Perceptions of Rehabilitation Access After SARS-CoV-2 Infection in Romanian Patients with Chronic Diseases: A Mixed-Methods Exploratory Study

Abstract

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients' perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro-Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann-Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0-2.0], quality of services 0.0 [0.0-4.0], staff empathy 0.0 [0.0-5.0], and perceived effectiveness 0.0 [0.0-5.0]. The median score for perceived difficulties in access was 1.0 [1.0-2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings.

Keywords: COVID-19; Romania; SARS-CoV-2; chronic diseases; healthcare access; mixed methods; patient satisfaction; rehabilitation services.