Clinical effectiveness of rehabilitation in COVID-19, in ICU, Post/Long COVID, and in Telerehabilitation: Systematic Review and Meta-analysis

Abstract

Objective: This systematic review and meta-analysis aims to assess the clinical effectiveness of rehabilitation and pulmonary physiotherapy treatments in Severe Acute Respiratory Syndrome (SARS) secondary to COVID-19 in adults, With three subgroups, 1- Patients in ICU or hospitalized, 2- those recovering from Post/Long COVID, and 3- Telerehabilitation. The outcomes analyzed were "Length of Stay (LOS)", “Six-Minute Walk (6 MW)” and “30 Second Sit to Stand (30-SSTS)”.Material and methods: The Cochrane® methodology was employed following PRISMA guidelines. The study protocol was registered in PROSPERO. We conducted a systematic literature search using the PICOS (Population, Intervention, Comparator, Outcomes, Study Design) framework.Data sources: PubMed, LILACS, Web of Science, gray literature, and Google Scholar.Study selection: The review included Randomized Controlled Trials (RCTs) published from 2020 to May 2025 using the PICOS structure. Data extraction: The screening was with Rayyan software and with independent researchers. Data synthesis: A flow PRISMA diagram was made, including 22 RCTs. The Risk of Bias was assessed using the RoB1 and RoB2 tools, involving 1390 patients from several countries. The meta-analysis of mean difference was calculated using Review Manager software version 5.4.1. Limitations of the study: Heterogeneity in outcome measurements and reporting scales across studies limited the inclusion of some primary studies. Results: These showed that rehabilitation and pulmonary physiotherapy interventions improved functional outcome. For LOS the heterogeneity was low with I2 = 21 % and p-value of 0.29. For 6 MW the heterogeneity was low with I2 = 24 % and p-value of 0.19. And for 30 Second Sit to Stand the heterogenity was moderate with I2 = 28 % and p-value of 0.24.Conclusion: Rehabilitation and pulmonary physiotherapy interventions led to clinically and statistically significant improvements in adults aged 18–75 with SARS secondary to COVID-19. The key outcomes, 6 MW, 30-SSTS, and LOS provided robust quantitative evidence supporting their effectiveness.