Telerehabilitation for COVID-19 and long COVID

A woman consults a physiotherapist via telehealth on a computer screen.

Telerehabilitation for COVID-19 and long COVID

A woman consults a physiotherapist via telehealth on a computer screen.

Physiotherapists Ricardo Kenji Nawa and Aléxia Gabriela da Silva Vieira and colleagues in Brazil recently published a systematic review of trials of telerehabilitation for people with COVID-19 or post-COVID conditions (more commonly known as long COVID).

What proportion of people with COVID-19 end up with persistent symptoms? Is it only those who are severe enough to be hospitalised who get long COVID?

Approximately 90 per cent of hospitalised patients with COVID-19 experience post-acute sequelae of COVID-19.

Even patients who have not required hospitalisation may experience different levels of respiratory and physical function impairment after the acute phase of the disease.

This indicates the importance and relevance of physical and respiratory rehabilitation.

Is the idea of telerehabilitation to avoid any need for face-to-face contact between therapist and patient?

Telerehabilitation goes beyond safety to the feasibility of physiotherapists and patients implementing rehabilitation without the need of face-to-face contact.

The reduction of costs and barriers and the possibility of reaching more people (ie, via mobile apps and other types of technological equipment) are the most valuable and beneficial uses of telerehabilitation from an economic and social standpoint.

The choice of telerehabilitation as a modality—synchronous and/or asynchronous—allows and facilitates the self-management of exercise programs and reinforces the importance of the physiotherapist as an educator.

Providing orientations for performing the exercises safely and on warning signs for interruption and prevention of adverse events are some of the benefits observed.

Given that COVID-19 is a relatively new but very common disease, has there been a flurry of research in this area?


An unprecedented number of publications related to COVID-19 has been observed from the beginning of the pandemic to now.

It is undeniable that mass vaccination against COVID-19 dramatically reduced the number of new cases of COVID-19 infection and changed the course of the pandemic around the world.

This may have changed the flow of inclusions, data collection and the conduction of randomised clinical trials, reflected in the delay of results publications.

The recent literature search conducted by our research team in different databases guaranteed the most up-to-date review of telerehabilitation.

Ricardo Kenji Nawa, Aléxia Gabriela da Silva Vieira and colleagues published a systematic review of trials of telerehabilitation for people with COVID-19 or long COVID.

We hope that this systematic review can help decision-makers, managers and consumers assess the applicability of this intervention around the world in different scenarios.

How much evidence did you find?

A total of 2962 records were identified through a high sensitivity search strategy in five different databases.

After the selection process, six trials with 323 participants were selected for this review.

All included trials presented some methodological limitations and a small sample size, which may have influenced the low certainty of evidence.

What types of interventions were included in the telerehabilitation regimens?

Basically, two types of interventions were identified in the telerehabilitation group.

The ‘breathing exercises’ consisted of different types of exercises to activate respiratory muscles in order to promote lung expansion, better ventilation and mucus clearance.

The ‘general exercises’ consisted of different types of exercise such as strengthening, resistance training and active exercises in order to promote and improve physical conditioning and to avoid physiological deterioration.

A large number of exercises were found; however, the characteristics of the exercise programs in all trials focused on a systematisation of frequency and intensity.

What were the effects of telerehabilitation based primarily on breathing exercises?

The analysis of the included trials identified that breathing exercises delivered via telerehabilitation in patients in the acute phase of COVID-19 may improve functional capacity, lower limb performance and dyspnoea compared with patients that did not perform any type of rehabilitation exercises.

What about the telerehabilitation programs involving more general exercise regimens?

The exercise programs delivered via telerehabilitation may improve functional capacity, lower limb performance, dyspnoea and the physical component of quality of life compared with ‘no rehabilitation’ exercises in the acute phase of COVID-19 and post-COVID-19 conditions.

Were the programs safe?


Although the occurrence of adverse events was observed in both groups, telerehabilitation appears to be safe.

With a similar median number of adverse events per participant between the experimental and control groups, the occurrence was mainly mild or moderate and telerehabilitation did not increase readmissions to hospital.

Do you think there will be more research to come in this area?

Probably yes.

According to the literature search in this systematic review, a total of 25 studies were identified as ‘ongoing’ and researchers around the world will be able to finalise their studies in the coming months.

We expect to see more randomised controlled trials published in a short period of time and an update of this systematic review will be needed in order to increase the certainty of the body of evidence of this topic.

This may solve the gaps in clinical practice identified in the outcomes of this systematic review and instigate new questions in clinical research.

>> Ricardo Kenji Nawa PhD, MSc, PT is a senior physiotherapist and clinical researcher at Hospital Israelita Albert Einstein, Sao Paulo, Brazil, and member of Associação Brasileira de Fisioterapia Cardiorrespiratória e Fisioterapia em Terapia Intensiva—ASSOBRAFIR.

>> Aléxia Gabriela da Silva Vieira PT is a physiotherapist at Hospital Israelita Albert Einstein, São Paulo, Brazil, and MSc student of Evidence-Based Health Program at Universidade Federal de São Paulo.


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