Predictors of Functional Dependence After COVID-19

Abstract

Objective The aim of this study was to examine the impact of demographics, preexisting medical conditions, and in-hospital complications of COVID-19 infection on functional status at discharge. Design and Participants A retrospective chart review was conducted on 119 patients hospitalized for COVID-19 infection between March 1, 2020, and April 20, 2020. Demographics, preexisting medical conditions, and newly diagnosed COVID-19 complications were collected from electronic medical records and entered in a deidentified database. Main Outcome The primary outcome was functional status at discharge, as measured by independence in activities of daily living. Results Older age, respiratory failure, cardiac conditions, and thromboembolic complications all made a statistically significant contribution to functional dependence at discharge, with thromboembolic complications evincing the strongest association (odds ratio, 25.58). Conclusion and Relevance New diagnosis of thrombosis during COVID-19 hospitalization, a measure of COVID-19 disease severity, was the factor most associated with dependence in activities of daily living at discharge. Interestingly, preexisting conditions including hypertension, severe obesity, lung disease, and diabetes did not correlate with dependent functional status at discharge.

Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of October 31st, 2020

“…After the removal of duplicates and the screening of titles and abstracts, 63 studies were retained, of which 22 were suitable for qualitative synthesis (Figure 1). The studies published in October 2020 were conducted in the following World Health Organization regions: 10 in Europe (Italy, 7-10 UK, 11,12 Belgium, 13,14 Germany 15 and Spain 16 ) and 10 in the Americas (USA, [17][18][19][20][21][22][23] Brazil 24,25 and Canada 26 ); one in Western Pacific (Australia 27 ) and one in the African region (Morocco). 28 A detailed overview of this update is provided as Supplementary Digital Material 1: Supplementary Table I (available on Cochrane Rehabilitation website).…”

“…Due to the heterogeneity of studies, a meta-analysis was not appropriate, and the results were described qualitatively. Based on the OCEBM 2011 Levels of Evidence table 29 the majority of studies (N.=17; 77.3%) were level 4 (six case report, 7,11,17,19,22,28 eight case series, 9,10,13,14,16,21,24,27 three historical cohort 20,23,26 ), whereas the remaining five were level 3 (four cohort studies 8,12,15,25 and one cross-sectional 18 study). No RCT or QRCTs were found in this update (Table I).…”

“…Twelve studies included COVID-19 patients in the acute phase, 7, 9, 11, 13, 16-19, 21, 24, 25, 28 seven in the postacute, 8,12,15,20,22,23,27 whereas there were no studies in the chronic phase. One descriptive study 26 reported data on late-onset manifestations and two studies on the impact of COVID-19 infection on people with pre-existing neurological diseases.…”

“…10,14 Seven studies reported the setting of rehabilitation service: according to the adopted classification, 5 they described four rehabilitation in acute care, 11,14,19,25 one general postacute, 26 one outpatient, 23 and one rehabilitation in the home. 27 According to the ICF-based classification of the limitations of functioning of rehabilitation interest (LFRI), most papers (N.=12; 55%) described the impact of COVID-19 infection on nervous system structure and related functions, 7, 9-12, 16, 18, 19, 21, 22, 24, 28 four studies reported on generic body structures and functions, 13,15,17,26 three on activity limitation and participation restriction, 20,23,27 two on respiratory structures and related functions, 8,14 and one on digestive function. 25 The main evidence is summarized below.…”

“…A historical cohort study described age and COVID-19 severity as the most important factors leading to a loss in independence in ADLs in a postacute phase of the disease. 20 In a case series of three patients, a COVID-19 telehealth rehabilitation program delivered within a pulmonary rehabilitation setting was presented. 27…”