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Background Many coronavirus disease 2019 (COVID‐19) survivors experience persistent symptoms, such as fatigue, dyspnea, and musculoskeletal pain. However, less is known about the impact of COVID‐19 on longer term functional outcomes. Objective To evaluate patient‐reported activity of daily living (ADL) function and fatigue symptoms 30 days after hospitalization for COVID‐19. Design Cross‐sectional study. Setting Tertiary care university hospital. Participants Adults 18 years or older hospitalized for COVID‐19 and survived to 30 days after discharge. Methods A standardized telephone questionnaire was administered 30 days after hospital discharge. Main Outcome Measures Ability to perform basic and instrumental ADLs and fatigue symptoms severity (Patient‐Reported Outcome Measurement Information System [PROMIS] Fatigue Short Form 7a) were assessed by self‐report. Results Participants (n = 55) were 22‐95 years old. Compared to pre‐COVID hospitalization, 52% developed new difficulty and 6% new dependence with performing basic ADLs (bADLs), 48% developed new difficulty and 11% new dependence with instrumental ADLs (iADLs), and 69% experienced a clinically significant worsening in their fatigue symptom severity. The average fatigue symptom severity T‐score before hospitalization was 44.2 ± 7.4 and after hospitalization was 54.5 ± 9.8. In exploratory multivariate analyses, each additional COVID symptom at presentation was associated with a predicted increase of 1.43 units (95% confidence interval [CI], 0.45–2.42) in the 30‐day fatigue symptom severity T‐score, each additional day of hospitalization was associated with an 1.2 times increased odds of worsening fatigue (95% CI, 0.98–1.5; p = .08), and each unit increase in baseline body mass index was associated with 0.8 times decreased odds of new bADL or iADL dependence at 30 days (95% CI, 0.65–0.99). Conclusions New functional impairments are common at 30 days after discharge among survivors of hospitalization for COVID‐19. Early rehabilitation, advance care planning, and referrals to appropriate therapies should be considered in postacute COVID‐19 care to maximize patients' functional outcomes. However, ongoing research is still needed regarding management of these patients.

IntroductionDeaths and injuries from all-terrain vehicle (ATV) crashes result in approximately 700 deaths each year and more than 100,000 emergency department (ED) visits. Common misconceptions about ATV crashes are a significant barrier to injury prevention efforts, as is the lack of key information about where and how crashes occur. The purpose of this study was to determine ATV crash patterns within a state, and to compare and contrast characteristics of these crashes as a function of crash-site rurality.MethodsWe performed descriptive, comparative, and regression analyses using a statewide off-road vehicle crash and injury database (2002–2013). Comparisons were performed by rurality as defined using the Rural Urban Commuting Area (RUCA) coding system, and we used geographic information system (GIS) software to map crash patterns at the zip code and county levels.ResultsATV crashes occurred throughout the state; 46% occurred in urban and 54% in rural zip code areas. Comparisons of rider and crash characteristics by rurality showed similarities by sex, age, seating position, on vs. off the road, and crash mechanism. Conversely, helmet use was significantly lower among victims of isolated rural crashes as compared to other victims (p=0.004). Crashes in isolated rural and small rural areas accounted for only 39% of all crashes but resulted in 62% of fatalities. In both rural and urban areas, less than one-quarter of roadway injuries were traffic related. Relative crash rates varied by county, and unique patterns were observed for crashes involving youth and roadway riders. During the study period, 10% and 50% of all crashes occurred in 2% and 20% of the state’s counties, respectively.ConclusionThis study suggests that ATV crashes are a public health concern for both rural and urban communities. However, isolated rural ATV crash victims were less likely to be helmeted, and rural victims were over-represented among fatalities. Traffic was not the major factor in roadway crashes in either rural or urban areas. Unique crash patterns for different riding populations suggest that injury prevention experts and public policy makers should consider the potential impact of geographical location when developing injury prevention interventions.

Patients with severe cases of coronavirus disease 2019 (COVID‐19) often become critically ill requiring intensive care unit (ICU) management. These individuals are at risk for developing ICU‐acquired weakness (ICUAW), a multifactorial condition in which polyneuropathy, myopathy, and/or disuse muscle atrophy result in motor weakness. This weakness is thought to contribute to the long‐term functional disability frequently observed in survivors of critical illness. This review discusses the current evidence regarding the epidemiology, pathophysiology, evaluation, risk factors, and rehabilitation‐specific management of ICUAW in patients with COVID‐19. Because of the novelty of COVID‐19, the exact prevalence of ICUAW is not well delineated among COVID‐19 patients. However, ICUAW has been reported in this population with retrospective studies showing weakness occurring in up to 45.5% of patients with severe COVID‐19. There are multiple risk factors for developing ICUAW among COVID‐19 patients, including premorbid health status, sepsis, multiple organ failure, mechanical ventilation, immobilization, neuromuscular blockade, corticosteroid use, and glycemic control. ICUAW is more likely to occur after prolonged mechanical ventilation and long hospital stays and can be diagnosed with manual muscle and electrodiagnostic testing. Although the long‐term sequela of COVID‐19 after ICU stays is not fully studied, increasing evidence indicates significant risk for this population developing long‐term functional impairments. Establishing postacute rehabilitation programs for COVID‐19 survivors will be important for recovery of endurance, mobility, and function.