Effectiveness of Multidisciplinary Rehabilitation on Functional Recovery in Post-COVID-19 Patients: A Multicentric Study Across Ecuadorian Healthcare Centers

Paola Yepez^1,2Juan Martinez-lemus³Alejandra Mafla-Viscarra^1,2Fernando Ortega Pérez¹David Sebastián Peña Campos¹Jorge Elías Rodríguez Arias¹Evelyn Caballero Caballero²Mirely Tobar²Killen H. Briones-Zamora⁴Killen H. Briones-Claudett^5*MIchelle Grunauer^1,2*

• ¹School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
• ²RISE (Reaching Impact, Saturation and Epidemic Control), Quito, Ecuador, El Salvador
• ³University of Texas Health Science Center, McGovern Medical School, Texas, United States
• ⁴Universidad de Especialidades Espiritu Santo, Samborondon, Ecuador
• ⁵Universidad Internacional del Ecuador, Quito, Ecuador

Background: Post-COVID-19 Condition (PCC) poses a major challenge for health systems, especially in low-and middle-income countries, and evidence on the benefits of multidisciplinary rehabilitation is limited. Objective: To evaluate functional and perceived health changes over 12 weeks of multidisciplinary rehabilitation and determine whether recovery differs between patients with and without PCC. Methods: We conducted a multicentric, longitudinal cohort study of adults with confirmed COVID-19 enrolled in a multidisciplinary rehabilitation program. PCFS and AVS were assessed at baseline and at 4-week intervals through Week 12. Patients were classified by PCC status at baseline (enrollment). Group comparisons, longitudinal analyses, and unadjusted and adjusted logistic regression models were performed to evaluate changes over time and factors associated with reduced functional improvement. Analyses were conducted using SPSS V.25 and GraphPad Prism V.10. Results: A total of 477 patients were enrolled; 354 (74.2%) met criteria for PCC at baseline (enrollment), and 123 (25.8%) were classified as non-PCC. Follow-up completion for PCFS was 351 patients at Week 4 (73.6%), 330 at Week 8 (69.2%), and 250 at Week 12 (52.4%). At baseline, PCC patients were younger (p = 0.030), had more comorbidities (p < 0.001), and differed in education (p = 0.007), occupation (p = 0.012), and initial provider type (p = 0.004), while sex did not differ (p = 0.299). Over 12 weeks, PCFS decreased by 0.48 points (95% CI –0.65 to –0.31, p < 0.0001) and AVS increased by 0.68 points (95% CI 0.56 to 0.80, p < 0.0001). In adjusted models, baseline PCC was strongly associated with lower odds of PCFS improvement (aOR 0.27, 95% CI 0.13–0.56, p < 0.001). AVS improvement did not differ by baseline PCC status (p = 0.062). Conclusion: A multidisciplinary rehabilitation program improved functional status and perceived health, though patients with baseline PCC showed less functional recovery. These findings underscore the importance of early identification of PCC status at enrollment and the need for targeted rehabilitation.