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Here you will find guidance, top tips and links to helpful resources for remote assessments and consultations with people recovering from COVID.

General guidance

Given the concern that many patients with long-COVID have serious underpinning pathology, telerehabilitation should only be offered after the patient has been seen at one of the post-COVID assessment clinics. An initial face-to-face (or at least 1:1 virtual) assessment allows identification of any psychosocial issues which may have arisen from an acute hospital or critical care stay - these are often missed early on.

Start rehabilitation early! As advised by the Chartered Society of Physiotherapy (CSP), early mobilisation, simple exercises and functional activities of daily living are encouraged as soon as deemed safe by the multi-disciplinary team.

Take a holistic, biopsychosocial approach and connect with your multi-disciplinary team. An advantage of video-based consultations is that many people can join to assess or observe the patient - make sure the patient is introduced to any other practitioners and is happy for them to be present.

Remote respiratory assessment - consultant and patient

Case study: Telerehab for COVID-19

Telerehab for COVID tips

Prepare in advance:
  • As with any virtual rehab, make sure the patient/their family is prepared for a remote consultation and has all the information they will need in advance. Signpost the patient to the ‘Your COVID Recovery’ website and encourage them to make a list of questions before the appointment.
What to look out for:
  • In your assessment, consider risk, comorbidities and what is currently known about COVID.
  • Long-COVID symptoms can arise at any time. Look out for subtle signs that might give an early indication of a long-COVID diagnosis, including general apathy or if the patient is struggling to progress with rehab.
  • Look out for long-COVID red flags that indicate a need for urgent treatment – for example, severe chest pain, rapidly worsening breathlessness, mononeuropathies or abnormal movements.
Pacing and goal-setting:
  • Pacing is key – start small and don’t ask the patient to do too much. ‘Your COVID Recovery’ suggests logging activity in an activity diary for a week or two, and then looking for ‘boom and bust’ patterns, establishing a regular baseline of activity and then building activity by no more than 10% a week, guided by activity monitors.
  • Encourage setting of personal, short-term and medium-term goals.
  • Try to do the consultation at a time of day when the patient is less fatigued, and keep the session short. Consultations can be done from the patient’s bed if necessary.
  • Be mindful of cognitive effort, not just physical effort: 

    Do not overload the client as using technology is effortful and can be cognitively challenging.

    Occupational Therapist, Traumatic Brain Injury

Provide reassurance:

Reassure patients that many of the issues of COVID recovery (particularly physical recovery) are shared with recovery from critical illness and therefore this is not entirely new.

Physiotherapist, Respiratory

  • Recognise that the patient and their family may be anxious about COVID and its long term effects. Listen to their concerns and provide reassurance that this is normal and that they are not alone. (see 'Your COVID Recovery: After a stay in ICU'). This information is aimed at young people aged 12 years and above. (see 'Your COVID Recovery: 'Managing emotions and feelings').
  • Provide general wellbeing advice including exercise, sleep and healthy eating (see ‘Your COVID Recovery: Your road to recovery’).
  • Be aware that COVID affects people differently and there is no ‘set pathway’ for improvement. Rehabilitation needs will differ between individuals and may change over time.
Offer telephone support:
  • Depending on the intervention, some telephone support may assist with maintaining adherence and motivation to a programme. Many post critical care patients have issues that arise which make them wary of exercising, and so to wait until the next scheduled session often results in up to a week or more of inactivity which could have been prevented.
Assessment tools:
  • You may find the Borg Rating of Perceived Exertion (RPE) scale helpful to assess effort and exertion, breathlessness and fatigue when the patient is resting or carrying out different tasks. This can be used in conjunction with heart rate monitoring if the patient has an activity monitor (such as a Fitbit®).
  • For details of COVID-specific assessment tools (e.g. C19-YRS, PICUPS, PCFS), see our Remote measures and assessment tools section. These may be used for screening as well as assessment of outcomes.

Rehabilitation for COVID resources:

Alberta Health Services COVID-19 Scientific Advisory Group

Rapid evidence report on rehabilitation of COVID-19 patients (May 2020)
Link to resource

British Thoracic Society (BTS)

Guidance around pulmonary rehabilitation in COVID patients.
Link to resource

CHAIN network

Library of resources on COVID rehabilitation (with links to research and resources on COVID-19 including long-COVID).
Link to resource

Chartered Society of Physiotherapy (CSP)

COVID-19 Rehabilitation Standards Including standards on community physiotherapy.
Link to resource

National Multiple Sclerosis Society

Guidance on COVID-19 in MS patients and telehealth.
Link to resource

National Institute for Health and Care Excellence (NICE)

Rapid guideline on managing the long-term effects of COVID-19 (including rehabilitation).
Link to resource

NHS England/NHS Improvement

Your COVID Recovery
Link to resource

NHS England/NHS Improvement

Coronavirus guidance for clinicians and NHS managers’ (for up-to-date guidance in primary, secondary and community care)
Link to resource

Pan American Health Organization (PAHO)

Rehabilitation considerations during the COVID-19 outbreak
Link to resource

Queen’s Nursing Institute

Guide for community nurses (but also the wider multi-disciplinary team) caring for people living with COVID-19.
Link to resource

Royal Society of Medicine (RSM)

COVID-19 Learning Hub (education and learning resources related to COVID-19, including past webinars, guidance, specialty training and current evidence).
Link to resource

World Physiotherapy

COVID-19 briefing papers exploring the impact of COVID and safe rehabilitation approaches for long-COVID

Link to resource

Visit our resources for practitioners page for useful general resources on telerehab.