Rehabilitation professionals at the COVID-19 frontline: a testimony-informed narrative review of health-worker mortality, vaccine hesitancy, physiotherapy and telerehabilitation

Background COVID-19 placed an unprecedented burden on health workers and disrupted rehabilitation services. Existing reviews have examined health-worker infection and mortality, vaccine hesitancy and telerehabilitation separately; few have considered these dimensions together from the perspective of rehabilitation professionals. Methods Narrative review following SANRA recommendations. PubMed, Scopus and Google Scholar were searched (initial search January 2019–December 2022; updated during revision to December 2025 to capture later publications reporting 2020–2021 data). Sources were selected purposively, prioritising systematic reviews, large multicentre studies and official agency reports. First-person clinical observations from the author's postgraduate training in two French university hospitals are presented separately, in labelled boxes, and are not used as evidence for quantitative claims. Results WHO estimated 80,000–180,000 health and care worker deaths from COVID-19 between January 2020 and May 2021 (central estimate 115,500), versus 6,643 reported through surveillance. Front-line workers had a 3.4-fold higher adjusted risk of a positive test than the general community. Vaccine hesitancy among health workers was 37% in a 91-country survey and 22.5% in a review of 76,471 workers; a scoping review of nurses reported 20.7% refusal. In a French tertiary centre, 73.1% were in favour, 23.1% hesitant and 3.9% opposed. Physiotherapy guidance addressed acute respiratory care, early mobilisation and post-COVID-19 rehabilitation. Telerehabilitation achieved outcomes similar to centre-based pulmonary rehabilitation, but accounted for only 6% of outpatient episodes in a large US database. Four heuristic constructs are proposed: Frontline Abandonment Syndrome (FAS), Vaccination Refusal Cascade (VRC), Telerehabilitation Emergency Pivot (TEP) and Post-COVID Functional Decoupling (PCFD). Each is positioned against existing terminology and presented as a testable hypothesis rather than a validated construct. Conclusions COVID-19 exposed gaps in health-worker protection, communication around vaccination and the integration of rehabilitation into pandemic preparedness. Telerehabilitation deserves a defined place in hybrid care models, and the proposed constructs require formal concept analysis and empirical testing.