Challenges of usability and access to a digital tool in a telerehabilitation program for COVID- 19 survivors in a developing country

Objective: The outbreak of COVID-19 brought many challenges for health system, including for rehabilitation facilities. To supply the high amount of patients with disabilities and functional impairments, telerehabilitation might be a feasible strategy. The aim of this prospective clinical trial is to present a practical experience of a 3-month physical telerehabilitation program, for post COVID-19 patients from a public health system, after hospital discharge. Method: The sample was recruited from a list of 407 patients, to be enrolled up to eight weeks after discharge. Primary outcome measures: Two-minute step test (2MST), Time to Five repetition in the Sit-To-Stand Test, EuroQol (EQ5D). This virtual-wise program consisted of customized videos for respiratory and functional exercises, on a 3-times a week basis. Results: Out of 407 patients, only 19 were enrolled, and 14 completed the program. Main sample losses were due to lack of phone contact, internet and technological constraints and in-person return to work needs. Participants mean age was 56 ± 16.8, 57.9% men; 12 (63.2%) lost weight during hospitalization. Patients increased the 2MST (p= 0.004), a reduction in the five repetitions in the sit and stand test (p= 0.002) and health status score (p= 0.007). Conclusion: Telerehabilitation is a promising option for the treatment of post-discharge COVID-19, physically disabled patients. However, socioeconomical barriers must be taken into account during the development of remote programs for rehabilitation, in order to ensure population access, especially to unequal countries.