Outcomes Among Patients Referred to Outpatient Rehabilitation Clinics After COVID-19 diagnosis

United States, January 2020-March 2021

Jessica S. Rogers-Brown, PhD; Valentine Wanga, PhD; Catherine Okoro, PhD; Diane Brozowsky, MBA; Alan Evans, DPT; David Hopwood, MSHI; Jennifer R. Cope, MD; Brendan R. Jackson, MD; Dena Bushman, MSN, MPH; Alfonso C. Hernandez-Romieu, MD; Robert A. Bonacci, MD; Tim McLeod, MPH; Jennifer R. Chevinsky, MD; Alyson B. Goodman, MD; Meredith G. Dixson, MD; Caitlyn Lufty, MPH; Julie Rushmore, PhD, DVM; Emily Koumans, MD; Sapna Bamrah Morris, MD; William Thompson, PhD


Morbidity and Mortality Weekly Report. 2021;70(27) 

In This Article


Among patients referred to Select Medical's outpatient rehabilitation clinics during January 2020–March 2021 (during the COVID-19 pandemic), patients who previously had COVID-19 reported poorer general, mental, and physical health (i.e., overall physical health, physical activities, and pain), and functioning (i.e., physical and social, such as ability to do chores, usual work, or activities with friends) compared with patients with no previous diagnosis of COVID-19 referred for cancer rehabilitation. Also, post–COVID-19 patients did not perform as well as control patients on a measured assessment of physical functioning (6MWT). Finally, post–COVID-19 patients used more rehabilitative services than control patients. These findings indicate that among patients referred to outpatient rehabilitation, those recovering from COVID-19 might have poorer physical health and functional status than do patients with cancer but not COVID-19 and could benefit from additional clinical support, including tailored physical and mental health rehabilitation services.

The identification of poorer physical health among post–COVID-19 patients is consistent with a previous study that found that 92% of post–COVID-19 patients had diagnoses potentially related to post–COVID-19 conditions, including weakness, malaise, fatigue, respiratory failure with hypoxia, and gait abnormalities.[2,3] Poorer self-reported physical and mental health is associated with long-term negative health outcomes including chronic diseases (e.g., diabetes and cardiovascular disease), functional decline,[4] and mortality.[5] The lower scores on applied cognitive ability tasks suggest more subtle deficits in cognitive functioning, which might indicate the need for further evaluation and additional need for health care resources and services.[6] Further, physical function, as measured by the 6MWT, has been shown to be an important outcome for assessing impact of COVID-19.[4] Additional studies have shown that patients recovering from COVID-19 have higher incidences of negative health outcomes, including poorer physical health and functional status, and might need additional clinical support such as tailored physical and mental health rehabilitation services.[7,8] These findings have implications for health care systems during and after the COVID-19 pandemic.[9] Postacute sequalae associated with COVID-19 have not been comprehensively described, and data from studies of long-term follow-up to provide reliable estimates of the long-term sequelae associated with COVID-19 are still emerging.[6–8] Continued assessments of self-reported health data are important to characterize the sequelae of novel infectious diseases and are critical for developing cost-effectiveness estimates for lifesaving interventions, such as vaccines and other potentially important rehabilitation therapies and interventions, including physical therapy, occupational therapy, and services and therapies associated with cognitive and functional decline.[9,10]

The findings in this report are subject to at least six limitations. First, date of infection was not available; therefore, time-varying effects associated with infection date could not be examined. Second, data on severity of illness, including hospitalization status, were not available, precluding assessment of the impact of illness severity on post–COVID-19 conditions. Third, given the large amount of missing data (>50%) for many demographic variables (e.g., race, ethnicity, employment status, and occupation), which are common limitations in large EHR data sets, it was not possible to control for additional demographic differences. Fourth, the absence of pre–COVID-19 assessments did not permit controlling for premorbid function. Fifth, the types of cancer diagnoses and treatments were not available, which is an important consideration given heterogeneity of cancer sequelae. Similarly, assessing other comorbidities was not possible; post–COVID-19 patients might have had more underlying medical conditions (e.g., diabetes or obesity) than did control patients, which could explain poorer physical and mental health measures. However, given that patients in the post–COVID-19 group were younger and more commonly employed than were those in the control group, it is likely that these two populations are different with regard to demographic factors and the prevalence of comorbid chronic conditions. Finally, referral to physical rehabilitation depended on nonstandardized clinical judgment, which might have led to differences in patient population by group. Therefore, these results should not be interpreted to mean that post–COVID-19 patients overall had poorer physical and mental health than patients with cancer. Instead, results indicate that post–COVID-19 patients specifically referred to a large physical rehabilitation network had poorer health measures than those referred for cancer, which indicates that some patients recovering from COVID-19 had substantial rehabilitation needs.

Patients recovering from COVID-19 might experience continued poor health and could benefit from additional support and tailored physical and mental health rehabilitation services. Health care systems and providers should be prepared to recognize and meet the ongoing needs of this patient population. Efforts to increase COVID-19 vaccination could include messaging that states that preventing COVID-19 also prevents post–COVID-19 conditions with potential effects on long-term health.