Effects of a multimodal rehabilitation program in COVID-19 patients admitted to the Intensive Care Unit: A quasi-experimental study

Abstract

Background: Patients with severe COVID-19 evolve to acute respiratory distress syndrome (ARDS) and require management in Intensive Care Units (ICU) where they are exposed to immobilization, immunosuppression, malnutrition, nosocomial infections; may develop ICU Acquired Weakness (ICUAW), which increases with the stay and use of mechanical ventilation (MV).There is evidence of the use of different modalities in rehabilitation to mitigate these effects. Goal: To determine the efficacy of a Multimodal Rehabilitation Program (MRP) in reducing the number of days of mechanical ventilation and stay in patients hospitalized for COVID-19 in ICU, as well as to describe its clinical and hospital characteristics. Material and Methods: An quasi-experimental study was designed, with sequential sampling and without blinding. A control and intervention group was formed, with 32 participants each. A Multimodal Rehabilitation Program (MRP) based on four therapeutic modalities was applied and the intervention was quantified through the use of proposed indicators. Results: The variation in days of ICU stay and days of MV were similar in both groups. The Multimodal Rehabilitation Index (iMR) ranged from 0.1 to 2.7 (mean = 1.2, SD = 0.7) and had significance for cut-off points ≤ 0.81 and ≤ 0.94 in mortality (p = 0.02) and Ventilator-free days at 28 days (VFDs-28) (p = 0.01). Conclusions: No statistically significant difference was found in favor of the intervention in terms of days of stay in the ICU and days of MV. Explanatorily, it was reported that iMR was related to (VFDs-28) and mortality in patients with severe COVID-19.

Multidisciplinary inpatient rehabilitation for older adults with COVID-19: a systematic review and meta-analysis of clinical and process outcomes

“…The 12 included studies in this review consisted of seven descriptive cohort studies, one pre-post intervention cohort, one quasi experimental study and three case series highlighting a dearth of robust experimental studies or analytical cohort studies describing the effect of multidisciplinary rehabilitation on the outcomes of older adults in the acute or post-acute setting following COVID-19 to facilitate systematic review and meta-analysis. A quasi-experimental study by Rodriguez and colleagues aimed to describe the effects of a multimodal rehabilitation programme in patients with COVID-19 admitted to the ICU [ 69 ] however this study was ineligible for inclusion in our review as the average age of the intervention cohort was 56.5 years and it was unclear if the intervention was multidisciplinary in nature. A large number of descriptive cohort studies and case series were not included in this review reporting outcomes following MDT rehabilitation following COVID-19 as their focus was on a younger population [ 30 , 52 – 59 , 70 , 71 ].…”