Neurological symptoms are very prevalent in people with long COVID. These may include tiredness, sleep disorders, movement disorders, paraesthesia and cognitive deficits (35). The latter have been defined with the term “brain fog’”, which is characterised by feeling slow, confused and disoriented; having difficulties staying focused; presenting some forgetfulness; and the inability to find the correct word (36, 37). Currently, no specific treatment has been approved for this cognitive impairment in people with long COVID, although it has been determined that cognitive stimulation may be useful in some cases (38).

The content of this session will include: a description of the types of neurological symptoms typical of long COVID; treatment of neurocognitive symptoms; the benefits of performing cognitive stimulation exercises; personalised recommendations about what cognitive exercises can be practiced, and how and when to do it; and implementation of these treatments.

Long COVID often includes respiratory symptoms. The most common are usually shortness of breath, coughing and chest pain (39). Physiotherapy programmes focused on improving respiratory function can be useful in managing these persistent symptoms (40).

The content of this session will include: a description of the types of respiratory symptoms of long COVID; treatment of respiratory symptoms; the benefits of performing breathing exercises; personalised recommendations about what breathing exercises can be practiced, and how and when to do it; and implementation of these treatments.

Patients will be advised to use a pulse oximeter during these exercises. Whenever the patients experience any anomaly in the pulse oximeter values (resting oxygen saturation < 88%) (41) as well as any sensation of pain or pressure in the chest, they should automatically stop performing these exercises and consult what happened with the health professional during the sessions so that he/she can personalize the exercises to that specific person.

People with long COVID describe drastically reduced physical function. Hence, it becomes difficult or impossible for them to perform some ADL (42). Research on physical activity and long COVID is still insufficient, although there is scientific evidence for benefits in other pathologies with similar characteristics. Existing recommendations on physical activity and long COVID emphasise the importance of personalised care based on the symptoms that each person presents (43, 44).

The content of this session will include: a description of the types of physical symptoms of long COVID; treatment of physical symptoms; the benefits of physical activity; personalised recommendations about what activity and physical exercises can be practiced, and how and when to do it; and implementation of these treatments.

As with the breathing exercises, patients will be recommended to use a pulse oximeter while performing physical exercises, as well as to stop performing the exercises and consult a professional when noticing any abnormality in the values or any type of pain.

The Clinical Guide for Long COVID patient care of the Spanish Society of General and Family Physicians (SEMG) recommends considering food and diet in the management of this disease to fill possible nutritional deficiencies (16). Some nutrients such as folic acid, vitamin D, omega-3 fatty acids and vitamin B12, present in the Mediterranean diet, are involved in the proper functioning of metabolism and the immune system, so they could be useful in the recovery process of these patients (45, 46).

The content of this session will include: recommendations for a healthy diet based mainly on adherence to the classic Mediterranean diet.

Sleep disorders (decreased sleep quality, daytime sleepiness, insomnia, sleep apnoea, nightmares, etc.) are common among the persistent symptoms of long COVID (47).

The content of this session will include: a description of the types of sleep disorders present in long COVID; information about different treatments for sleep disorders; a sleep hygiene programme; and recommendations for sleep and rest.

There is extensive research on the emotional impact on people with persistent symptoms of COVID-19. Anxiety, depression, post-traumatic stress disorder, mood fluctuations and sleep disorders are some of the consequences that long COVID can have on the mental health of people who have the disease (48).

The content of this session will include: a description of the emotional impact of long COVID; treatments aimed at addressing the emotional impact; recommendations about emotional management; an explanation of the first steps to take to meditate; and implementation of two meditation dynamics.

The limiting persistent symptoms of long COVID, the consequences on mental health and the reduction in quality of life have a great impact on the organisation of the lives of people with this disease. They are limited in their ability to perform basic ADL, as well as their occupational, social and leisure activities in the community. This isolation is increased by feelings such as fear or uncertainty, barriers to accessing the health system or stigmatisation (7, 8, 49).

The content of this session will include: a description and examples of community health assets (HA); the benefits of using resources offered by the community itself; and personalised recommendations about what community resources can be used, and how and when to do it.

The last session, held the last week of the programme, will aim at collecting the most important therapeutic recommendations and at resolving doubts and questions that have arisen and that have not already been resolved in the previous sessions.

It is important to highlight that although each session is mainly aimed at addressing a specific type of symptomatology or impact on quality of life, the exercises described in the previous sessions will continue to be carried out and doubts that arise will be resolved. For example, in session 1, some cognitive stimulation guidelines will be explained, and cognitive stimulation exercises will be provided to patients to perform at home. In session 2, the patients will be able to express problems that have arisen when carrying out these exercises at home, and the therapist will even be able to carry out some other exercises to evaluate the progress of the patients with these symptoms.

Age, gender, marital status, education, household and occupation will be collected.

The date of contracting COVID-19 and the number and severity of persistent symptoms measured by Visual Analog Scale (69) will be collected. Persistent symptoms include: low-grade fever (37–38°C), fever (> 38°C), chills without fever, headaches, dizziness, tiredness or fatigue, sore throat, cough, dyspnoea, loss of smell and/or taste, blurred vision and other eye problems (dry eyes, increased dioptres, conjunctivitis), bruising, hair loss, tachycardia, myalgia, joint pain, orthostatic hypotension, chest pain, back pain (cervical, thoracic and/or lumbar), gastrointestinal symptoms, urinary symptoms (overactive bladder, infections), neurological symptoms (spasms, tingling, etc.), cognitive impairment (memory loss, reduced attention, mental fog), altered menstrual cycle, loss of libido or erectile dysfunction, and other symptoms that the participants consider persistent (70–72).

The official Spanish version of the Montreal Cognitive Assessment (MoCA) (52–54) will be used to assess the presence of cognitive impairment in the participants of this study. This is a test with adequate internal consistency (Cronbach’s alpha = 0.76) and assesses six cognitive domains: memory, visuospatial capacity, executive function, attention/concentration/working memory, language and orientation. Of the total score of 30 points, a correction of one point can be made in the case of subjects with less than 12 years of schooling. The cut-off point of this scale for the detection of mild cognitive impairment in its original version is 26. This test has been used in previous research to assess cognitive impairment in people with long COVID (73, 74).

The presence of short-term memory impairment will be measured by using the Spanish version of the Memory Impairment Screen (MIS). This short test assesses the presence of memory disturbances by testing free recall (without clues) or selective recall (with semantic clues) of four words. Dementia screening has adequate interobserver (0.85) and test–retest (0.81) reliability. One point is awarded per word recalled with the help of semantic clues, and two points per word obtained by free recall. The total score ranges from 0 to 8, with a score of ≤4 points indicating possible deterioration (55, 56).

The Semantic Verbal Fluency Test (Animals) will be used to assess whether verbal fluency is affected. The test–retest reliability is 0.68. This test consists of counting the number of correct words within the ‘Animals’ category, reproduced for 1 min. Normally, a healthy person will be able to reproduce about 16 words per minute (57, 58).

The Stroop Colour and Word Test will be used to assess processing speed. This test consists of three phases spread over three different pages. On the first page, the words “red”, “green” and “blue” are printed in black ink, randomly repeated in columns. On the second page, the element “XXXX” appears repeatedly and in columns, printed in red, green or blue ink. On the third page, the words “red”, “green” and “blue” are printed in red, green or blue, but the words do not match the colour in which they are printed. The patient must, by columns, read words or name the ink colours as quickly as possible for 45 s (75, 76). There are scales corrected for age (7–80 years) to calculate the total score for this test. In the various existing versions, this test has shown consistent reliability, obtaining indices of 0.85, 0.81 and 0.69 for the three direct scores (59).

The Sit to Stand Test will be used to measure the strength and endurance of the lower limbs (60). The 30-s version of this test will be used; it is specifically designed to detect respiratory diseases (58). It evaluates endurance at high power or speed in terms of muscular endurance or strength by recording the number of times a person can stand up and sit down completely in 30 s. This instrument had good test–retest reliability (0.84 < R < 0.92). The 30-s Sit to Stand Test has been translated into Spanish and used in patients with COVID-19 (77).

The affective state will be evaluated by using the Hospital Anxiety and Depression Scale (HADS) questionnaire (61). This is a self-report-based scale designed to screen for depression and anxiety disorders in primary care settings. It consists of 14 items that assess symptoms of anxiety and depression (HADS-A and HADS-D, respectively), each item corresponding to a 4-point scale (0–3), with a score range from 0 to 21 for anxiety symptoms and depression symptoms. Higher scores indicate more severe symptoms. To facilitate its use in international trials, this test has been translated into multiple languages, including Spanish (78).

The Insomnia Severity Index (ISI) will be used to measure the participants’ sleep quality (60). This is a self-report that measures the patient’s perception of nocturnal and daytime symptoms of insomnia: difficulty falling asleep or staying asleep, waking up early in the morning, satisfaction with the current sleep pattern, interference with the daily functioning, perceived impairment attributed to sleep deprivation and level of distress or worry caused by the lack. This scale has seven items, each of which is scored from 0 to 4. The total score ranges from 0 to 28, with a higher score indicating more severe insomnia. The Spanish version of the ISI (79) has shown adequate internal consistency (Cronbach’s alpha = 0.82). This test has already been used in other studies about long COVID (80).

Self-efficacy will be measured by using the Self-Efficacy Scale-12 (64). The original scale consists of 17 items that are scored using a 5-point Likert scale. Woodruff and Cashman (81) derived a factor structure representing the three aspects underlying the scale: willingness to initiate the behaviour (“Initiative”), willingness to strive to complete the behaviour (“Effort”) and persistence in the face of adversity (“Persistence”). These are the three factors that this scale evaluates. Five items have been excluded due to low item-remainder correlations and ambiguous wording, resulting in a 12-item version (GSES-12). The total scale has a Cronbach’s alpha of 0.69, and its internal consistency is 0.64 for “Initiative”, 0.63 for “Effort” and 0.64 for “Persistence” (82).

The Health Literacy Europe Questionnaire (HLS-EUQ16) will be used to measure the health literacy of the participants (79). This is defined as the motivation of the population, their knowledge and their individual capacity to understand and make decisions regarding the promotion and maintenance of their health. The questionnaire consists of 16 items, each scored from 1 (very easy) to 4 (very difficult). The total score is obtained by adding the scores of all the items. The final score can be converted into a dichotomous answer: very difficult and difficult = 0; easy and very easy = 1. Poorer health literacy is indicated by higher scores. The official Spanish version presents high consistency (Cronbach’s alpha = 0.982) (83).

The activation of the patient about his own health will be measured by using the Patient Activation Measure (PAM) (66). This tool evaluates the skills, knowledge and confidence perceived by the patient when carrying out health self-management activities. It comprises 13 items that are evaluated on a Likert-type scale from 1 (totally disagree) to 4 (totally agree). The resulting score ranges from 13 to 52, with higher scores indicating higher levels of activation. There is only one official version in Spanish that applies to patients with chronic disease. It has a reliability of 0.98 and a parametric discrimination index of 6.64 (84).

In the last assessment, using a Likert-type scale from 0 to 10, the level of satisfaction both with the content of the program and with the tools used for its development will be assessed.