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Final Program


Final Program

COVID Rehabilitation

902 - Rehabilitation Strategies for COVID-19–Induced Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Scoping Review from a PM&R Perspective

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • SM

    Smeet P. Madhani, DO

    Resident
    Mercy Fitzgerald Hospital
    Philadelphia, Pennsylvania, United States

  • NM

    Nicole Marici, DO

    Resident
    Mercy Fitzgerald Hospital
    Philadelphia, Pennsylvania, United States

    • Submitter(s)

  • SM

    Smeet P. Madhani, DO

    Mercy Fitzgerald Hospital
    Philadelphia, Pennsylvania, United States

Objectives: To synthesize and evaluate rehabilitation strategies for patients with COVID-19–induced ME/CFS, with a focus on interventions applicable in physiatric practice. Post-acute sequelae of SARS-CoV-2 infection (PASC) can include ME/CFS, characterized by debilitating fatigue, post-exertional malaise, cognitive dysfunction, and autonomic symptoms. The optimal rehabilitation approach for this population remains unclear, and PM&R clinicians are increasingly involved in designing individualized care plans.

Design:  A scoping review was conducted in January 2025 using PubMed, Embase, and Cochrane databases. Search terms included “COVID-19,” “ME/CFS,” “rehabilitation,” “physical medicine,” and “long COVID.” Inclusion criteria: peer-reviewed studies published between January 2020 and December 2024; adult or pediatric populations; interventions targeting rehabilitation; English language. Of 214 abstracts screened, 27 met inclusion criteria and underwent full-text review.

Results:

Rehabilitation approaches fell into five main categories:



  1. Activity Pacing & Energy Conservation (14 studies) – Structured pacing programs reduced symptom exacerbation and improved daily function without triggering post-exertional malaise.




  2. Autonomic Regulation (8 studies) – Interventions such as compression garments, hydration strategies, and tilt-training benefited patients with co-existing orthostatic intolerance.




  3. Cognitive Rehabilitation (5 studies) – Targeted neurocognitive exercises and compensatory strategies improved attention and working memory.




  4. Low-Intensity Physical Therapy (7 studies) – Gentle, graded stretching and breathing exercises showed benefit when tailored to avoid symptom flares.



  5. Adjunctive Modalities (4 studies) – Emerging evidence supports neuromodulation and mind-body therapies (yoga, mindfulness-based stress reduction) as feasible adjuncts.



Conclusions: COVID-19–induced ME/CFS requires rehabilitation protocols distinct from traditional post-viral fatigue or deconditioning programs. Physiatrists should emphasize pacing, symptom-trigger avoidance, and autonomic stabilization while cautiously integrating physical and cognitive therapy. More high-quality RCTs are needed to refine evidence-based guidelines.