Scientific Papers

Comprehensive analysis of research related to rehabilitation and COVID-19, hotspots, mapping, thematic evolution, trending topics, and future directions | European Journal of Medical Research


From 2003 to 2023, a total of 3764 original research documents pertaining to COV-REH were produced by 3470 authors affiliated with 160 organizations across 119 countries (Table 1). A total of 1467 sources revealed the existence of these scholarly productions. The annual growth rate has reached 53.73%, with an average document age of 1.3. This finding aligns with prior research that has demonstrated the progression of studies pertaining to COVID-19. The volume of research in the years 2020–2023 is approximately 99%. 2022 and 2021 are the years in which research was conducted, estimated at two-thirds of the knowledge volume carried out in COV-REH. Research output from 2020 to 2023 exhibited a voluminous proportion of approximately 99%. The years 2022 and 2021 mark the period during which research was conducted, accounting for approximately two-thirds of the knowledge volume related to COV-REH.

Table 1 Main information about data

Vitacca, M. of the Respiratory Rehabilitation Institute in Lumezzane, Italy, authored a total of 14 research articles, securing the top position. Research conducted by Vitacca primarily focused on three key areas: pulmonary rehabilitation, telerehabilitation, and the neuropsychological characteristics exhibited by individuals during their recovery from COVID-19 [16, 31,32,33,34,35,36]. The following is Sivan M. from the University of Leeds, UK, with 13 publications. Sivan and his research group have conducted a study on the development of an integrated rehabilitation pathway. Italy proposed an evidence-based report outlining an integrated rehabilitative approach for individuals with COVID-19. Remarkably, among the 119 nations, the USA (n = 834) exhibited the highest level of productivity, followed by the UK (n = 455), Italy (n = 421), China (n = 236), and Canada (n = 199) (Fig. 2). According to the data presented in Table 1, a total of 160 organizations were actively engaged in rehabilitation research pertaining to the COVID pandemic. Nevertheless, a few institutions have emerged as prominent examples, including Harvard University (n = 64) in the USA, the University of Toronto (n = 62) in Canada, and the University of Milan (n = 52) in Italy. Approximately 43 universities have generated more than 30 research documents, while 27 universities have surpassed a threshold of 20 research documents. The International Journal of Environmental Research And Public Health (n = 151) is the leading source followed by the BMJ Open (n = 71), Plos One (n = 57), and the American Journal of Physical Medicine And Rehabilitation (n = 51).

Fig. 2
figure 2

Country specific production in COV-REH. The density of the clue color indicates high production of COV-REH-related publications

The knowledge framework of COV-REH was established through the involvement of twenty-seven scientific and research disciplines, suggesting that COV-REH exhibits numerous intersections within professional and academic domains (Fig. 3). The proportion of scholars in the field of medicine who participated in this study was approximately 54.1% (Fig. 3). This was followed by the Health Professions (10.7%), Nursing (4.5%), and Neuroscience (4.5%). Additional information is depicted in Fig. 3. The allocation of research areas presented herein is derived from the Scopus database.

Fig. 3
figure 3

Distribution of documents per subject area related to the COV-REH. The subject areas were Medicine, Health Professions, Nursing, Neuroscience, Biochemistry, Genetics and Molecular Biology, Environmental Science, Social Sciences, Psychology, Engineering, Computer Science, Immunology and Microbiology, Multidisciplinary, Pharmacology, Toxicology and Pharmaceutics, Materials Science, Chemical Engineering, Physics and Astronomy, Agricultural and Biological Sciences, Arts and Humanities, Dentistry, Chemistry, Business, Management and Accounting, Mathematics, Energy, Earth and Planetary Sciences, Veterinary, Economics, Econometrics and Finance, and Decision Sciences

Social analysis: co-authorship

In this study, 108 of the documents were authored by a single researcher. The average number of researchers per document is 7.47. According to Fig. 4, the USA, UK, Italy, Canada, and China, achieved the highest number of co-authored documents (420, 399, 233, 153, and 62, respectively). The UK cooperated with 74 countries worldwide to conduct research related to COV-REH, followed by the USA (n = 70), then Italy (n = 54), Canada (n = 53), and China (n = 53), respectively. Zambia, Yemen, Sri Lanka, Qatar, Morocco, Kuwait, Hungary, Ethiopia, El Salvador, and Bangladesh were identified as countries that exhibited limited cooperation with other nations, as evidenced by their research output, which was predominantly represented by a maximum of one document. In addition to delineating collaborative research endeavors in nations, it is imperative to consider other bibliographic elements such as academic institutions. The IRCCS Galeazzi Orthopedic Institute, Italy, is the most collaborative organization.

Fig. 4
figure 4

Mapping of international collaboration among countries. Mapping was performed using the Bibliometrix application

Figure 5 depicts the distribution of countries responsible for the corresponding authorship of a publication, categorized by country. The USA holds the highest position among the top three countries, with a total of 497 research papers. Italy ranks second with a total of 244 published articles, which prominently feature the corresponding authors of Italian origin. The UK occupies the third position producing a total of 217 papers. The nations exhibiting the most pronounced levels of international collaboration include the USA, Italy, the UK, China, Canada, India, Spain, Brazil, Germany, Australia, France, Turkey, Japan, and Iran. It is noteworthy that despite the USA having the highest number of corresponding authors, there is a need for increased national collaboration. Korea exhibits a comparable trend, wherein there is notable scientific output but a deficiency in intra-collaborative efforts.

Fig. 5
figure 5

Country of the corresponding author. Collaboration between countries (SCP) and within countries (MCP) from 2020 to 2023. The figure was generated using the BibTex file in the Bibliometrix application

Impactfil research: citation analysis

The objective of this study was to employ these methodologies in the context of the COV-REH domain and gain insight into citation patterns and associated attributes. The BMJ, Thorax, European Journal of Physical and Rehabilitation Medicine, Nature Medicine, and International Journal of Environmental Research and Public Health are among the most frequently cited sources in the context of COV-REH research, with citation counts of 1394, 1004, 967, 956, and 852, respectively. The USA (n = 10,337), the UK (n = 9219), China (n = 5332), Italy (n = 4978), France (n = 3347), Canada (n = 2458), and Sweden (n = 2113) were the most frequently cited countries. According to the citations and references in the bibliographies of the authors’ works, the USA plays a key role in analyzing their choice of 840 documents.

When examining the trend between the number of citations and the quantity of research documents generated by a singular institution, it becomes apparent that there is a disparity between these two metrics. An illustration of this can be seen in the case of Zoe Global, a company based in the UK, which achieved the highest ranking in terms of citation count. Remarkably, this was achieved by using only two documents, resulting in an impressive count of 956 citations. The subsequent entities in the sequence were West Hertfordshire Hospitals NHS Trust, UK; West Hertfordshire Respiratory Service-Central London Community Healthcare; Veterans Affairs Center for Clinical Management Research, USA; and UCL Respiratory, University College London, UK, all of which have garnered over 400 citations each. When establishing a criterion of five or more documents for a single organization, it was observed that IRCCS Istituto Ortopedico Galeazzi in Italy ranked first in terms of citations, with a total of 598 citations and 14 documents. Following closely is the University of Queensland in the UK, with 332 citations and seven documents, and subsequently Imperial College London, also in the UK, with 285 citations and seven documents.

Figure 6 presents data regarding the aggregate number of citations received by various papers, their annual citation rate, and the normalized total citations. Presented below is an analysis of the data: Of the papers provided, “SUDRE CH, 2021, NAT MED” exhibits the highest cumulative citations, amounting to 956. This substantial figure underscores the notable influence of this study on the respective fields. The citation rate of 478 per year indicates continuous acknowledgment and impact, as supported by scholarly literature. Furthermore, in the context of normalized total citations, which account for the citation rate in relation to the average within the dataset, this study demonstrated a noteworthy value of 69.90, indicating its exceptional performance. Additional notable papers in the field of study encompass “LOPEZ-LEON S, 2021, SCI REP” which has garnered a total of 763 citations and exhibits a citation rate of 381.5 per annum. Furthermore, “HALPIN SJ, 2021, J MED VIROL” has amassed 668 citations in total, with a citation rate of 334 per year. Both studies have demonstrated a significant impact and recognition within their respective academic disciplines. Moreover, scholarly articles such as “BARBARO RP, 2020, LANCET,” “MANDAL S, 2021, THORAX,” and “ARNOLD DT, 2021, THORAX” exhibit notable citation frequencies annually, suggesting their enduring significance and impact. These papers also demonstrated noteworthy normalized total citation scores, thereby underscoring their substantial influence within their respective fields. In contrast, the research documents were evaluated by considering the number of citations, as indicated in Table 2. The analysis revealed that “SUDRE CH, 2021, NAT MED” did not relinquish its position as the first-ranked entity. However, “GREENHALGH T, BMJ, 2020” held second position in the ranking.

Fig. 6
figure 6

Global citation of documents

Table 2 Top-cited articles based on simple citation count

Mapping and co-occurrence of keywords: lexical analysis

The present work demonstrates the effectiveness and usefulness of lexical analysis’s in discovering knowledge components and the structure of the COV-REH field. The most frequent keywords were COVID-19 (freq 1697), rehabilitation (freq 546), sars-cov-2 (freq 295), telerehabilitation (freq 57), pandemic (freq 146), telemedicine (freq 141), telehealth (freq 137), physiotherapy (freq 115), and exercise (freq 102). The word tree between 2003 and 2023 (top 50 author keywords) is shown in Fig. 7a. Figure 7b also depicts the highly frequent keywords, considering their chronological occurrence within the timeframe analyzed in this study. The spectrum of this phenomenon spans from the color violet, which represents the earliest occurrences, to the color yellow, which signifies the most recent events. The most recent keywords in the field of COVID-19 research and healthcare (COV-REH) include “mortality,” “vaccination,” “long-covid,” “dyspnea,” “public health,” “stress,” and “qualitative research.”

Fig. 7
figure 7

Word tree between 2003 and 2023 (top 50 author keywords). a provides an in-depth examination of the research landscape within each time period encompassed by this study (2033–2023). b was utilized to ascertain the temporal scope of the latest research advancements (2021–2023) by employing keyword analysis, a distinctive attribute absent in the VOSviewer software. These two figures collectively offer a comprehensive depiction of the research patterns throughout the entire study duration (a) and specifically post-2021 (b)

Thematic map

The seven research themes covering the entire dataset of these COV-REH studies between 2020 and 2023 are shown in Fig. 8. These are labeled as “covid-19,” “case report,” “pandemic,” “telerehabilitation,” “anxiety,” “quality of life,” and “students.” To facilitate the identification of COV-REH conversations, each cluster was assigned a straightforward label based on the keywords that appeared most frequently within the cluster. Given that these labels serve as the central topics within each cluster, they epitomize the most pivotal subjects in the field of COV-REH research. The magnitude of the spheres corresponds to the quantity of keywords/subjects within a given cluster. The thematic map is detailed as follows:

Fig. 8
figure 8

Thematic map by author keywords

Two clusters classified as niche themes—“students,” and “case report, corona virus disease 2019, critical care.”

Two clusters for the motor theme—“quality of life, pulmonary rehabilitation, long-covid,” and “pandemic, exercise, covid-19 pandemic.” These two clusters exhibited transthematic behavior.

Two clusters of basic themes—“covid, rehabilitation, sars-cov-2,” and “telerehabilitation, telemedicine, telehealth.”

One cluster is classified as emerging or declining themes—“anxiety, depression, stress.”

Additionally, a categorization of themes was conducted in the field of COV-REH, including basic, motor, niche, and emerging/declining themes. By examining the progression of themes over time, a more nuanced understanding of the conceptual framework within the field can be developed. Table 3 presents the keywords found in each cluster along with their respective frequencies. For instance, the cluster labeled “telerehabilitation” encompasses keywords such as telemedicine, telehealth, physiotherapy, physical therapy, occupational therapy, education, digital health, children, pain, cerebral palsy, and qualitative, with a frequency count of 16. These keywords were grouped together in this cluster because of their consistent appearance in relevant articles. This implies that it is common practice among authors to examine these keywords in conjunction with one another.

Table 3 Keywords within the seven clusters and their frequency

Thematic evolution

The progression of the research themes, clusters, or subjects over two time periods (2020–2021 and 2022–2023) is depicted in Fig. 9. Despite evolution and diversification the research themes over time, the fundamental concepts persisted. Throughout the whole COV-REH investigations, the clusters “anxiety,” “telerehabilitation,” and “covid-19” were the top three research themes. Despite the fact that the image concentrates on the evolution of important subjects, core development may be seen between the two time slices. A component of “telerehabilitation” is now the cardiac rehabilitation cluster. Three clusters make up the “Lockdown” topic: “telerehabilitation,” “COVID-19,” and “epidemiology.” Anxiety and “covid-19” were created when the “anxiety” cluster united. The “epidemiology” cluster is derived from the “lockdown” cluster from the standpoint of new clusters in the timeframe 2020–2023. In conclusion, Fig. 9 depicts the overall development of the subjects and fundamental development over two time slices. Between the two time slices, clusters were divided and combined. From a few study themes in the 2020–2021 time slice, a new cluster emerged. It is noteworthy that “epidemiology” emerged as a new research area in the 2020–2023 time frame.

Fig. 9
figure 9

Thematic evolution by author keywords

Trending topics

As shown in Fig. 10, the trending topics in COV-REH are “coronavirus,” “symptoms,” “case report,” “rehabilitation,” “rehabilitation,” “protocol,” and “community-based rehabilitation.”

Fig. 10
figure 10

The trending topics in COV-REH



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