[Importance of avoidance and endurance in post-COVID syndrome : Can dysfunctional patterns be changed?]

Background: The importance of dysfunctional coping strategies in the chronification of pain is well documented. The avoidance endurance model (AEM) has proven to be well-suited which, according to initial clinical experiences, is also well-suited to depicting dysfunctional illness behavior in post-COVID syndrome (PCS, COVID coronavirus disease). The aim of this study is to demonstrate which patterns occur and how frequently in PCS patients and whether they change in the context of multimodal rehabilitation.

Method: As part of the PoCoRe multicenter study, N = 721 PCS rehabilitation patients were examined with respect to illness behavior according to the AEM at the start and end of rehabilitation. Frequency analyses, χ²-tests and Sankey diagrams were used.

Results: At the start of rehabilitation around 68% of PCS patients exhibited dysfunctional illness behavior, of which 45.5% were dysfunctional endurers (distress endurance response), in 22.3% fear avoidance was present, in 21.6% eustress endurance and in 10.5% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 11.3% towards adaptive response and by 10.6% to eustress endurance, which mainly comes from the former distress endurance types (-13.9%). Fear avoidance decreased by approx. 12%. Within the individual AEM reaction patterns, dysfunctional patterns can change in favor of functional patterns as well as functional patterns in favor of dysfunctional patterns.

Conclusion: The clear predominance of dysfunctional patterns in this highly chronified sample suggests that the avoidance endurance concept is also relevant in the chronification of fatigue in PCS. In contrast to chronic pain patients, however, the endurance patterns clearly predominate here. There was a clear shift towards the functional pattern during rehabilitation, which speaks in favor of modifiability; however, around 10% of patients developed in an unfavorable direction, which should be taken into account in treatment planning and investigated further.