Interprofessional Rehabilitation for Patients With Post-COVID Condition

PostCovid

Rehabilitation, Everyday occupations, Health, Life Satisfaction

Since 2020, millions of individuals have been infected with SARS-CoV-2 virus and a substantial proportion continue to experience persistent symptoms that impair functional capacity, limit daily activities, and negatively affect quality of life. The terminology and definitions surrounding this condition remain diverse, such as long COVID, post-COVID-19 syndrome or ongoing symptomatic COVID-19 . In October 2021, the World Health Organization (WHO) introduced the term post-COVID condition (PCC) through a Delphi consensus process defined as: "As the persistence or onset of new symptoms three months after the initial SARS-CoV-2 infection, with symptoms lasting for at least two months and not explained by alternative diagnoses". PCC is characterized by a wide range of symptoms, most commonly fatigue, cognitive impairments, muscle weakness, respiratory and cardiac symptoms, and pain often occurring alongside anxiety, depression, and sleep disturbances. Research shows that PCC markedly impairs activities of daily living (ADL), work ability, and overall functioning. Qualitative studies further demonstrate that the combination of physical and cognitive symptoms limits individuals' ability to engage in everyday occupations and reduce work capacity. Consequently, PCC is associated with difficulties in maintaining employment, often resulting in prolonged sick leave, reduced working hours, or the need for workplace accommodations. Given the heterogeneous nature of PCC, its impact on everyday life varies between individuals, highlighting the importance of understanding patients´ own experiences and priorities when planning rehabilitation interventions. Global efforts have focused on understanding and managing PCC, with rehabilitation emerging as a central strategy. Rehabilitation strategies seem to be a key intervention for improving fatigue, cognitive dysfunction, mood disturbances, and decrease overall well-being; however, current evidence is heterogeneous and insufficient to establish standardized interventions. A lack of research on PCC patients would lead to profound consequences for both patients and society. Without such knowledge, patients' risk of being misdiagnosed or receiving inadequate care, rehabilitation efforts may be ineffective, and healthcare systems will struggle to allocate resources properly. This increases long-term disability, reduces work ability, and places an avoidable burden on individuals and society. Therefore, a deeper understanding of the scope and nature of PCC is essential for understanding this patient group better, developing effective rehabilitation approaches and informing public health policy. The goal of this observational study is to learn more about the impact of post-COVID condition (PCC) on individuals' everyday occupational performance, cognitive functioning, perceived health, and life satisfaction, with the aim of understanding these patient groups better, and to generate evidence to guide rehabilitation strategies. The research focuses on patients diagnosed with post-COVID condition who are receiving an interprofessional rehabilitation program at a specialized Rehabilitation Clinic in Sweden, Danderyds Hospital, The main questions aim to answer are: * Which activities do individuals with PCC identify as most important to improve, and how do they rate these activities in terms of performance and satisfaction? * How do individuals with PCC rate their overall health and occupational performance before and after participating in an interprofessional rehabilitation program?

This is a prospective clinical cohort study, describing occupational performance, cognitive dysfunction and health aspects within patients with post-COVID condition (PCC), which have participated in an interprofessional rehabilitation program. Data collection began in 2021 and continued through 2025. Participants were recruited prior to initiation of rehabilitation and assessed at baseline, immediately post-intervention, and at six-month follow-up. Setting The study was conducted at the Stockholm Department of Rehabilitation Medicine, Danderyd University Hospital, within the Cognitive Post-COVID Clinic . Participants Between August 2021 and December 2025, patients with persistent cognitive symptoms and fatigue following mild COVID-19 infection were assessed for eligibility. A total of approximately 100 patients aged 18-65 years were included. All patients underwent a comprehensive interdisciplinary assessment to determine the need for and potential benefit from interprofessional multimodal rehabilitation (IMR). Only patients who provided written informed consent were enrolled in the study. Intervention: Interprofessional Rehabilitation Program The interprofessional rehabilitation program was initiated in spring 2021 and progressively refined based on expanding clinical knowledge of PCC and neurorehabilitation. The program is grounded in principles of chronic pain rehabilitation and neurorehabilitation. Rehabilitation was delivered in a group-based, in-person format consisting of half-day sessions once weekly for 10 weeks. Participants attended together with other patients with PCC. Interventions were individually adapted according to participants' energy levels and physical capacity and included: * Educational components (theory and lectures) * Physical activity * Body awareness training * Pacing strategies * Cognitive and behavioral strategies aimed at improving daily functioning and facilitating return to work when applicable The interdisciplinary rehabilitation team comprised an occupational therapist, psychologist, physiotherapist, physician, and social worker. Procedures Baseline Assessment Prior to the start of rehabilitation: * All participants completed self-reported questionnaires addressing health, quality of life, and psychological well-being * Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM) during occupational therapy evaluation * Background variables including age, sex, educational level, and family situation were recorded Follow-Up Assessments Assessments were conducted: 1. Immediately after completion of the rehabilitation program 2. Six months post-rehabilitation At follow-up, participants completed the same outcome measures as at baseline, with additional assessments of fatigue, insomnia, and participation. Study Objectives The planned analyses aim to: 1. Evaluate changes in occupational performance, satisfaction, and self-rated health from baseline to post-intervention and six-month follow-up 2. How do cognitive functions, such as attention and executive functions, correlate with rehabilitation outcomes? Statistical Analysis and Sample Size The COPM is the primary outcome measure. The study has 90% power to detect a pre-post difference of 2.2 COPM points, assuming a standard deviation of 2.1, a significance level of 5%, and using non-parametric methods, with a sample size of 10 participants. Non-parametric statistical methods will be applied due to the nature of the data. Spearman's rank correlation will be used for correlation analyses. Logistic regression analyses will be conducted to investigate factors associated with rehabilitation outcomes, including age, sex, and educational level.

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