Inpatient rehabilitation can improve functional outcomes of post-intensive care unit COVID-19 patients—a prospective study

Rodrigues, Margarida; Costa, Ana João; Santos, Rui; Diogo, Pedro; Gonçalves, Eugénio; Barroso, Denise; Almeida, Miguel P; Vaz, Inês Machado; Lima, Ana Ruth Vieira de

doi:10.1080/09638288.2022.2032408

Cited by 24 publications

(28 citation statements)

References 58 publications

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“…Our study exclusively included survivors of severe-to-critical COVID-19 in the tertiary hospital, who were expected to experience functional decline after acute care based on their scores of 5–7 on the WHO ordinal scale. The duration of ICU stay was longer compared with the relatively short durations in other studies (10.22 ± 4.87 days in the study by Piquet et al, 22 19 ± 14 days in the study by Puchner et al, 46 17.98 ± 8.66 days in the study by Curci et al, 47 and 20 ± 13 days in the study by Rodrigues et al 21 ). Moreover, the APACHE II score was slightly higher in our study than in another retrospective cohort study of COVID-19 survivors (10.87 ± 4.40).…”

Section: Discussionmentioning

confidence: 56%

“… 41 Judging by the APACHE II score and duration of ICU stay, the severity of participants in our study was more severe than in previous studies. 21 22 41 46 47 Despite the severe-to-critical disease severity in our study, comprehensive rehabilitation management, including exercise training in addition to nutritional and psychological support, led to a significant improvement in muscle strength (MRC sum score and handgrip strength) and physical functional performance (1-min sit-to-stand repetitions, FAC, BBS, and gait speed) at discharge.…”

Section: Discussionmentioning

confidence: 64%

“…Several studies have explored the feasibility and effect of rehabilitation on physical function in COVID-19 survivors. 20 21 22 However, as far as we know, existing studies have not followed up on the effect of rehabilitation on COVID-19 patients after discharge, and the majority have investigated rehabilitation of whole COVID-19 patient cohorts regardless of disease severity. Therefore, this study focused on the rehabilitation of patients with severe COVID-19 in a tertiary university hospital.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

Woo

Lee

et al. 2022

J Korean Med Sci

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Background This study aimed to investigate the effects of comprehensive rehabilitation management on functional recovery and examine the correlation between clinical parameters and improvements in functional outcomes in severe-to-critical inpatients with coronavirus disease 2019 (COVID-19) in a tertiary hospital. Methods Post-acute COVID-19 patients who had a World Health Organization (WHO) ordinal scale of 5–7, underwent intensive care, and received comprehensive rehabilitation management, including exercise programs, nutritional support, dysphagia evaluation, and psychological care were included. The appendicular skeletal muscle mass index (SMI), Medical Research Council sum score, handgrip strength, number of repetitions in the 1-minute sit-to-stand test, gait speed, Berg Balance Scale (BBS), and Functional Ambulation Classification (FAC) were evaluated at hospital stay, discharge, and 1-month follow-up. The correlation between the rehabilitation dose and improvement in each outcome measure was analyzed. Results Overall, 37 patients were enrolled, of whom 59.5% and 32.4% had a score of 6 and 7 on the WHO ordinal scale, respectively. Lengths of stay in the intensive care unit and hospital were 33.6 ± 23.9 and 63.8 ± 36.5 days. Outcome measures revealed significant improvements at discharge and 1-month follow-up. The SMI was significantly increased at the 1-month follow-up (6.13 [5.24–7.76]) compared with that during the hospital stay (5.80 [5.39–7.05]). We identified dose-response associations between the rehabilitation dose and FAC (ρ = 0.46) and BBS (ρ = 0.50) scores. Patients with older age, longer hospitalization, longer stay at the intensive care unit, longer duration of mechanical ventilation, tracheostomy, a more depressive mood, and poorer nutritional status revealed poorer improvement in gait speed at the 1-month follow-up. Conclusion Comprehensive rehabilitation management effectively improved muscle mass, muscle strength, and physical performance in severe-to-critical COVID-19 patients. Dose-response relationship of rehabilitation and functional improvement emphasizes the importance of intensive post-acute inpatient rehabilitation in COVID-19 survivors. Trial Registration ClinicalTrials.gov Identifier: NCT05104411

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

Woo

Lee

et al. 2022

J Korean Med Sci

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“…However, timely promotion of physical activities or exercises is crucial to minimize the functional impact of hospitalized COVID-19 patients. 6 …”

Section: Introductionmentioning

confidence: 99%

“…However, timely promotion of physical activities or exercises is crucial to minimize the functional impact of hospitalized COVID-19 patients. 6 Describing safe exercise methods that simultaneously mitigate the risk of viral transmission is thus paramount to promoting rapid physical recovery of COVID-19 patients. Therefore, we aimed to evaluate the impact of wearing the surgical facemask on dyspnoea, exercise performance and cardiorespiratory response in the course of a submaximal exercise test that reflects the physical level of daily life activities in hospitalized patients with COVID-19 close to hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial

et al. 2022

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Background Wearing a surgical mask in hospitalized patients has become recommended during care, including rehabilitation, to mitigate coronavirus disease 2019 (COVID-19) transmission. However, the mask may increase dyspnoea and raise concerns in promoting rehabilitation activities in post-acute COVID-19 patients. Objective To evaluate the impact of the surgical mask on dyspnoea, exercise performance and cardiorespiratory response during a 1-min sit-to-stand test in hospitalized COVID-19 patients close to discharge. Methods COVID-19 patients whose hospital discharge has been planned the following day performed in randomized order two sit-to-stand tests with or without a surgical mask. Outcome measures were recorded before, at the end, and after two minutes of recovery of each test. Dyspnoea (modified Borg scale), cardiorespiratory parameters and sit-to-stand repetitions were measured. Results Twenty-eight patients aged 52 ± 10 years were recruited. Compared to unmasked condition, dyspnoea was significantly higher with the mask before and at the end of the sit-to-stand test (mean difference[95%CI]: 1.0 [0.6, 1.4] and 1.7 [0.8, 2.6], respectively). The difference was not significant after the recovery period. The mask had no impact on cardiorespiratory parameters nor the number of sit-to-stand repetitions. Conclusion In post-acute COVID-19 patients near hospital discharge, the surgical mask increased dyspnoea at rest and during a submaximal exercise test but had no impact on cardiorespiratory response or exercise performance. Patients recovering from COVID-19 should be reassured that wearing a surgical facemask during physical or rehabilitation activities is safe. These data may also mitigate fears to refer these patients in rehabilitation centres where mask-wearing has become mandatory.

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Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID‐19 pulmonary disease

Goodman

Jensen

Walaszek

et al. 2023

PM&R

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BackgroundCoronavirus disease (COVID‐19) has introduced a new subset of patients with acute end‐stage lung damage for which lung transplantation has been successfully performed.ObjectiveTo describe the inpatient rehabilitation course of patients who underwent bilateral lung transplant due to severe COVID‐19 pulmonary disease.DesignRetrospective chart review.SettingFree‐standing, academic, urban inpatient rehabilitation hospital.ParticipantsSeventeen patients aged 28–67 years old (mean 53.9 ± 10.7) who developed COVID‐19 respiratory failure and underwent bilateral lung transplant.InterventionsPatients participated in a comprehensive inpatient rehabilitation program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual.Main Outcome MeasuresPrimary outcome measures of functional improvements, include mobility and self‐care scores on section GG of the Functional Abilities and Goals of the Improving Post‐Acute Care Transformation Act, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, Mann Assessment of Swallowing Ability (MASA), and Cognition and Memory Functional Independence Measure (FIM) scores. Wilcoxon signed rank sum test was used to evaluate statistical significance of change between admission and discharge scores.ResultsFourteen patients completed inpatient rehabilitation. Self‐care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6‐minute walk distance improved from 174.1 to 467.6 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All functional measures demonstrated statistically significant improvements with p value ≤ .008, except for cognition and memory FIM scores, which did not show a statistically significant difference. A majority (76%) of patients discharged home.ConclusionThis new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications.

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Inpatient rehabilitation can improve functional outcomes of post-intensive care unit COVID-19 patients—a prospective study

Cited by 24 publications

References 58 publications

Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial

Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID‐19 pulmonary disease

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