Real-world outcomes of a multidisciplinary rehabilitation programme for adults with Long COVID: A retrospective cohort study.

Abstract

Background Long COVID imposes a substantial and ongoing burden, with persistent symptoms affecting daily functioning and quality of life. Multidisciplinary rehabilitation has been widely implemented in clinical practice; however, evidence describing real-world patient outcomes and service delivery remains limited. This study aimed to describe clinical and patient-reported outcomes among adults participating in a structured multidisciplinary rehabilitation programme for Long COVID, and to explore the association between referral-to-assessment time and changes in outcomes. Methods This retrospective cohort study analysed routinely collected clinical data from adult patients who completed a structured multidisciplinary rehabilitation programme at the Long COVID rehabilitation centre in a university hospital in South London (January 2021–December 2023). Seven validated outcome instruments were administered at baseline and discharge: the Work and Social Adjustment Scale (WSAS), Fatigue Severity Scale (FSS), MRC Dyspnoea Scale, Patient Health Questionnaire-2 (PHQ-2), Generalised Anxiety Disorder-2 (GAD-2), EQ-5D-5 L, and 1-minute Sit-to-Stand test (STS-1). Pre-to-post changes were assessed using paired t-tests and Wilcoxon signed-rank tests; the proportion of patients achieving minimal clinically important differences (MCIDs) was determined for each measure. The association between referral-to-assessment time and outcome change was examined using linear correlation and restricted cubic spline (RCS) modelling. Results A total of 170 participants were included. Statistically significant improvements were observed across all primary domains after adjustment for multiple comparisons, except self-care and pain/discomfort. The largest effect was recorded for physical endurance (STS-1: r = 0.590, p < 0.001), followed by breathlessness (MRC: r = 0.491), fatigue (FSS: r = 0.382), and functional impairment (WSAS: d = − 0.323). MCID thresholds were achieved by 63.5% of patients on the STS-1, 48.8% for breathlessness, and 45.9% for depression. No significant linear association was identified between referral delay and outcome change. Non-linear therapeutic windows were identified in functional and psychological domains using RCS modelling. Patients assessed 100–150 days after referral showed the greatest improvement, with benefits declining thereafter. Conclusion Participants demonstrated improvements in clinical and patient-reported outcomes over time during engagement in a multidisciplinary rehabilitation programme for Long COVID. While causal attribution is limited by the observational design, these findings provide real-world evidence on patient outcomes and highlight the potential importance of timely access to rehabilitation services. Further prospective and controlled studies are needed to evaluate effectiveness and optimise care pathways.