Assessment of the Need for Early Initiation of Rehabilitation Treatments in Patients with Coronavirus Disease 2019

Abstract

Objective: The aim of this study was to describe the clinical characteristics of coronavirus disease (COVID-19) patients, including risk factors for deep vein thrombosis and pulmonary embolism, and to evaluate the need for rehabilitation to prevent pulmonary embolism. Methods: A retrospective medical record review was conducted of patients admitted to the study hospital with COVID-19 between April 2 and April 23, 2020. The clinical characteristics and blood test results of patients with no history on admission of oral anticoagulant use were evaluated to assess the importance of inflammation and clotting function as risk factors for pulmonary embolism. Results: A total of 51 patients with COVID-19 were admitted during the study period. Their median age was 54.0 years (range: 41–63 years) and 38 of 51 (74.5%) were men. The most common comorbidities in men were diabetes (9/38, 23.7%) and hypertension (13/38, 34.2%). On admission, white blood cell counts were normal in both sexes, whereas C-reactive protein and hemostatic marker levels, except for the activated partial thromboplastin time, were significantly higher in men. Moreover, C-reactive protein and hemostatic marker levels were significantly higher in patients that required invasive ventilation. Two patients were diagnosed with acute pulmonary embolism, neither of whom required invasive ventilation. Conclusions: Hypercoagulability and hyperinflammation were observed in COVID-19 patients, especially in men with high oxygen demand. We recommend anticoagulant therapy and early rehabilitation intervention to prevent pulmonary embolism in COVID-19 patients.

Providing rehabilitation to patients recovering fromCOVID‐19: A scoping review

“…In total, we included 128 articles in our review (see Figure 1 for PRISMA diagram) 3,4,13‐138 . With respect to article type, 33 were primary data articles (ie, observational studies, case reports), 22,24,33,41,51,55,57,63,69,78‐89,115,117,119,127‐129,131,132,134,136‐138 82 were secondary articles (ie, reviews, letters to the editor that did not report results of an original research project, commentaries)…”

“…Additionally, one article described a physician's experience with being treated for COVID, 57 a second outlined the organizational changes made to accommodate COVID patients, 63 and a third estimated the postacute rehabilitation needs of COVID patients 55 . Three studies aimed to describe the demographics, clinical characteristics, and level of rehabilitation of patients with COVID at their institutions 79,80,85 . One additional study investigated the rehabilitation needs of COVID patients at their institution 134 .…”

“…In total, 30 studies reported sample sizes. Seventeen case report studies reported on 1 to 9 patients, 33,51,78,79,81,83‐86,88,115,117,119,128,131,132,137,138 and the remaining 16 studies reported sample sizes ranging from 9 to 312, with a mean of 101. The mean age of patients in the case reports was 53 years old (range: 41‐69).…”

“…Twenty‐seven studies reported participants' gender. All but five of the case reports 83,115,128,131,132 reported on male patients 33,51,78,79,81,84‐86,88,117,119,137,138 and the RCT study included only men in both the intervention (n = 24) and control groups (n = 25). The remaining six cross‐sectional studies 22,24,55,127,129,134 reported a mean of 61 women and 101 men.…”

Rehabilitation for Patients with COVID-19: A Japanese Single-center Experience

“…Initially, to avoid hospital-acquired infections and preserve PPE supplies, we planned to provide late-phase rehabilitation only for COVID-19 survivors because an increase in COVID-19 cases was expected, as had been observed in other countries. However, two cases of pulmonary embolism 6 ) caused by hypercoagulability and hyperinflammation associated with COVID-19 7 , 8 , 9 ) occurred as soon as we began to admit patients. Subsequently, we started providing early rehabilitation for patients with COVID-19, regardless of the patients’ polymerase chain reaction (PCR) test results, thereby improving respiratory function by counteracting immobilization that could lead to decreased muscle strength, insufficient sputum drainage, increased risk of deep vein thrombosis or pulmonary embolism, as well as addressing neuropsychological issues.…”