What is PASC and Where Does Rehabilitation Therapy Fit In?

By: Cheryl “Chae” Dimapasoc Canon, PT, DPT;  OptimisPT Director of Implementation and Compliance

PASC stands for Post-Acute Sequelae of SARS-CoV-2; it’s often used interchangeably with “long-COVID” and “post-COVID syndrome”.  While most people fully recover from COVID-19, it is estimated that 10% become “long-haulers”.  That equates to over 2 million people in the US that are going to require long-term rehab. While symptoms vary from person to person and can persist for months or even years, the most common lasting symptoms include but are not limited to impairments in muscle strength, heart and lung capacity, pain, balance, endurance, cognitive changes, and walking ability leading to a loss of function and independence.

So, where does Rehab Therapy fit in?

When we look at the lasting symptoms, many are areas that could benefit from physical, occupational and/or speech therapy intervention.  If we are not actively marketing to our referral sources, patients and communities that “if they have experienced COVID and have any of these symptoms, they should seek out therapy”, we are missing out on a lot of individuals that we could be helping. 

A disclaimer that the APTA includes and is recommended in the communication with the public: If you have symptoms of long COVID, contact your primary care doctor. Long COVID may include other health complications that require labs, tests, or imaging before being referred to a physical therapist for an evaluation and treatment specific to your condition. Note: Exercise may not be appropriate for everyone living with long COVID.

The CDC then goes on to say, “When it comes to PASC, the CDC recommends a holistic approach that doesn’t rely solely on lab testing and standard physical exam.” The CDC imparts that the patient history and validating the effects of symptoms on daily life are key to developing a successful treatment plan, “Where clinically indicated, symptom management and a comprehensive rehabilitation plan can be initiated simultaneously with laboratory testing for most patients.”

So what are the tests that retrospective research has shown to be the most valuable and effective in the treatment of PASC patients?  Here is a list of some that should be considerations in your evaluation:

Impairment Measures

  • 6 Minute Walk Test or 2-min step test (endurance)
  • 10 Meter Walk Test (gait speed)
  • Mobility
  • Strength
  • Manual Assessment of Respiratory Motion (MARM)
  • Transfer and ambulation independence

Additional Evaluative Findings

  • O2 sat
  • BP (at rest and during exertion)
  • Heart Rate

Outcome Measures

  • Berg Balance Scale (measures of fall risk) 
  • St. Louis University Mental Status examination (SLUMs) (cognition) 
  • Speech and swallowing (American Speech and Hearing Association National Outcomes Measurement System Functional Communication Measures)
  • Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (functional status)
  • PHQ-9 (screening for depression)

While this list is not all inclusive, it provides general guidance based on the literature.

OptimisPT is committed to continuing to provide evidence-based patterns and content to assist the therapist in creating compliant, defensible documentation that supports medical necessity.  New text templates and measures are available within OptimisPT for patients with long-COVID.

As we learn more and more about the long term effects of COVID, it is becoming very clear that rehabilitation therapies are going to be extremely beneficial in decreasing and recovering from the deficits brought on by COVID.  Now is a great time for you and your rehab staff to familiarize yourself with the specific measures and treatments that are available for your long-haul COVID patient population, which unfortunately, is sure to increase as the pandemic continues.



Zhu, Yuetong et al. “Summary of respiratory rehabilitation and physical therapy guidelines for patients with COVID-19 based on recommendations of World Confederation for Physical Therapy and National Association of Physical Therapy.” Journal of physical therapy science vol. 32,8 (2020): 545-549. doi:10.1589/jpts.32.545

Zampogna E, Paneroni M, Belli S, Aliani M, Gandolfo A, Visca D, Bellanti M, T, Ambrosino N, Vitacca M: Pulmonary Rehabilitation in Patients Recovering from COVID-19. Respiration 2021;100:416-422. doi: 10.1159/000514387

Cameron Spencer Olezene ,Elizabeth Hansen,Hannah K. Steere,Joseph T. Giacino,Ginger R. Polich,Joanne Borg-Stein,Ross D. Zafonte,Jeffrey C. Schneider. Functional outcomes in the inpatient rehabilitation setting following severe COVID-19 infection. Published: March 31, 2021. https://doi.org/10.1371/journal.pone.0248824

Rogers-Brown JS, Wanga V, Okoro C, et al. Outcomes Among Patients Referred to Outpatient Rehabilitation Clinics After COVID-19 diagnosis — United States, January 2020–March 2021. 

MMWR Morb Mortal Wkly Rep 2021;70:967–971. DOI: http://dx.doi.org/10.15585/mmwr.mm7027a2external icon