Evaluating Telerehabilitation for Post-CCOVID Sequelae in City Hospital

Thesis Abstract

This study addresses the growing burden of post-acute sequelae of SARS-CoV-2 infection (PASC) and the accessibility gaps in conventional rehabilitation by evaluating telerehabilitation delivery for individuals with post-COVID-19 sequelae at City Hospital. The problem centers on heterogeneous symptom profiles, limited in-person rehabilitation capacity, and potential disparities in access to care, which may influence functional outcomes and quality of life. The aim is to assess the effectiveness, safety, patient satisfaction, and cost-effectiveness of a structured telerehabilitation program for post-CCOVID sequelae, with specific objectives to (i) determine changes in physical function, fatigue, dyspnea, and health-related quality of life after a 12-week telerehabilitation protocol; (ii) examine adherence, safety, and adverse events associated with remote delivery; (iii) compare outcomes with a matched conventional in-person rehabilitation cohort; (iv) identify patient and program factors predicting improved outcomes; and (v) evaluate clinicians’ and patients’ perceived acceptability using a mixed-methods framework. The methodological approach adopts a pragmatic, parallel-group, prospective design guided by the Health Belief Model and the Technology Acceptance Model to explore behavioral determinants of engagement and adherence. The study population comprises adults (18–75 years) with documented post-COVID-19 sequelae referred to City Hospital’s Rehabilitation Department. A sample size of 240 participants (120 in telerehabilitation and 120 in conventional rehabilitation) is targeted, with allocation through propensity score matching to minimize baseline differences. Data collection employs validated instruments the 6-Minute Walk Test (6MWT) and Sit-to-Stand Test for physical function; the Fatigue Severity Scale (FSS); the Modified Medical Research Council Dyspnea Scale (mMRC); the EQ-5D-5L for health-related quality of life; the Hospital Anxiety and Depression Scale (HADS) for psychological well-being; and a patient safety log for adverse events. Telerehabilitation sessions, delivered thrice weekly for 12 weeks, comprise aerobic and resistance training, breathing retraining, aerobic capacity progression, and self-management education, conducted via a secure videoconferencing platform and supported by asynchronous instructional content. Data analysis integrates quantitative and qualitative methods descriptive statistics and repeated-measures ANOVA or linear mixed-effects models to evaluate within- and between-group changes over time; regression analyses to identify predictors of functional gains; and thematic analysis of semi-structured interviews with a purposive subsample of 30 patients and 12 clinicians to elucidate experience, satisfaction, and perceived facilitators/barriers. Economic evaluation includes a cost-utility analysis from the healthcare payer perspective, estimating incremental cost-effectiveness ratios (ICERs) based on quality-adjusted life years (QALYs) gained. The study anticipates that telerehabilitation will produce non-inferior improvements in 6MWT distance, fatigue, dyspnea, and HRQoL compared with conventional rehabilitation, with higher accessibility and comparable safety profiles. It is expected that adherence will be moderated by digital literacy, social support, and baseline symptom burden, while satisfaction will be enhanced by flexible scheduling and real-time feedback. The anticipated contribution to knowledge includes robust evidence on the clinical effectiveness, safety, economic viability, and patient and clinician acceptability of telerehabilitation for post-CCOVID sequelae, addressing a critical gap in scalable post-acute care. The results are expected to inform guidelines on remote multidisciplinary rehabilitation, patient selection criteria, and implementation strategies in urban hospital settings. The main conclusion will delineate whether telerehabilitation provides a viable, cost-effective alternative to in-person care for post-COVID rehabilitation and under what conditions. Recommendations will target policy makers and hospital administrators to promote integration of telerehabilitation into standard care pathways, emphasize training for clinicians in remote delivery and data security, develop digital literacy programs for patients, and establish monitoring frameworks for long-term outcomes and safety.