Protocol Multimodal Web-Based Telerehabilitation for Patients With Post–COVID-19 Condition: Protocol for a Randomized Controlled Trial 2025 Tomaskovic et al

Abstract

Background:
Patients with post–COVID-19 condition (PCC) experience persistent, long-term health consequences following SARS-CoV-2 infection, including fatigue, hyperventilation, cognitive impairment, and limitations in daily activities. There is emerging evidence suggesting that exercise and respiratory therapy–based telerehabilitation is safe and could potentially improve physical capacity while reducing health care costs.

Objective:
This study aims to evaluate the superiority of a multimodal, symptom-titrated telerehabilitation program over standard care in patients with PCC who are severely affected, using the highest oxygen uptake rate (VO2peak [mL/min/kg]) achieved during the cardiopulmonary exercise test (CPET) and minute ventilation/carbon dioxide production slope (VE/VCO2 [full slope]) as primary outcomes. In addition, this study seeks to provide novel insights into the clinical and physiological adaptations associated with PCC, informing future rehabilitation strategies.

Methods:
This prospective, randomized, waitlist-controlled trial was approved by the Rhineland-Palatinate Medical Association ethics committee. All procedures comply with the Declaration of Helsinki. This study comprises 3 examination time points, which include patient-reported outcomes, clinical assessments, and a CPET. It is structured into an 8-week intervention phase followed by an 8-week follow-up phase. Following baseline assessment, patients will be randomly assigned to either the intervention group (IG) or the control group (CG). During the intervention phase, IG participants will receive a web-based, multimodal, symptom-titrated telerehabilitation program consisting of sports medicine consultations, weekly teleconsultations, a structured pacing approach, and exercise and respiratory therapy. In contrast, CG participants will receive treatment as usual, which includes a single sports medicine consultation on healthy habits and a self-directed pacing approach for managing symptoms and daily activities.

During the follow-up phase, IG participants will continue training independently without teleconsultations, whereas CG participants will undergo the same telerehabilitation intervention as the IG. A follow-up assessment will be conducted for both groups to evaluate long-term effects. This study adheres to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines and follows the Consensus on Exercise Reporting Template.

Results:
Recruitment began in August 2023 and was extended until March 2025. As of March 2025, 80 participants have been recruited, and data analysis is ongoing. Final results are expected by December 2025, with a cross-sectional analysis of baseline data anticipated by July 2025.

Conclusions:
This study is the first randomized controlled trial investigating the effectiveness of multimodal and symptom-titrated telerehabilitation in patients with PCC who are severely affected. The integration of various objective diagnostic systems will provide valuable insights into emerging postviral fatigue syndromes, supporting the development of CPET-based diagnostics, personalized rehabilitation strategies, and future research on long-term telerehabilitation effectiveness. The findings will be disseminated through peer-reviewed publications, professional networks, and patient advocacy groups to ensure scientific, clinical, and public impact.

Open access

 

How convenient to post the protocol after the study is completed..

The official page for the protocol shows that they swapped the primary outcome in August 2024, a year after they started recruitment.

One of the primary outcomes were supposed to be the Nijmegen hyperventilation index. That has been changed to a secondary outcome and replaced with the former secondary outcome of Regression quotient from minute ventilation and carbon dioxide production: VE/VCO2 slope [Full-Slope].

At the same date, they also changed it from a crossover-trial to a parallell trial. It seems like they changed their mind again, because this protocol says it’s a crossover.

 

I also do not understand how the outcomes are supposed to be useful. It’s irrelevant if you can exercise more if your daily functioning doesn’t also increase. They seem to have forgotten the purpose of rehabilitation..

 

To keep rehabilitationists in a job?

 

It's been 5 years, folks. 5 years of exactly this being a standard treatment that is widely criticized while it's widely known that there is no treatment for this, a statement that explicitly covers this exact treatment approach. I guess you could lamely say something like this in early 2023, still weak but whatever, if this paper is going to be published in 2025, you have to adjust your facts to fit this since time has this pesky habit of plowing on regardless of whether people get stuck in the past.

Good grief this is weak. Exactly how much medical research funding is straight up burned in a money hole?