Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study

Abstract

Objectives: Determine the safety, feasibility and initial efficacy of a multicomponent telerehabilitation programme for COVID-19 survivors.

Design: Pilot randomised feasibility study.

Setting: In-home telerehabilitation.

Participants: 44 participants (21 female, mean age 52 years) discharged home following hospitalisation with COVID-19 (with and without intensive care unit (ICU) stay).

Interventions: Participants were block randomised 2:1 to receive 12 individual biobehaviourally informed, app-facilitated, multicomponent telerehabilitation sessions with a licenced physical therapist (n=29) or to a control group (n=15) consisting of education on exercise and COVID-19 recovery trajectory, physical activity and vitals monitoring, and weekly check-ins with study staff. Interventions were 100% remote and occurred over 12 weeks.

Primary and secondary outcome measures: The primary outcome was feasibility, including safety and session adherence. Secondary outcomes included preliminary efficacy outcomes including tests of function and balance; patient-reported outcome measures; a cognitive assessment; and average daily step count. The 30 s chair stand test was the main secondary (efficacy) outcome.

Results: No adverse events (AEs) occurred during testing or in telerehabilitation sessions; 38% (11/29) of the intervention group compared with 60% (9/15) of the control group experienced an AE (p=0.21), most of which were minor, over the course of the 12-week study. 27 of 29 participants (93%; 95% CI 77% to 99%) receiving the intervention attended ≥75% of sessions. Both groups demonstrated clinically meaningful improvement in secondary outcomes with no statistically significant differences between groups.

Conclusion: Fully remote telerehabilitation was safe, feasible, had high adherence for COVID-19 recovery, and may apply to other medically complex patients including those with barriers to access care. This pilot study was designed to evaluate feasibility; further efficacy evaluation is needed.

Trial registration number: NCT04663945.

Keywords: COVID-19; REHABILITATION MEDICINE; Rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Trial flow chart reasons for ineligibility are provided in the table at the right side of the figure. If ineligibility was determined through chart review (eg, patient had active cancer or was deceased), the patient was not contacted by the study team. Five individuals signed the informed consent form but did not complete baseline testing due to already being healthy and no longer perceiving benefit (n=2), losing interest/no longer wanting to participate and being lost to follow-up. *Most common reasons for ineligibility were that the patient had physical therapy (PT) needs that were too high (n=416), the patient had language barriers (n=236), the patient was deceased (n=195), the patient had active cancer (n=140) or the patient had neurological involvement (n=129). At week 6, one participant in the control group completed patient-reported outcome measures but did not complete functional testing. At week 12, one participant in the intervention group completed patient-reported outcome measures but did not complete functional testing.

Figure 2

The distribution of the functional outcomes at baseline, week 6 and week 12 for the 30 s chair stand test (A), timed up-and-go (TUG) test (B) and four-stage balance test (C).