Post-COVID-19 syndrome: epidemiological and sociodemographic profile of patients referred for physical therapy rehabilitation

Síndrome pos-covid-19: perfil epidemiológico y sociodemográfico de los pacientes remitidos a rehabilitación fisioterapéutica

ABSTRACT

The spread of the SARS-CoV-2 virus, which causes COVID-19, has led to thousands of infections and deaths worldwide. Among survivors, a substantial proportion develop persistent symptoms, commonly referred to as post-COVID-19 syndrome. This study aims to describe the epidemiological and sociodemographic profile of patients with post-COVID-19 syndrome referred for rehabilitation. This is an observational, cross-sectional, descriptive study using a convenience sample. Fifty-eight participants aged over 18 were included, and data were collected at a university hospital in the city of Curitiba, Paraná State, Brazil. There was a prevalence of females aged 24-75, most of whom were white, married, and had completed high school education. None were current smokers, one reported harmful alcohol use, and most were physically inactive prior to COVID-19 infection. Most participants required Intensive Care Unit (ICU) admission during the acute phase of COVID-19 and required invasive mechanical ventilation, and all required oxygen therapy. The main reported symptoms were dyspnea and fatigue. Most participants had at least one comorbidity, with cardiovascular disease, obesity, and diabetes being the most prevalent. The findings suggest a strong association between disease severity and the presence of comorbidities, contributing to symptom persistence and the need for rehabilitation after hospital discharge.

Keywords:
Acute post-COVID-19 syndrome; COVID-19; Rehabilitation; Physical therapy

RESUMO

A disseminação do vírus SARS-CoV-2, causador da covid-19, culminou em milhares de infecções e óbitos. Entre os sobreviventes da doença, o número de indivíduos com sintomas persistentes, a chamada síndrome pós-covid, tornou-se frequente. Este estudo tem como objetivo descrever o perfil epidemiológico e sociodemográfico de pacientes com síndrome pós-covid-19 encaminhados para reabilitação. Trata-se de um estudo observacional, transversal e descritivo com amostra de conveniência. Foram incluídos 58 participantes maiores de 18 anos, e a coleta de dados foi realizada em um hospital universitário da cidade de Curitiba (PR). Observou-se prevalência pessoas do sexo feminino, na faixa etária de 24 a 75 anos, brancas, casadas e com o ensino médio completo. Nenhum participante era tabagista, um era etilista e a maioria era sedentária antes da infecção por covid-19. A maior parte permaneceu em UTI durante a infecção e necessitou de ventilação mecânica invasiva, e todos os pacientes fizeram uso de oxigenoterapia. As principais queixas referidas foram dispneia e fadiga. A maior parte dos participantes declarou pelo menos uma comorbidade, sendo as mais relatadas as cardiovasculares, obesidade e diabetes. Os resultados obtidos indicam forte relação entre gravidade da infecção e presença de comorbidades, com a persistência de sintomas e necessidade de reabilitação após alta hospitalar.

Descritores:
Síndrome pós-covid-19 Aguda; Covid-19; Reabilitação; Fisioterapia

RESUMEN

La propagación del virus SARS-CoV-2 causante de la covid-19 llevó a numerosas infecciones y muertes. Entre los sobrevivientes de la enfermedad es frecuente encontrar a individuos con síntomas persistentes llamado síndrome pos-covid. Este estudio tiene como objetivo describir el perfil epidemiológico y sociodemográfico de los pacientes con síndrome pos-covid-19 remitidos a rehabilitación. Se trata de un estudio observacional, transversal y descriptivo con una muestra de conveniencia. Se incluyeron 58 participantes con más de 18 años de edad, y la recolección de datos se realizó en un hospital universitario de la ciudad de Curitiba (Paraná, Brasil). Hubo una prevalencia de mujeres, de entre 24 y 75 años, blancas, casadas y con educación secundaria completa. Ninguno de los participantes era fumador, uno era alcohólico y la mayoría era sedentaria antes de la infección por covid-19. La mayoría de ellos permanecieron en la UCI durante la infección y requirieron ventilación mecánica invasiva, y todos los pacientes se sometieron a oxigenoterapia. Las principales quejas reportadas fueron disnea y fatiga. La mayoría de los participantes declararon al menos una comorbilidad, y las más reportadas fueron la enfermedad cardiovascular, la obesidad y la diabetes. Los resultados indican una fuerte relación entre la gravedad de la infección y la presencia de comorbilidades, con la persistencia de los síntomas y la necesidad de rehabilitación tras el alta hospitalaria.

Palabras clave:
Síndrome posagudo de covid-19; Covid-19; Rehabilitación; Fisioterapia

INTRODUCTION

In December 2019, the first cases of respiratory infection caused by SARS-CoV-2, a new coronavirus, were reported in China. COVID-19 became the third major epidemic after SARS-CoV-1 and MERS-CoV. Transmission occurs primarily through respiratory droplets and contact with contaminated surfaces, and common symptoms include fever, fatigue, cough, and dyspnea. Disease severity varies: approximately 80% of cases are mild, 15% are severe, and 5% are critical. Older adults and individuals with comorbidities are at higher risk of developing severe forms of the disease¹.

Following the acute phase of COVID-19 infection, some individuals report persistent symptoms consistent with “long COVID” or “post-COVID-19 syndrome.” These symptoms-such as memory loss, difficulty concentrating, dyspnea, cough, and fatigue-may persist or emerge three weeks or more after the initial infection. The exact cause of this condition remains unclear, but it is believed to be associated with multi-organ damage or the persistence of viral remnants^2,3.

Management of post-COVID-19 syndrome requires a multidisciplinary approach, including pharmacological treatment, nutritional support, and rehabilitation. Regular exercise provides immunoregulatory and anti-inflammatory effects, making physical therapy essential for alleviating persistent symptoms. Physical therapy has been crucial both in hospital settings, supporting mechanical ventilation and early mobilization, and in home-based rehabilitation, focusing on restoring muscle strength, pulmonary function, and aerobic capacity. Furthermore, this approach has been fundamental in managing post-COVID-19 syndrome, improving patients’ quality of life and physical capacity^4,5.

With the growing number of recovered individuals, it is essential to understand the profile of patients with persistent symptoms to develop more effective treatment and follow-up strategies. This study aimed to describe the epidemiological and sociodemographic profile of patients with post-COVID-19 syndrome referred to rehabilitation programs.

METHODOLOGY

This is an observational, cross-sectional, descriptive study conducted with a convenience sample of adults diagnosed with post-COVID-19 syndrome who were referred for pulmonary rehabilitation between August 2020 and October 2022.

Patients hospitalized at the Hospital de Clínicas of the Federal University of Paraná (UFPR) and diagnosed with COVID-19 received outpatient medical follow-up after discharge. Those who presented persistent functional, physical, and respiratory complaints four weeks or more after the onset of acute infection, with no other likely causes, were referred for outpatient physical therapy to participate in a rehabilitation program. It is important to note that all referrals were made at least four weeks after the onset of infection, consistent with post-COVID-19 syndrome.

Inclusion criteria comprised individuals of both sexes aged over 18 years who had been hospitalized, tested positive for COVID-19, and received a medical referral for physical therapy after discharge. Cases with incomplete hospitalization data were excluded.

Upon admission to the service, patients were informed about the study procedures and the voluntary nature of participation, and were then invited to undergo an initial assessment. Those who agreed to participate provided written informed consent.

Data were collected using a physical therapy evaluation with a form developed by the research team, which included epidemiological and sociodemographic information, medical history (lifestyle habits, comorbidities, and reported symptoms), and data related to hospitalization for COVID-19. The evaluation was conducted and recorded by one of the physical therapists of the research team, who had been previously trained for the study. Information regarding hospitalization was extracted from electronic medical records.

Data were stored in Microsoft Excel^® spreadsheets and analyzed using the Jamovi^® software (version 2.3.21). Results were expressed using descriptive statistics: categorical variables were presented as frequencies (absolute and relative), while continuous numerical variables were summarized using measures of central tendency (mean, median, minimum, and maximum) and dispersion (standard deviation).

RESULTS

Of the 87 patients who accessed the rehabilitation service, 29 declined to participate in the study, resulting in a final sample of 58 participants.

Of these, 31 (53.4%) were female and 27 (46.6%) were male, with ages ranging from 24 to 75 years and a mean age of 55.9 years. The predominant age group was 41-60 years, comprising 37 (63.8%) participants (Table 1).

Regarding race and marital status, 52 (89.7%) participants self-identified as white, and there was a prevalence of married individuals, totaling 41 (70.7%). Most participants had completed high school (n=21; 36.2%), followed by 18 (31.0%) with incomplete elementary education (Table 1).

As also shown in Table 1, in terms of occupation, there was a predominance of workers in commerce and construction, who together accounted for 18 participants (31% of the sample).

Table 1
Sociodemographic characterization of the participants

Characteristic	Total (n=58)	%	Mean	SD
	n
Gender
Female	31	53.4
Male	27	46.6
Age
Years	58		55.9	10.8
Age group (years)
24-75	58	100
20-40	3	5.2
41-60	37	63.8
61-75	18	31
Self-reported race/skin-color
White	52	89.7
Mixed-race	4	6.9
Black	1	1.7
Indigenous	1	1.7
Marital status
Single	6	10.3
Married	41	70.7
Separated	3	5.2
Divorced	1	1.7
Widowed	3	5.2
Other	4	6.9
Schooling level
No schooling	2	3.4
Incomplete middle school	18	31
Complete middle school	5	8.6
Incomplete high school	2	3.4
Complete high school	21	36.2
Incomplete higher education	2	3.4
Complete higher education	2	3.4
Academic specialization	2	3.4
Does not know	4	6.9
Occupation
Retired	8	13.8
Homemaker	6	10.3
Self-employed	7	12.1
Trade worker	9	15.5
Construction worker and related occupations	9	15.5
Healthcare worker	5	8.6
Administrative worker	5	8.6
Domestic worker	5	8.6
Other	4	6.9

• Note: results presented as mean ± standard deviation (SD) or as absolute (n) and relative (%) frequencies.

Regarding lifestyle habits, this study found that one participant (1.7%) reported harmful alcohol use, and none were current smokers. However, 31 (53.4%) had a history of smoking, of which 17 (54.8%) had quit smoking more than 10 years earlier. Regarding physical activity prior to COVID-19 infection, 35 (60.3%) were sedentary (Table 2).

Table 2
Participants’ lifestyle habits

Habit	Total (n=58)	%
	N
Harmful alcohol use
Yes	1	1.7
No	57	98.3
Smoking
Current	0	0
History of smoking
Yes	31	53.4
No	27	46.6
Quit more than 10 years ago (n=31)	17	54.8
Physical activity prior to COVID-19
Yes	23	39.7
No	35	60.3

• Note: results presented with absolute (n) and relative (%) frequency.

Regarding hospital data, length of stay ranged from three to 82 days, with a mean hospitalization duration of 24.1 days. Additionally, 40 (58%) participants required a stay in the Intensive Care Unit (ICU), 30 (51.7%) required invasive mechanical ventilation (IMV), and 58 (100%) required oxygen therapy. Furthermore, eight (13.79%) participants were discharged with supplemental oxygen for home use (Table 3).

Table 3
Data regarding hospitalization due to COVID-19

Parameter	Total (n=58)	%	Mean	SD	Median	Min.	Max.
	n
Length of hospitalization
Days			24.1	17.2	21	3	82
3-10 days	12	20.7
11-30 days	32	55.2
31-60 days	10	17.2
61-82 days	4	6.9
ICU admission
Yes	40	69.0
No	18	31.0
Use of IMV
Yes	30	51.7
No	28	48.3
Oxygen therapy
Yes	58	100.0
No	0	0.0
Discharge with supplemental oxygen
Yes	7	12.1
No	51	87.9

• Note: results presented with mean ± standard deviation (SD), median (minimum and maximum), and absolute (n) and relative (%) frequencies.

Among symptoms reported by participants, the most common were dyspnea, reported by 39 (67.2%) participants, followed by muscle fatigue in 29 (50%) and pain in 23 (39.6%). Regarding dyspnea, which was the most frequently reported symptom, 34 (58.6%) participants experienced dyspnea on moderate exertion. In terms of comorbidities, cardiovascular conditions were the most prevalent, affecting 20 (34.5%) participants, followed by obesity in 16 (27.6%) and diabetes in 16 (27.6%) (Table 4).

Table 4
Main symptoms and comorbidities

Parameter	Total (n=58)	%
	n
Main symptoms
Dyspnea	39	67.2
Muscle fatigue	29	50.0
Pain	23	39.7
Memory loss	14	24.1
Paresthesia	11	19.0
Paresis	10	17.2
Cough	7	12.1
Hoarseness	2	3.4
Edema	2	3.4
Other	15	25.9
Dyspnea
Small exertion	12	20.7
Moderate exertion	34	58.6
Great exertion	12	20.7
Comorbidities
Cardiovascular	20	34.5
Obesity	16	27.6
Diabetes	16	27.6
Lung diseases	6	10.3
Neoplasms	4	6.9
Chronic kidney diseases	3	5.2
Autoimmune diseases	2	3.4
Neurological	2	3.4
Organ transplantation	1	1.7
Immunodeficiency	1	1.7
No comorbidities reported	2	3.4

• Note: results presented with absolute (n) and relative (%) frequency.

DISCUSSION

The study revealed a predominance of females participants, with ages ranging from 24 to 75 years and a mean age of 55.9 years. Previous studies have reported a similar sex distribution, with a mean age of 52.3 years^6,7. In Paraná State, where the study was conducted, 53% of confirmed COVID-19 cases occurred among women, which is consistent with the findings of this and other studies⁸.

Regarding race/skin-color, this study found that 89.6% of participants self-identified as white. A study conducted in a Brazilian hospital reported that 46.2% of patients with persistent COVID-19 symptoms were white⁹. Another study performed in Paraná State indicated that, among hospitalized cases, 85% were white, 14% were Black, 1% were Asian, and less than 1% were Indigenous. Although most hospitalizations involved white individuals, mortality rates are higher among Black patients⁸.

Racial distribution in Brazilian cities is influenced by socioeconomic factors, public policies, and structural inequalities. The analysis of racial disparities highlights that factors such as access to healthcare, living conditions, and disease history affect the prevalence and severity of post-COVID-19 syndrome across different populations. Studies indicate that ethnic minority groups experienced greater disease severity and higher mortality during the pandemic¹⁰. According to the 2022 census conducted by the Brazilian Institute of Geography and Statistics (IBGE), the population of Paraná State is composed of 64.6% white, 30.1% Mixed-race, 4.2% Black, 0.9% Asian, and 0.2% Indigenous individuals, reinforcing the findings of this study¹¹.

There was a predominance of participants with complete high school education, accounting for 36.2% of the sample. A similar result was observed in a study conducted in Mexico City, which found that 35.3% of participants had completed high school or had incomplete higher education, followed by 24.8% with completed higher education or post-graduate degrees¹². Paraná State has one of the lowest illiteracy rates in Brazil, with Curitiba, its capital, reporting only 1.5% illiteracy-the second lowest rate among Brazilian cities with more than 500,000 inhabitants¹¹.

The study found that 30% of participants worked in commerce and construction. In contrast, a study conducted in Canada reported that 53% of participants worked in healthcare and 19% in commerce. Thus, the occupation variable does not show strong correlation across studies, possibly due to the diversity of professional activities and sample limitations¹³.

In this study, 60.3% of the analyzed population was classified as sedentary, a result consistent with findings by Silva et al.¹⁴, who reported a 54.9% prevalence of physical inactivity among individuals with post-COVID-19 sequelae, suggesting a possible association.

According to the Brazilian Ministry of Health Physical Activity Guidelines, adults should engage in at least 150 minutes of moderate activity per week¹⁵. The Brazilian National Health Survey¹⁶ reported that 40% of adults in Paraná State were insufficiently active. However, data from Vigitel¹⁷ showed that 57.3% of the population in Curitiba engaged in regular physical activity, placing the city among the Brazilian capitals with the highest levels of physical activity, in contrast to the national average, in which 48.7% of adults were physically inactive.

Regarding smoking, the study found that none of the patients were current smokers, but 53.4% had a history of smoking-a result similar to that reported by Evans et al.¹⁸, who found 1.8% current smokers and 45.4% former smokers. These findings suggest a possible association between smoking history and the persistence of COVID-19 symptoms. In Paraná State, tobacco use rates have been declining, with 14.6% of the adult population reporting tobacco use in 2019, compared to 17.8% in 2013. However, smoking remains a significant public health concern¹⁶.

In this study, 58% of participants required admission to the ICU, a proportion comparable to a previous study reporting a 51.1% ICU stay among 178 patients undergoing post-COVID-19 rehabilitation¹⁹. In Paraná State, the ICU admission rate was 46%, suggesting an association between the severity of COVID-19 infection and the presence of prolonged symptoms⁹. Discrepancies between states and cities may reflect differences in disease severity or variations in ICU capacity and management of critically ill patients.

The study found that 51.7% of participants required IMV; however, its relationship with the severity of long-term symptoms was not assessed. Other studies indicate that, 90 days after hospital discharge, there were no significant differences in symptom severity between patients who required IMV and those who did not¹².

Participants’ reported symptoms showed that dyspnea was the most prevalent, affecting 67.2% of patients, followed by fatigue, present in 50% of the sample. These findings are consistent with other studies, such as that by Montani et al.³, which identify dyspnea as the most common respiratory symptom, especially among patients who required ICU admission. Fatigue is also widely reported in the literature, although the study by Battistella et al.⁹ did not identify significant levels of this symptom³.

This study showed that 34.5% of participants reported cardiovascular comorbidities, followed by 27.6% with obesity and diabetes. These findings are consistent with other studies that have also identified cardiovascular and metabolic diseases as predominant^3,20,21. In Paraná State, 34.3% of cases are associated with chronic cardiovascular diseases and 22.9% with diabetes mellitus, reflecting a similar pattern across several studies. The high rate of severe infections in among older adults, combined with the prevalence of comorbidities, highlights the need for targeted strategies for the prevention and management of COVID-19 and post-COVID-19 syndrome, emphasizing the importance of an integrated approach that considers the impact of these conditions on disease severity⁸.

Given the millions of individuals infected worldwide, further studies are essential to better understand the socioeconomic and epidemiological profile of this population, aiming to improve health management related to post-COVID-19 syndrome.

CONCLUSION

The study provided a comprehensive overview of the sociodemographic and epidemiological profile of patients with post-COVID-19 syndrome, highlighting the predominance of women, physical inactivity, and a history of smoking as factors associated with symptom persistence. It was observed that many of these patients required ICU admission, suggesting that individuals with more severe forms of the disease face greater challenges during rehabilitation. Post-COVID-19 syndrome was also associated with preexisting comorbidities, indicating potential long-term health implications.

Considering these findings, the implementation of integrated approaches tailored to this patient profile is essential. Early identification and management of associated comorbidities may significantly improve clinical outcomes and promote quality of life. Future studies should continue to explore these relationships to refine prevention and intervention strategies, ensuring a more effective response to the long-term consequences of COVID-19.

ACKNOWLEDGMENTS

The authors acknowledge the support of the Master’s Program in Public Health at the Federal University of Paraná (UFPR). This study is part of the master’s thesis entitled “Functional capacity in the post-COVID-19 syndrome: physical therapy in public health and rehabilitation.”

DATA AVAILABILITY STATEMENT

The entire dataset supporting the results of this study is available within the article.

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• Financing source:
  nothing to declare
• 3
  Approved by the Research Ethics Committee of the UFPR Hospital de Clínicas Complex: Opinion No. 4.805.035. (CAAE: 47158821.6.0000.0096).

Edited by

• Responsible editor:
  Sônia LP Pacheco de Toledo

Publication Dates

• Publication in this collection
  26 June 2026
• Date of issue
  2026

History

• Received
  02 May 2024
• Accepted
  07 Jan 2025