Symptom-TArgeted Rehabilitation for Cognitive Complaints after COVID (STAR-C3)

We now know that up to 40% of adults with COVID are still having cognitive problems months later, including "brain fog", mental fatigue, memory impairments, and difficulty with everyday tasks like following a conversation. People report these problems affect their ability to do things like return to work. We know "Long COVID" can cause long-lasting cognitive problems, but we don't know how best to treat them. One source of guidance for helping patients with Long COVID is research on a group with similar challenges: adults with traumatic brain injury (TBI), especially those with mild TBI or concussion. Adults with mild TBI have many of the same cognitive problems as those with Long COVID. Best practices in mild TBI rehabilitation should apply equally well to Long COVID, because they are best practices for all patients with cognitive challenges: treatments must be tailored to the person and their needs, focused on solving everyday thinking challenges rather than 'fixing' deficits, and given in a relatively high dose. As a first step, we will conduct a pilot randomized clinical trial of a mild TBI rehabilitation method called Symptom-Targeted Rehabilitation (STAR), which we have adapted for adults with post-COVID cognitive challenges. At present, most adults with these challenges receive no rehabilitation, and therefore we will randomize participants to either the STAR intervention or current standard care, which is receiving general information about how to manage cognitive challenges. Participants will be 100 adults with Long COVID. Our main outcomes will be feasibility of recruitment, adherence to intervention, and participants and therapists ratings of the feasibility, appropriateness, and acceptability of the STAR methods. These results will prepare us for the next step: a multi-centre, international study to test the effectiveness of STAR for adults with Long COVID.