Interprofessional Rehabilitation for Patients With Post-COVID Condition

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:

• Immediately after completion of the rehabilitation program
• 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:

• Evaluate changes in occupational performance, satisfaction, and self-rated health from baseline to post-intervention and six-month follow-up
• 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.

Inclusion criteria

• Individuals aged 18 and older with confirmed COVID-19 or with a very likely prior COVID-19 infection.
• Newly developed cognitive impairments or cognitive fatigue.

--A clear temporal link between COVID-19 onset and symptom onset, with symptoms affecting return to previous activities/occupation.

• The acute phase of illness ended at least 3 months earlier.
• Basic investigations for specific differential diagnoses must have been completed at the initial clinic visit, according to "COVID-19 - persistent symptoms" (see viss.nu), excluding anemia, thyroid dysfunction, and alcohol overconsumption. Assessment for depression.
• Medication review and relevant adjustments carried out with regard to the patient's symptoms

Exclusion criteria

• Predominant recurrent and/or fluctuating infectious symptoms, circulatory, respiratory, or cardiac problems.
• Other symptoms due to organ failure that should primarily be managed by an organ specialist.
• Severe psychiatric illness, including depression with pronounced cognitive symptoms.
• Cognitive impairments primarily related to neurodegenerative disease or substance misuse, e.g., alcohol-related dementia, Korsakoff's dementia, or other dementia disorders.