Post-COVID Rehabilitation Outcomes: A Comparative Cohort Study, 2025, Prüfer et al.

[SNT Gatchaman]

Post-COVID Rehabilitation Outcomes: A Comparative Cohort Study

Spoiler: Authors

Ferdinand Prüfer; Alexander Kautzky; Alexandra Unger; Špela Matko; Michael J Fischer; Ralf Harun Zwick; Vincent Grote

OBJECTIVE
To evaluate and compare rehabilitation outcomes in patients with post-COVID syndrome (post-COVID) vs those with pulmonary, cardiovascular, metabolic, and orthopedic conditions.

DESIGN
Monocentric comparative cohort pre-post study.

SETTING
Outpatient rehabilitation center.

PARTICIPANTS
Consecutive sample of 597 outpatient rehabilitation patients (N=597) (post-COVID, 227; orthopedic disorder, 147; cardiovascular disorder, 84; metabolic disorder, 83; chronic obstructive pulmonary disease [COPD], 35; asthma, 24) aged 50.3±12.7 years, 54.6% women.

INTERVENTIONS
Individualized, multidisciplinary outpatient rehabilitation (6-10wk, total 3.000min, minimum 3sessions/wk, and 2-3h/session) including strength/endurance training, physiotherapy, psychological support, and nutritional counseling.

MAIN OUTCOME MEASURES
Physical function was assessed with the 6-minute walking test (6MWT), and quality of life (QOL) with the 5-level EuroQol 5-dimensional questionnaire were measured at admission and discharge of outpatient rehabilitation. Differences within and between groups were analyzed using the analysis of variance, and the effect of baseline values on the outcomes performance was modeled.

RESULTS
The Post-COVID group was younger (44.7±12.6y), and the percentage of women (75.4%) was higher than in other outpatient rehabilitation groups. All groups improved significantly during rehabilitation. Patients with post-COVID showed the lowest baseline and discharge QOL scores. Baseline-adjusted scores demonstrated that, despite overall improvements, the post-COVID group reported significantly lower QOL than other outpatient rehabilitation groups, except the COPD group. In contrast, the post-COVID group achieved the highest physical function gains in 6MWT (+60.4m, P<.001). Baseline-adjusted scores indicated the highest physical function in patients with post-COVID (6MWT, PC=632.4 m vs ALL=603.4 m), outperforming all other outpatient rehabilitation groups. Baseline and change scores were negatively correlated, highlighting the need for baseline adjustment.

CONCLUSIONS
Although outpatient rehabilitation was associated with improvements in physical function in patients with post-COVID, QOL deficits persist, discordant with other common outpatient rehabilitation indications. Targeted rehabilitation strategies addressing mental health and fatigue are needed to optimize post-COVID recovery.

Web | DOI | PDF | Archives of Rehabilitation Research and Clinical Translation | Open Access

 

[SNT Gatchaman]

The T2D performance score offers a robust alternative, allowing fair comparisons across baseline differences, while minimizing bias. The T2D performance score is a distributionbased metric that adjusts discharge scores for rehabilitation-induced improvement using the formula T2D=t2 + D (with D = changes from t1 to t2). Incorporating both final status and relative improvement, it provides a more meaningful assessment of rehabilitation outcomes.

the T2D score avoids ceiling effects and provides a more valid comparison across heterogeneous patient populations. Along these lines, we found a negative correlation between the admission and change scores for all measures, and this finding was consistent for all diagnostic groups. Notably, the MCID does not adequately capture this negative correlation in all tests. In contrast, the T2D performance score reflects this negative correlation more accurately, making it a better indicator of patient performance

We did not adjust for age or BMI because of strong collinearity between age and diagnostic group and negligible effects of BMI on outcomes. Age, in particular, was unequally distributed across groups and highly confounded with diagnosis (eg, patients with PC were substantially younger than those with orthopedic or COPD diagnoses). Including age as a covariate removed meaningful time effects, despite clear within-group improvements, leading us to exclude it from the model. Future studies should investigate rehabilitation effects in age- or BMI stratified cohorts to better understand potential interactions.

 

[SNT Gatchaman]

For the 6MWT, patients with COPD had the lowest scores at both time points, whereas patients with cardiovascular disorders had the highest scores. All groups showed increases in walking distance, with the PC, cardiovascular, metabolic, and orthopedic disorder groups demonstrating highly significant (P<.001) improvements with medium to large effects (Cohen’s d=0.74-0.87). Although patients with PC experienced the highest 6MWT D, their T2D score was outperformed by patients with cardiovascular and metabolic disorders, who achieved higher walking distances at both time points.

more patients with PC performed substantially below average on the EQ-5D-5L index (36.6%) and EQVAS (33.9%) than patients in other groups, with the exception of patients with COPD regarding the EQ-VAS (37.1%). In the 6MWT, however, only 21.9% of patients with PC were assigned to the substantially below average category, outperforming patients with asthma, COPD, and orthopedic disorders, matching the metabolic disorder group (21.7%), and only being outperformed by patients with cardiovascular disorders (17.9%).

Putting these results into perspective, patients with PC consistently demonstrated poorer PROMs based on the EQ-5D-5L index (T2D post-COVID, 0.82±0.28 vs T2D ALL, 0.87±0.32) and EQ-VAS (T2D post-COVID, 71.71±33.66 vs T2D ALL, 78.59±40.37) than the other diagnostic groups but showed notable improvements in the CROM (6MWT), where they achieved the highest D and T2D performance adjusted for sex (T2D post COVID, 632.4±168.4 m vs T2D ALL, 588.8±199.9 m).

Although significant improvements in all outcome measures (EQ-5D-5L index, EQ-VAS, and 6MWT) were observed from admission to discharge in all patient groups, patients with PC had significantly lower QOL scores than patients in other groups at both time points. Patients with PC also showed greater improvements in physical performance as assessed using the 6MWT.

This finding suggests that patients with PC are physically capable of improvement, but that their subjective sense of well-being remains negatively affected, possibly reflecting the ongoing health challenges they experience even after rehabilitation.

These findings are also consistent with reports that PC symptoms resemble those described for myalgic encephalomyelitis/chronic fatigue syndrome, which often includes postexertional malaise that can limit patients’ perceived recovery despite functional improvements.

This seems to be framing as PEM being a subjective / psychological barrier to rehabilitation-derived physical improvements, but I guess they're leaving some room for interpretation.

These findings have several clinical implications. They highlighted the need for tailored rehabilitation protocols for patients with PC that address not only physical limitations but also persistent QOL issues such as fatigue and mental health concerns. We suggested the integration of mental health support, energy management strategies, and interventions to reduce post exertional malaise, in line with the recommendations of Wong and Weitzer and the WHO.

 

[Utsikt]

These findings have several clinical implications. They highlighted the need for tailored rehabilitation protocols for patients with PC that address not only physical limitations but also persistent QOL issues such as fatigue and mental health concerns. We suggested the integration of mental health support, energy management strategies, and interventions to reduce post exertional malaise, in line with the recommendations of Wong and Weitzer and the WHO.

Then stop making them exercise!

This study makes it clear that improving the physical fitness of pwLC does not really improve their overall health. And that the rehab ideologists think that fatigue is not a «physical limitation».

But because they were able to walk a measly 60 meters extra in the 6MWT, the rehab ideologists are happy. For reference, my 6MWT improved by 200 meters in five weeks. I ended up bedbound.

And of course there are no control groups.

 

[Hutan]

Yes, they measured the wrong thing. We've discussed the inappropriateness of the 6 minute walking test for measuring physical incapacity in mild ME/CFS a number of times. If these researchers had taken the time to carefully talk to people with 'post-covid syndrome', they would have known that the 6MWT is not a useful measure.

It makes as much sense as measuring the success of rehabilitation of un-set broken arms with a 6MWT. And when people complain that their arm still hurts and they can't do what the did before their accident, concluding that these people need more help with their mental health, because clearly their body works just fine.

The relatively young, probably relatively mildly affected, people in the PC group are unlikely to have much of an issue with 6 minutes of walking - their results confirm that. For sure, a bit of familiarity with the technique of a good 6MWT would lead to a relatively small improvement in these people.

 

[Utsikt]

I also wonder how on earth they can think that physical deconditioning is an issue in patients that are able to participate in these programs.

It’s just blind faith again. Everything can be rehabilitated.

This is exactly why I advocate for just completely ignoring the entire field. I have yet to see a single rehab practitioner that’s willing to acknowledge that rehab isn’t part of the answer, so they will never not be harmful for us. It’s just a matter of the degree of harm, but everything will be a net negative.

 

[SNT Gatchaman]

From their table 3: 6MWT in m —

	Admission	Discharge	Change
1. Post-COVID	495.4±112.9	555.8±101.4	60.4±75.4
2. Asthma	529.0±142.2	559.9±99.4	30.9±76.1
3. COPD	423.6±128.7	455.4±132.4	31.8±115.2
4. Cardiovascular disorder	551.9±105.2	599.3±112.8	47.4±64.0
5. Metabolic disorder	528.9±93.7	575.5±102.5	46.6±60.5
6. Orthopedic disorder	484.6±115.4	531.4±121.9	46.8±54.1
ALL	502.5±115.9	553.0±114.6	50.5±70.6

By contrast my phone-estimated (because I don't walk for a continuous 6 minutes) average 6MWT over 6 months is 232.5m. Could I do more distance, including walking for 6 minutes continuously? Possibly. Reliably, repeatedly and safely? No way.

 

[rvallee]

This finding suggests that patients with PC are physically capable of improvement, but that their subjective sense of well-being remains negatively affected, possibly reflecting the ongoing health challenges they experience even after rehabilitation.

No it doesn't. Good grief this is a cult. Hell, most cults are more rational than this otherwise they just crumble.

These findings are also consistent with reports that PC symptoms resemble those described for myalgic encephalomyelitis/chronic fatigue syndrome, which often includes postexertional malaise that can limit patients’ perceived recovery despite functional improvements.

Cult. This is a cult.

They highlighted the need for tailored rehabilitation protocols for patients with PC that address not only physical limitations but also persistent QOL issues such as fatigue and mental health concerns. We suggested the integration of mental health support, energy management strategies, and interventions to reduce post exertional malaise, in line with the recommendations of Wong and Weitzer and the WHO.

Absolute cult. There is no such thing. Absolutely delusional nonsense.