The Role of Physiotherapy in Long-COVID Functional Rehabilitation

Abstract

Long-COVID, characterized by persistent symptoms following acute SARS-CoV-2 infection, presents a significant challenge to global healthcare systems. Patients report ongoing fatigue, dyspnea, musculoskeletal weakness, cognitive dysfunction, and reduced exercise tolerance, all of which impair daily functioning and quality of life (Carfì et al., 2020). Functional rehabilitation aims to restore mobility, strength, cardiovascular fitness, and independence in activities of daily living. Physiotherapy, as a cornerstone of rehabilitation, integrates exercise prescription, respiratory interventions, neuromuscular facilitation, and patient education to optimize recovery outcomes. This study examines the role of physiotherapy in long-COVID functional rehabilitation and evaluates its impact on functional status, fatigue, respiratory capacity, and quality of life. A conceptual model was developed to hypothesize that physiotherapy interventions positively influence functional outcomes through mediators including adherence, symptom management, and patient engagement. Using a quantitative cross-sectional survey design, data were collected from 200 post-COVID patients attending outpatient rehabilitation centers. Standardized instruments measured physiotherapy exposure, functional independence (using Barthel Index), fatigue (using Fatigue Severity Scale), respiratory function (spirometry), and quality of life (SF-36). Structural equation modeling (SEM) using SmartPLS evaluated direct and indirect relationships. Results indicate that physiotherapy significantly improves functional independence (β = 0.53, p < .001), reduces fatigue (β = –0.42, p < .001), enhances respiratory function (β = 0.47, p < .001), and improves overall quality of life (β = 0.49, p < .001). Adherence and patient engagement mediated these effects, suggesting that active participation is critical for optimal outcomes. The measurement model demonstrated strong reliability (Cronbach’s alpha > 0.8) and validity (AVE > 0.5). Structural paths confirmed hypothesized relationships, explaining 61 percent of variance in functional outcomes. These findings highlight physiotherapy as a pivotal component of long-COVID rehabilitation, emphasizing individualized exercise programs, respiratory techniques, and patient education to restore function and independence. Challenges include variable symptom severity, patient adherence, and resource constraints. Recommendations include tele-rehabilitation programs, integration of multidisciplinary teams, standardized protocols for long-COVID physiotherapy, and patient-centered approaches to optimize adherence. This study contributes empirical evidence supporting physiotherapy as a core intervention to mitigate long-term functional impairments in post-COVID populations, informing clinical practice and policy development.