Multimodal Telerehabilitation in Post COVID-19 Condition Recovery: A Series of 12 Cases, 2025, Carpallo-Porcar et al.

[SNT Gatchaman]

Multimodal Telerehabilitation in Post COVID-19 Condition Recovery: A Series of 12 Cases

Spoiler: Authors

Carpallo-Porcar, Beatriz; Beamonte, Esther del Corral; Jiménez-Sánchez, Carolina; Córdova-Alegre, Paula; Brandín-de la Cruz, Natalia; Calvo, Sandra

BACKGROUND
Post COVID-19 Condition is a recently recognized syndrome characterized by the persistence of various symptoms, including dyspnea, physical and mental fatigue, and post-exertional malaise. Currently, there is no established treatment or clear consensus on the effectiveness of rehabilitation, and given that patients could benefit from home-based rehabilitation, telerehabilitation, defined as remote rehabilitation using telematic systems, may be an option to reach more of the population with persistent COVID-19 symptoms. Therefore, it is necessary to show the efficacy of this telematic approach and the benefits of a multimodal rehabilitation strategy in these patients.

METHODS
Patients underwent home rehabilitation using a 12-week synchronous telerehabilitation system. The intervention included therapeutic education and physical and respiratory rehabilitation. The following variables were analyzed: Fatigue, quality of life, dyspnea, respiratory strength, aerobic capacity, and upper and lower limb strength.

CONCLUSIONS
After 12 weeks, significant improvements were found in fatigue, aerobic capacity, and limb and respiratory strength. However, no improvement was found in dyspnea scores, which did not correlate with respiratory strength. Interestingly, a post-intervention correlation emerged between the distance covered in aerobic capacity and perceived fatigue, suggesting that asynchronous telerehabilitation could be a viable treatment strategy for these patients.

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[Hutan]

First, there are no controls. 12 people with persistent symptoms following a Covid-19 infection showed, on average, improvements over 12 weeks. That is exactly what we would expect simply with the passage of time. It would be extraordinary if they did not. The abstract gives us no reason to think that the improvements were due to anything other than normal recovery.

They don't tell us how long the participants had been ill for, before starting this intervention. They don't quantify the improvements beyond "significant improvements", they don't tell us how many people experienced improvements. They don't tell us how many people started the programme and did not complete it. They don't give us any evidence that people adhered to the rehabilitation exercises.

There is nothing at all to suggest that the treatment has had an effect above and beyond what we would expect from people left to recover, or not, on their own.


Second, they demonstrate bias, a lack of equipoise.

Currently, there is no established treatment or clear consensus on the effectiveness of rehabilitation, and given that patients could benefit from home-based rehabilitation, telerehabilitation, defined as remote rehabilitation using telematic systems, may be an option to reach more of the population with persistent COVID-19 symptoms. Therefore, it is necessary to show the efficacy of this telematic approach and the benefits of a multimodal rehabilitation strategy in these patients.

They tell us that there is no consensus on the effectiveness of rehabilitation. They then say that they know that patients could benefit from home-based rehabilitation. Rather than saying 'it is worthwhile investigating whether telerehabilitation can work', they say 'it is necessary to show the efficacy of [the approach] and the benefits of [the strategy].

No, that is not science, the delivering of something that is seen as necessary. It brings to mind Wessely's safe harbour metaphor, with the investigators steering the good ship towards its inevitable destination.