Clinician perspectives on Long-COVID physical rehabilitation: challenges, uncertainty, and semantics, 2026, Reeves

[rvallee]

Clinician perspectives on Long-COVID physical rehabilitation: challenges, uncertainty, and semantics

https://www.tandfonline.com/doi/full/10.1080/09638288.2026.2682998

Spoiler: Authors

Jack M. Reeves, Justin McNab, Lissa M Spencer, Ling-Ling Tsai, Andrew J. Baillie & Jennifer A. Alison

Abstract​

Purpose​

To understand the perspectives of clinicians who provided rehabilitation services to people with Long-COVID or referred people to such services.

Methods​

Clinicians involved with Long-COVID rehabilitation were recruited via email and interviewed. Recruitment continued until thematic saturation on physical rehabilitation approaches was reached. Semi-structured interviews were recorded, deidentified, and transcribed. Reflexive thematic analysis was used to develop themes from codes.

Results​

Twenty-one clinicians were interviewed about their perceptions of Long-COVID rehabilitation. Clinicians were physiotherapists, exercise physiologists, clinical psychologists, respiratory physicians, rehabilitation physicians, an infectious disease physician, and a general practitioner. Four overarching themes were identified. (1) “Long-COVID is hard to characterise,” including Subtheme 1.1 “Naming Long-COVID: opinions and impacts of differing terminology”; and 1.2 “Framing Long-COVID: one syndrome, experienced as many.” (2) “Challenges of diagnosis in a novel condition.” (3) “Management of a novel condition – Who knows what to do?” (4) “Exercise therapy is complex,” including Subtheme 4.1 “Graded exercise therapy – semantic discordance despite alignment in approach” and 4.2 “Clinicians question public opposition to exercise.”

Conclusion​

Clinicians described Long-COVID as a heterogenous condition which challenges traditional rehabilitation frameworks. This study highlights how uncertainty with rehabilitation methods leads to fragmented approaches to rehabilitation and inconsistencies in care.

Implications for rehabilitation​

• Long-COVID rehabilitation should be framed around a heterogenous and largely “invisible” condition where validation of symptoms and careful assessment is prioritised.
• Where appropriate, exercise should be prescribed as highly individualised, symptom-titrated physical activity rather than rigid, pre-set incremental exercise programmes regardless of terminology employed.
• Discrepancies in terminology can undermine engagement; clinicians should aim for consistent and patient-friendly language (typically Long-COVID) while still aligning with formal terminology.
• Knowledge gaps and variable beliefs about models of care contribute to inconsistencies in patient management.

 

[Hutan]

Australian authors - the University of Sydney

Regardless, there is a long history of those with “invisible illnesses” (i.e., conditions without outwardly visible signs) receiving poor support and late or minimal recognition from healthcare systems and society, often due to ambiguity in the mechanism or measurability of symptoms [Citation10]. This discrimination, sometimes borne through sexism or ableism, can leave sufferers feeling dismissed due to medical scepticism, with symptoms inappropriately attributed primarily to psychological causes.

Given the recency of Long-COVID, there is inadequate evidence to guide best practice in rehabilitation, and initially clinicians relied on expert advice through well-regarded health organisations [Citation11,Citation12]. There has existed and persists a concern over the safety of some rehabilitation interventions being provided, namely, of exercise interventions for people exhibiting post-exertional malaise (PEM) or post-exertional symptoms exacerbation (PESE) [Citation12]. This may stem from controversies surrounding the use of graded exercise therapy in people with myalgic encephalitis/chronic fatigue syndrome (ME/CFS) [Citation13–15] given the similar symptom profile with Long-COVID [Citation16]. Proponents of graded exercise therapy in ME/CFS have suggested that carefully supervised activity may help to reduce deconditioning [Citation17]. Critics of graded exercise therapy highlight the lived experience of those with ME/CFS demonstrating lack of benefit and that the studies that support graded exercise therapy are methodologically weak [Citation14,Citation18].

Reasonably neutral statements of the situation regarding graded exercise therapy, although I suggest that proponents of graded exercise therapy for ME/CFS are not primarily trying to reduce deconditioning. They are in fact trying to cure the person of ME/CFS, as a result of correcting various issues perceived by the clinician e.g. the patient's fear of movement or over-reaction to normal aches following exercise.

The sample consisted of seven physiotherapists, five exercise physiologists, two clinical psychologists, three respiratory physicians, two rehabilitation physicians, an infectious disease physician, and a general practitioner.

If you ask physiotherapists and exercise physiologists providing services to people with Long Covid what services are best, you are probably going to get replies along the lines of 'exercise, but carefully supervised by physiotherapists and exercise physiologists'. 'Have hammer, see nails.'

The research team consisted of clinicians with experience of providing rehabilitation services for people following COVID infection (JR, LS, LLT), researchers who have previously published on rehabilitation for people with Long-COVID (JR, LS, LLT, AB, JA), researchers with experience in qualitative research methods (JR, JM, LS, LLT, JA), and researchers who convene a collaboration of clinicians, researchers, and consumers (Long-COVID Australia Collaboration; AB, JA).

They acknowledged the impact their professional backgrounds in physiotherapy (JR, LS, LLT, JA), clinical psychology (AB), and social anthropology (JM) would have on analysis and interpretation. For example, physiotherapists tended to focus on aspects of physical rehabilitation and how they were perceived while those with a background in psychology and anthropology brought attention to cultural context, navigating the health system, and how opinions align with alternate health contexts.

The bias is not going to be helped by most of the researchers also having a background in physiotherapy. 'Also have hammers, so applaud the seeing of nails...'

 

[Trish]

They even have the jargon: 'symptom titrated physical activity'.
Yet from what I have read on this thread, they seem to think this requires a clinician to prescribe it and oversee it as a program of treatment. Surely it means inform the patient about PEM and pacing, and don't prescribe exercise or rehab. programs.

 

[Sean]

Clinicians involved with Long-COVID rehabilitation were recruited via email and interviewed.​

How were the recipients selected for the email in the first place?

Where appropriate,​

That 'appropriate' is doing a lot of heavy lifting. Who decides what is appropriate, particularly given the abysmal track record of rehabilitation pros on this matter so far?