Post-Acute Sequelae of COVID-19: Frequency and Rehabilitation

Sick female lying on bed in ICU. Mid adult patient is looking away while wearing protective face mask. She is in hospital during COVID-19 pandemic.
What are the risk factors for post-acute sequelae of COVID-19, and which patients are most likely to seek rehabilitation services to address these sequelae?

Post-acute sequelae of COVID-19 — a condition often referred to as “long COVID” — was found in 42.8% of adults with COVID-19 in a large retrospective study patients with COVID-19 conducted by researchers at the University of Minnesota. The study also found that patients with post-acute sequelae of COVID-19 frequently used rehabilitation services. These were among study findings published in Archives of Physical Medicine and Rehabilitation.

Previous studies suggest rehabilitation may be helpful for patients with post-acute sequelae of COVID-19 or long COVID. Researchers for the current study sought to investigate the frequency of long COVID as well as factors associated with the use of rehabilitation among patients experiencing post-acute sequelae of COVID-19. “We hypothesized that patients with more severe disease and more comorbidities would require more rehabilitation services,” the researchers noted.

Study authors retrospectively assessed medical records of 19,792 patients (17,808 ≥18 years of age) who had been seen or hospitalized for COVID-19 at 12 participating hospitals and 60 primary care clinics between March 2020 and January 2021. Among the adult population of this cohort, 42.8% developed post-acute sequelae of COVID-19, and these patients with long COVID also had a greater utilization of rehabilitation services that those without post-acute sequelae of COVID-19 (8.6% vs 3.8%, respectively; P <.001), the investigators found.

In assessing demographic factors associated with risk for developing post-acute sequelae of COVID-19, the study authors found that those patients with greater risk for post-acute sequelae of COVID-19 were Asian or Black, lived in rural areas, were non-English speaking, or were pregnant. Conversely, male sex appeared to be protective against development of post-acute sequelae of COVID-19, the investigators found.

The study also found that a higher risk for developing post-acute sequelae of COVID-19 was associated with inpatient admission for COVID-19, the need for rehabilitation prior to COVID-19 infection, and having certain comorbidities or taking certain medications prior to COVID-19 infection.

Among patients with post-acute sequelae of COVID-19, risk factors associated with the need for rehabilitation services included younger age, pregnancy, and comorbidities. Characteristics associated with higher use of rehabilitation services included male sex, older age, being Asian, and being Hispanic.

Notably, study investigators found that patients on angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor-blockers (ARBs) 3 months prior to COVID-19 infection had a decreased risk of needing rehabilitation (Odds Ratio [OR] 0.80; 95% CI, 0.64-0.99; P =.04) compared with non-users of ACE inhibitors or ARBs.

Researchers concluded that there is a high frequency of post-acute sequelae of COVID-19, that these patients “had a high amount of resource utilization,” and that several demographic features and comorbidities were associated with greater use of rehabilitation services.

Study limitations included the inability to draw casual relationships, residual confounding, selection bias, and no control cohort for comparison.


Abdelwahab N, Ingraham NE, Nguyen N, et al. Predictors of post-acute sequelae of COVID-19 development and rehabilitation: A retrospective study. Arch Phys Med Rehabil. Published online May 12, 2022. doi:10.1016/j.apmr.2022.04.009