Development of a home-based pulmonary rehabilitation program for long COVID in Jordan using an expert consensus survey informed by qualitative item generation

Abstract

Long COVID is associated with persistent fatigue, dyspnea, and reduced functional capacity, yet access to centre-based pulmonary rehabilitation remains limited, particularly in low- and middle-income settings. This study aimed to develop a consensus-based, evidence-informed home-based pulmonary rehabilitation (HBPR) programme for individuals with Long COVID in Jordan through an expert consensus survey informed by qualitative item generation. The programme development process involved a qualitative item-generation phase followed by a quantitative consensus survey with 15 experts, including physiotherapists and rehabilitation physicians with expertise in pulmonary rehabilitation and Long COVID management. The qualitative item-generation phase was informed by findings from a prior systematic review and meta-analysis, with qualitative responses analyzed thematically to generate preliminary programme components. In the subsequent consensus survey, experts rated the importance and feasibility of each component using a 5-point Likert scale, with consensus defined as ≥ 70% agreement and a median score of ≥ 4. Of 97 statements evaluated, 90 (92.8%) achieved consensus. The final HBPR programme included recommendations on programme structure, safety, exercise prescription, patient education, pacing, symptom-guided progression, screening for post-exertional malaise, and low-technology delivery, while components requiring intensive supervision or advanced technology were considered less feasible. This consensus-based, evidence-informed HBPR programme provides a structured framework for home-based rehabilitation in individuals with Long COVID, particularly in resource-limited settings, and warrants further evaluation of its feasibility, acceptability, and clinical effectiveness.