HBOT) 💊 for long COVID. It found that while a majority of patients (56-63%) experienced significant improvements in quality of life and cognitive symptoms three months after treatment, a notable minority (13-19%) got significantly worse. This is a crucial finding, as it highlights a potential risk of deterioration, possibly because the intensive treatment is too exhausting for those with post-exertional malaise. Because the study did not have a placebo group and included only patients who could pay for the treatment themselves, the authors cannot be certain the benefits were caused by the HBOT 💊. The results underscore that HBOT 💊 is not a guaranteed cure and may carry serious risks for some patients.
What was researched?
This study used a prospective registry to gather real-world data on the patient characteristics and outcomes of long COVID patients who underwent hyperbaric oxygen therapy (HBOT) 💊. This paper specifically reports the results from the 3-month follow-up period.
Why was it researched?
HBOT 💊 has shown potential benefits for long COVID, leading to high patient demand. However, many clinical questions remain, and the treatment lacks formal guideline recommendations or reimbursement. This registry was created to gain more insight into its real-world effects, especially in long-term ill patients.
How was it researched?
This was a prospective registry study involving 232 long COVID patients from six hyperbaric centers in the Netherlands. Patients had been ill for a median of 20 months before starting treatment. Researchers collected patient-reported outcome measures (PROMS) at baseline, after treatment, and at 3-month follow-up. The primary outcomes were the mental (MCS) and physical (PCS) component scores of the SF-36 quality of life questionnaire. A clinically relevant change was defined as a 10-point or more increase (responder) or decrease (negative-responder) at 3 months.
What has been found?
At the 3-month follow-up, 56-63% of patients were classified as “responders,” showing a clinically relevant improvement in their quality of life scores (MCS/PCS). However, 13-19% of patients were “negative-responders,” experiencing a clinically relevant deterioration in their scores. The symptoms that showed the most improvement were predominantly in the cognitive domain, such as brain fog, memory problems, and word-finding problems. Work status was largely unchanged, with only a small fraction of patients (11%) who were unable to work returning to work.
Discussion
The authors state the primary limitation is the observational nature of the study and the lack of a control group, meaning a causal effect of HBOT 💊 cannot be established. They note a likely selection bias, as patients had to be able to finance the off-label treatment themselves. The finding that 13-19% of patients worsened is highlighted as an important safety signal, suggesting the intensive HBOT 💊 treatment may be too exhausting for certain patients, particularly those with post-exertional malaise.
Conclusion & Future Work
The authors conclude that while the majority of patients reported a significant increase in quality of life, a minority reported a significant deterioration. They state that clinicians must be alert to this risk of worsening. This registry data will serve as a foundation for future prospective, controlled trials to confirm the results and investigate dose-response, with one such trial already planned in the Netherlands.