{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:58:25Z","timestamp":1783609105844,"version":"3.55.0"},"reference-count":53,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JRM"],"abstract":"<jats:p>Objective: Post-COVID-19 condition is associated with persistent respiratory symptoms and impaired functional capacity. This study evaluated the effects of adding an incentive spirometer to standard rehabilitation in adults with post-COVID-19 condition, with peak expiratory flow, dyspnoea, and quality of life as the prespecified primary outcomes.\nDesign: Randomized controlled trial.\nSubjects\/Patients: Eighty-two previously hospitalized adults diagnosed with post-COVID-19 condition, were randomly assigned to an experimental group (rehabilitation plus incentive spirometer, n\u2009=\u200941) or a control group (rehabilitation alone, n\u2009=\u200941).\nMethods: Eight outcomes were assessed at baseline and 1 month, including peak expiratory flow, Medical Research Council dyspnoea scale, EQ-5D-5L, and functional performance tests.\nResults: Both groups improve at 1-month follow-up. The experimental group showed greater improvements in peak expiratory flow (between-group difference\u2009=\u200965.85 L\/min; 95% CI: 4.35 to 127.35; p\u2009=\u20090.007), and dyspnoea (MRC difference\u2009=\u2009\u22121.08; 95% CI: \u22121.54 to \u22120.62; p\u2009&lt;\u20090.001) compared with the control group. No significant between-group differences were observed for quality of life or functional performance measures.\nConclusion: Adding incentive spirometry to standard rehabilitation improved peak expiratory flow and reduced dyspnoea in adults with post-COVID-19 condition, supporting its use as a low-cost adjunct for respiratory symptom management.<\/jats:p>","DOI":"10.2340\/jrm.v58.44926","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:32:10Z","timestamp":1777980730000},"page":"jrm44926","source":"Crossref","is-referenced-by-count":1,"title":["Effects of incentive spirometer added to standard rehabilitation in previously hospitalized adults with post-COVID-19 condition: a randomized controlled trial"],"prefix":"10.2340","volume":"58","author":[{"given":"Marina","family":"Kloni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Heraclides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theognosia","family":"Panteli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexios","family":"Klonis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Rentzias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Karagiannis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"154325","doi-asserted-by":"crossref","unstructured":"Gonzalez-Gerez JJ, Saavedra-Hernandez M, Anarte-Lazo E, Bernal-Utrera C, Perez-Ale M, Rodriguez-Blanco C. 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Symptoms, complications and management of long COVID: a review. J R Soc Med 2021; 114: 428\u2013442.","DOI":"10.1177\/01410768211032850"},{"key":"154330","doi-asserted-by":"crossref","unstructured":"Natarajan A, Shetty A, Delanerolle G, Zeng Y, Zhang Y, Raymont V, et al. A systematic review and meta-analysis of long COVID symptoms. Syst Rev 2023; 12: 88\u2013107.","DOI":"10.1186\/s13643-023-02250-0"},{"key":"154331","unstructured":"WHO (2025) Clinical management of COVID-19. Living guideline, June 2025 [accessed February 27, 2026]. Available from: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/d1021eff-f570-4c22-b630-a44bf4267a6c\/content"},{"key":"154332","unstructured":"National Academies of Sciences, Engineering, and Medicine. A Long COVID definition: a chronic, systemic disease state with profound consequences. Washington, DC: National Academies Press; 2024."},{"key":"154333","doi-asserted-by":"crossref","unstructured":"Hawley HB. Long COVID: clinical findings, pathology, and endothelial molecular mechanisms. Am J Med 2025; 138: 91\u201397.","DOI":"10.1016\/j.amjmed.2023.08.008"},{"key":"154334","doi-asserted-by":"crossref","unstructured":"Sk Abd Razak R, Ismail A, Abdul Aziz AF, Suddin LS, Azzeri A, Sha\u2019ari NI. Post-COVID syndrome prevalence: a systematic review and meta-analysis. BMC Public Health 2024; 24: 1785.","DOI":"10.1186\/s12889-024-19264-5"},{"key":"154335","doi-asserted-by":"crossref","unstructured":"Bansal A. Economic burden of long COVID: macroeconomic, cost-of-illness and microeconomic impacts. NPJ Prim Care Respir Med 2025; 35: 53.","DOI":"10.1038\/s41533-025-00460-8"},{"key":"154336","doi-asserted-by":"crossref","unstructured":"Koumpias AM, Schwartzman D, Fleming O. Long-haul COVID: healthcare utilization and medical expenditures 6 months post-diagnosis. BMC Health Serv Res 2022; 22: 1010\u20131024.","DOI":"10.1186\/s12913-022-08387-3"},{"key":"154337","doi-asserted-by":"crossref","unstructured":"Maya S, Kahn JG, Lin TK, Jacobs LM, Schmidt LA, Burrough WB, et al. Indirect COVID-19 health effects and potential mitigating interventions: cost-effectiveness framework. PLoS One 2022; 17: e0271523.","DOI":"10.1371\/journal.pone.0271523"},{"key":"154338","doi-asserted-by":"crossref","unstructured":"Sapna F, Deepa F, Sakshi F, Sonam F, Kiran F, Perkash RS, et al. Unveiling the mysteries of the long COVID syndrome: exploring the distinct tissue and organ pathologies linked to prolonged COVID-19 symptoms. Cureus 2023; 15: e44588 https:\/\/doi.org\/10.7759\/cureus.44588","DOI":"10.7759\/cureus.44588"},{"key":"154339","doi-asserted-by":"crossref","unstructured":"Tsilinggiris D, Vallianou NG, Karampela I, Christodoulatos GS, Papavasileiou G, Petropoulou D, et al. Laboratory findings and biomarkers in long covid: what do we know so far? Insights into epidemiology, pathogenesis, therapeutic perspectives and challenges. Int J Mol Sci 2023; 24: 10458.","DOI":"10.3390\/ijms241310458"},{"key":"154340","doi-asserted-by":"crossref","unstructured":"Barash M, Ramalingam V. Post-COVID interstitial lung disease and other lung sequelae. Clin Chest Med 2023; 44: 263\u2013277.","DOI":"10.1016\/j.ccm.2022.11.019"},{"key":"154341","doi-asserted-by":"crossref","unstructured":"Wu X, Liu X, Zhou Y, Yu H, Li R, Zhan Q, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med 2021; 9: 747\u2013754.","DOI":"10.1016\/S2213-2600(21)00174-0"},{"key":"154342","doi-asserted-by":"crossref","unstructured":"van Willigen HDG van, Wynberg E, Verveen A, Dijkstra M, Verkaik BJ, Figaroa OJA, et al. One-fourth of COVID-19 patients have an impaired pulmonary function after 12 months of disease onset. 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Eight months follow-up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID-19 survivors. Sci Rep 2021; 11: 13854.","DOI":"10.1038\/s41598-021-93191-y"},{"key":"154346","doi-asserted-by":"crossref","unstructured":"van der Sar - van der Brugge S, Talman S, Boonman - de Winter L, de Mol M, Hoefman E, van Etten RW, et al. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir Med 2021; 176: 106272\u2013106276.","DOI":"10.1016\/j.rmed.2020.106272"},{"key":"154347","doi-asserted-by":"crossref","unstructured":"Lewthwaite H, Byrne A, Brew B, Gibson PG. Treatable traits for long COVID. Respirology 2023; 28: 1005\u20131022.","DOI":"10.1111\/resp.14596"},{"key":"154348","doi-asserted-by":"crossref","unstructured":"Li S, Dai B, Hou Y, Zhang L, Liu J, Hou H, et al. Effect of pulmonary rehabilitation for patients with long COVID-19: a systematic review and meta-analysis of randomized controlled trials. Ther Adv Respir Dis 2025; 19: 17534666251323482.","DOI":"10.1177\/17534666251323482"},{"key":"154349","doi-asserted-by":"crossref","unstructured":"Bal-Boche\u0144ska M, Wyszy\u0144ska J, Ko\u0142odziej M. Breathe better after COVID: the impact of a two-week pulmonary rehabilitation program on pulmonary function, inflammatory markers, and quality of life in post-COVID syndrome. J Clin Med 2025; 14: 4533.","DOI":"10.3390\/jcm14134533"},{"key":"154350","doi-asserted-by":"crossref","unstructured":"Volckaerts T, Ruttens D, Quadflieg K, Burtin C, Cops D, De Soomer K, et al. Improved functional exercise capacity after primary care pulmonary rehabilitation in patients with long COVID (PuRe-COVID): a pragmatic randomised controlled trial. BMJ Open Respir Res 2025; 12:e003653.","DOI":"10.1136\/bmjresp-2025-003653"},{"key":"154351","doi-asserted-by":"crossref","unstructured":"Yue Y, Han X, Chen Q, Dai L, Ai Q, Zhang Z, et al. The effect of pulmonary rehabilitation for post-acute sequelae of SARS-CoV-2 infection in patients: a systematic review and meta-analysis. Front Rehabil Sci 2025; 6:1634351.","DOI":"10.3389\/fresc.2025.1634351"},{"key":"154352","unstructured":"Franklin E, Anjum F. (2022) Incentive spirometer and inspiratory muscle training [accessed March 17, 2023]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK572114\/"},{"key":"154353","doi-asserted-by":"crossref","unstructured":"Restrepo RD, Wettstein R, Wittnebel L, Tracy M. Incentive spirometry: 2011. Respir Care 2011; 56: 1600\u20131604.","DOI":"10.4187\/respcare.01471"},{"key":"154354","unstructured":"Hristara-Papadopoulou A, Tsanakas J, Diomou G, Papadopoulou O. Current devices of respiratory physiotherapy. Hippokratia 2008; 12: 211\u2013220."},{"key":"154355","doi-asserted-by":"crossref","unstructured":"Abo Elyazed TI, Abd El-Hakim AAE, Saleh OI, Sonbol MMF, Eid HA, Moazen E, et al. Diaphragmatic strengthening exercises for patients with post COVID-19 condition after mild-to-moderate acute COVID-19 infection: a randomized controlled study. J Rehabil Med 2024; 56: jrm25491.","DOI":"10.2340\/jrm.v56.25491"},{"key":"154356","doi-asserted-by":"crossref","unstructured":"Loganathan D, Malavika D, Anandhi D, Shirly M, Pugazhendhi S, Jayanthi NN. Effect of incentive spirometry on pulmonary function test in post COVID-19 pneumonia patients. Fizjoterapia Polska 2022; 22: 122\u2013128.","DOI":"10.56984\/8ZG20AZsV"},{"key":"154357","doi-asserted-by":"crossref","unstructured":"Kusumawardani RI, Tinduh D, Andriati, Poerwandari D, Marhana IA, Melaniani S. The effectiveness of incentive spirometry exercise on pulmonary function in COVID-19 survivors: a randomised controlled trial study. Bali Med J 2023; 12: 539\u2013544.","DOI":"10.15562\/bmj.v12i1.3956"},{"key":"154358","unstructured":"Shakerian N, Mofateh R, Niloofar R, Saghazadeh A, Nima R. 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Efficacy of incentive spirometer in increasing maximum inspiratory volume in an out-patient setting. Cureous 2021; 13: e18483.","DOI":"10.7759\/cureus.18483"},{"key":"154362","doi-asserted-by":"crossref","unstructured":"Tabor-Gray L, Vasilopoulos T, Plowman EK. Concordant validity of a digital peak cough flow meter to assess voluntary cough strength in individuals with ALS. Dysphagia 2020; 35: 568\u2013573.","DOI":"10.1007\/s00455-019-10060-7"},{"key":"154363","doi-asserted-by":"crossref","unstructured":"Papiris SA, Daniil ZD, Malagari K, Kapotsis GE, Sotiropoulou C, Milic-Emili J. et al. The Medical Research Council dyspnea scale in the estimation of disease severity in idiopathic pulmonary fibrosis. Respir Med 2005; 99: 755\u2013761.","DOI":"10.1016\/j.rmed.2004.10.018"},{"key":"154364","doi-asserted-by":"crossref","unstructured":"Kontodimopoulos N, Pappa E, Niakas DA, Yfantopoulos J, Dimitrakaki C, Tountas Y. Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. 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