Multicenter Study

. 2025 Oct 31;20(10):e0334941.

doi: 10.1371/journal.pone.0334941. eCollection 2025.

Utilization of interdisciplinary in-hospital early rehabilitation in COVID-19 patients - a multicenter cohort study in the National Pandemic Cohort Network (NAPKON) in Germany

Max E Liebl¹, Anett Reisshauer¹, Dana Loudovici-Krug², Philipp Baumbach³, Katharina S Appel⁴, Sabine Blaschke⁵, Johanna Erber⁶, Ilka Grewe⁷, Marina Hagen⁸, Ekaterina Heim⁹, Sina M Hopff¹⁰, Kristin Lehnert^{11

12}, Patrick Meybohm¹³, Olga Miljukov^{14

15}, Milena Milovanovic¹⁶, Susana M Nunes de Miranda¹⁰, Christoph Römmele¹⁷, Phil-Robin Tepasse¹⁸, Jörg J Vehreschild^{4

10

19}, Norman Weinert²⁰, Martin Weigl²¹, Julia Wendel¹⁴, Christina Lemhöfer²

Affiliations

¹ Department of Physical and Rehabilitation Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
² University Hospital Jena, Institute of Physical and Rehabilitation Medicine, Friedrich-Schiller University Jena, Jena, Germany.
³ Department for Anesthesiology and Intensive Care Medicine, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
⁴ Faculty of Medicine, Goethe University Frankfurt, Institute for Digital Medicine and Clinical Data Science, Frankfurt, Germany.
⁵ Central Emergency Department, University Medical Center Göttingen, Göttingen, Germany.
⁶ TUM School of Medicine and Health - Clinical Department for Internal Medicine II, TUM University Hospital, Technical University of Munich, Munich, Germany.
⁷ I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development, Hamburg, Germany.
⁸ Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany.
⁹ Trusted Third Party of the University Medicine Greifswald, Greifswald, Germany.
¹⁰ Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.
¹¹ DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany.
¹² Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
¹³ Department of Anaesthesiology, University Hospital Würzburg, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
¹⁴ University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany.
¹⁵ University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany.
¹⁶ Malteser Krankenhaus St. Franziskus Hospital, Medical Clinic I, Flensburg, Germany.
¹⁷ Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany.
¹⁸ Department of Medicine B for Gastroenterology, University Hospital Münster, Hepatology, Endocrinology and Clinical Infectiology, Münster, Germany.
¹⁹ German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany.
²⁰ Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.
²¹ Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.

PMID: 41171750
PMCID: PMC12578259
DOI: 10.1371/journal.pone.0334941

Multicenter Study

Utilization of interdisciplinary in-hospital early rehabilitation in COVID-19 patients - a multicenter cohort study in the National Pandemic Cohort Network (NAPKON) in Germany

Max E Liebl et al. PLoS One. 2025.

. 2025 Oct 31;20(10):e0334941.

doi: 10.1371/journal.pone.0334941. eCollection 2025.

Authors

Affiliations

¹ Department of Physical and Rehabilitation Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
² University Hospital Jena, Institute of Physical and Rehabilitation Medicine, Friedrich-Schiller University Jena, Jena, Germany.
³ Department for Anesthesiology and Intensive Care Medicine, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
⁴ Faculty of Medicine, Goethe University Frankfurt, Institute for Digital Medicine and Clinical Data Science, Frankfurt, Germany.
⁵ Central Emergency Department, University Medical Center Göttingen, Göttingen, Germany.
⁶ TUM School of Medicine and Health - Clinical Department for Internal Medicine II, TUM University Hospital, Technical University of Munich, Munich, Germany.
⁷ I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development, Hamburg, Germany.
⁸ Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany.
⁹ Trusted Third Party of the University Medicine Greifswald, Greifswald, Germany.
¹⁰ Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.
¹¹ DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany.
¹² Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
¹³ Department of Anaesthesiology, University Hospital Würzburg, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
¹⁴ University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany.
¹⁵ University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany.
¹⁶ Malteser Krankenhaus St. Franziskus Hospital, Medical Clinic I, Flensburg, Germany.
¹⁷ Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany.
¹⁸ Department of Medicine B for Gastroenterology, University Hospital Münster, Hepatology, Endocrinology and Clinical Infectiology, Münster, Germany.
¹⁹ German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany.
²⁰ Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.
²¹ Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.

PMID: 41171750
PMCID: PMC12578259
DOI: 10.1371/journal.pone.0334941

Abstract

Background: Early rehabilitation in acute hospitals aims to prevent immobilization-related complications and improve the functional capacity of patients with severe or critical illness. Early rehabilitation can be a useful concept to improve functioning in COVID-19 patients. However, literature concerning early in-hospital rehabilitation in COVID-19 patients is scarce.

Aim: To analyze the utilization of in-hospital interdisciplinary early rehabilitation (IER) in COVID-19 patients and characterize the sample of IER patients.

Design: Prospective cohort study.

Setting: Hospitalized COVID-19 patient cases.

Population: This study used data from the National Pandemic Cohort Network (NAPKON) in Germany.

Methods: IER utilization rates were retrieved. Demographic and clinical data from hospitalized COVID-19 patients who had received IER during the course of their treatment were evaluated.

Results: Out of the 2,644 patients in the Cross-Sectoral Platform (German abbreviation: SUEP) cohort, 0.79% [95% CI: 0.51% to 1.22%] received IER during their stay in an acute care hospital. Among the subgroup of patients who had previously been treated in intensive care, 2.13% [95% CI: 1.16% to 3.63%] received IER. The most common comorbidities were cardiovascular diseases (66.7%) and neurological/psychiatric diseases (36.1%). The small sample size limited further analyses.

Conclusion: The low rate of early rehabilitation in acute hospitals for COVID-19 patients indicates an unmet need, particularly in severe cases. Structural changes in the health system are needed to close this gap. The WHO and the German Medical Council have recently acknowledged the necessity of early in-hospital rehabilitation and have issued a call for its implementation in acute hospitals.

Copyright: © 2025 Liebl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

EJ received honoraria for lectures and/or travel expenses support from Gilead Sciences. EJ and SMH received travel expenses support from Tillots Pharma AG. JJV has received honoraria from Merck / MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), University Hospital Freiburg/ Congress and Communication, Academy for Infectious Medicine, University Manchester, German Society for Infectious Diseases (DGI), Ärztekammer Nordrhein, Ärztekammer Hessen, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine (DGIM), Shionogi, Molecular Health, Netzwerk Universitätsmedizin, Janssen, NordForsk, Biontech, APOGEPHA, German Cancer Consortium (DKTK), University Hospital Oldenburg. JJV has received support for attending meetings and/or travel from German Centre for Infection Research (DZIF), University Manchester, German Society for Infectious Diseases (DGI), University Hospital Aachen, German Society for Internal Medicine (DGIM), Netzwerk Universitätsmedizin, German Cancer Consortium (DKTK). JJV participate on Data Safety Monitoring Board or Advisory Board of Merck / MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), Academy for Infectious Medicine, University Manchester, German Society for Infectious Diseases (DGI), German Society for Internal Medicine (DGIM), Netzwerk Universitätsmedizin, Janssen, Biontech. JJV received grants or contracts from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), German Federal Ministry of Education and Research (BMBF), Deutsches Zentrum für Luft- und Raumfahrt (DLR), University of Bristol, Rigshospitalet Copenhagen, German Network University Medicine, German Cancer Consortium (DKTK), German Federal Ministry of Health (BMG), European Union. The funders provided support for authors EJ, SMH, and JJV, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.

Figures

**Fig 1. Flow chart.**
IER utilization data stratified by prior ICU treatment (SUEP: German abbreviation: Cross-Sectoral Platform, IER: in-hospital interdisciplinary early rehabilitation, ICU: intensive care unit).

**Fig 2. Flow chart.**
Clinical analysis sample with 3MFU (3MFU: 3 Month Follow Up, SUEP: German abbreviation: Cross-Sectoral Platform, ER: early rehabilitation, IER: in-hospital interdisciplinary early rehabilitation).

See this image and copyright information in PMC

References

1. Beyer J, Berliner M, Glaesener J-J, Liebl M, Reiners A, Reißhauer A, et al. Positionspapier zur Fachübergreifenden Frührehabilitation. Phys Rehab Kur Med. 2015;25(05):260–80. doi: 10.1055/s-0035-1564089 - DOI
1. Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019;14(10):e0223185. doi: 10.1371/journal.pone.0223185 - DOI - PMC - PubMed
1. Lau HM-C, Ng GY-F, Jones AY-M, Lee EW-C, Siu EH-K, Hui DS-C. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother. 2005;51(4):213–9. doi: 10.1016/s0004-9514(05)70002-7 - DOI - PMC - PubMed
1. Masiero S, Zampieri D, Del Felice A. The Place of Early Rehabilitation in Intensive Care Unit for COVID-19. Am J Phys Med Rehabil. 2020;99(8):677–8. doi: 10.1097/PHM.0000000000001478 - DOI - PMC - PubMed
1. Fleischmann-Struzek C, Rose N, Born S, Freytag A, Ditscheid B, Storch J, et al. White Paper - Improving the care of patients with impairments following sepsis and infections. Dtsch Med Wochenschr. 2022;147(8):485–91. doi: 10.1055/a-1741-3013 - DOI - PubMed

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Utilization of interdisciplinary in-hospital early rehabilitation in COVID-19 patients - a multicenter cohort study in the National Pandemic Cohort Network (NAPKON) in Germany

Affiliations

Utilization of interdisciplinary in-hospital early rehabilitation in COVID-19 patients - a multicenter cohort study in the National Pandemic Cohort Network (NAPKON) in Germany

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Full Text Sources

Medical

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