Efficacy of Synchronous vs. Asynchronous Telerehabilitation for Musculoskeletal Symptoms in Post-Covid-19 Syndrome: A Randomized Clinical Trial.

Objective: Compare the effects of physiotherapist-supervised synchronous telerehabilitation (TR) with unsupervised asynchronous TR in adults diagnosed with post-COVID syndrome (PCS). Methods: In this single-blind randomized controlled trial conducted with 31 participants with PCS were randomized into a synchronous telerehabilitation (STR) group, which underwent two-hour sessions per week for eight weeks, and an asynchronous telerehabilitation (ATR) group, which performed unsupervised exercises. Lower limb functional strength (Five Times Sit-to-Stand Functional Test) as the primary outcome, and the dyspnea (Modified Medical Research Council), fatigue (Fatigue Assessment Scale), stress, anxiety, depression (Depression, Anxiety, and Stress Scale-21), and quality of life (World Health Organization Quality of Life-BREF Questionnaire) were assessed remotely at the baseline, after 8 weeks of intervention, and at a 20-week follow-up. Data were analyzed using a mixed-model analysis of variance. Intervention: Participants were randomized into a synchronous telerehabilitation (TRS) group, which performed two-hour sessions per week for eight weeks, and an asynchronous telerehabilitation (TRA) group, which performed the same exercise protocol but without the supervision of a physiotherapist. Instructional videos were made available via social media (WhatsApp and YouTube). Participants were also instructed to perform the protocol twice a week for eight weeks. Results: A statistically significant difference was only observed in lower limb functionality between both groups (p = 0.02). The STR group demonstrated significant improvements in lower limb functional strength (p = 0.03), dyspnea (p = 0.02), fatigue (p = 0.00), stress (p = 0.03), and quality of life (p = 0.00), without any adverse events. Conversely, the ATR group experienced significant improvements in fatigue (p = 0.00) and anxiety (p = 0.02). Conclusion: The present findings show that both modalities demonstrated positive effects over an 8-week TR program in adults with PCS. However, the synchronous approach achieved greater improvements in lower limb functionality, dyspnea, fatigue, stress, and quality of life. Our findings revealed that asynchronous model was associated with higher dropout rates and suggest synchronous TR may offer advantages regarding treatment adherence.