Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

Abstract

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Course of recovery in COVID-19 patients with pre-existing post Koch’s sequelae

“…Thus Case 2 consumed more energy for walking. There was significant drop in O2 saturation (> 4%) during walking which recovered in 1 to 3 minutes this indicates that further pulmonary rehabilitation is required with close monitoring of saturation and adequate pauses [19,20]. Figure 4 shows the similarities and differences of the two patients described above.…”

Recomendações de exercício físico após adoecimento por COVID-19: revisão de escopo

“…A total of 445 articles were found. After exclusion of duplicates, reading of titles, abstracts, and the entire texts of the selected studies, 16 articles were included in the final version [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] .…”

“…Of the studies included, only three were experimental [27][28][29] and none were randomized controlled trials. Six studies were classified as narrative reviews [30][31][32][33][34][35] , one a scoping review 36 and the others trials or opinion articles [37][38][39][40][41][42] . One study in this last group proposed a randomized controlled trial 39 .…”

“…One was a consensus declaration from the Defence Medical Rehabilitation Centre Stanford Hall 40 and another the shared experience of different rehabilitation centers consisting of specialists in physical medicine and rehabilitation from eleven different countries in Europe and North America 38 . In addition, one study made recommendations based on the Brazilian Guidelines for Cardiovascular Rehabilitation and the Chinese Association of Rehabilitation Medicine 32 . The sample size of experimental studies [27][28][29] was between 10 and 30 subjects of both sexes, with average age of more than 50 years and hospitalization time of 5 to 19 days.…”

“…Considering all the studies, the characteristics of the target population varied widely. These contained individuals aged 18 years or older, convalescing from different degrees of COVID-19, with or without the need for mechanical ventilation 32,36,39,41 , with no symptoms such as fever, dyspnea or tachycardia, low oxygen saturation and stable hemodynamic and respiratory or mild pulmonary symptoms 28,34,36,38 . Two experimental studies 27,28 and 9 reviews or trials 31,32,[35][36][37][38][39][40]42 applied or suggested biosafety protocols, with distance rehabilitation 27,31,32,36,38,39,42 and the use of personal protective equipment the most recommended procedure 28,[35][36][37][38]40 .…”