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

Abstract

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