Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID‐19 condition

Abstract

Introduction Outpatient rehabilitation is recommended in the treatment of post coronavirus disease 2019 (COVID‐19) condition. Although racial and ethnic disparities in the incidence and severity of COVID‐19 have been well documented, little is known about the use of outpatient rehabilitation among patients with post COVID‐19 condition. Objective To examine factors associated with outpatient rehabilitation use following COVID‐19 and to ascertain whether differential incidence of sequelae explain variation in post COVID‐19 rehabilitation utilization by race and ethnicity. Design Case–control study. Setting Community. Participants U.S. adults with COVID‐19 during 2020 in the TriNetX database. Intervention N/A. Main Outcome Measures Receipt of outpatient rehabilitation services within 6 months of COVID‐19 diagnosis and incidence of post COVID‐19 condition symptoms (weakness, fatigue, pain, cognitive impairment, mobility difficulties, and dyspnea). Results From 406,630 laboratory‐confirmed COVID‐19 cases, we identified 8724 individuals who received outpatient rehabilitation and matched 28,719 controls. Of rehabilitation users, 43.3% were 40 years old or younger, 54.8% were female, 58.2% were White, 17.9% were African American/Black, 2.1% were Asian, 13.0% were Hispanic, 39.2% had no comorbidities, and 40.3% had been hospitalized for COVID‐19. Dyspnea (20.4%), fatigue (12.4%), and weakness (8.2%) were the most frequently identified symptoms. Although there were no racial differences in the incidence of the six post COVID‐19 condition symptoms considered, African American/Black individuals were significantly less likely than their White counterparts to receive outpatient rehabilitation (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.84–0.96; p = .003). Hispanic individuals had higher outpatient rehabilitation utilization (OR = 1.22; 95% CI: 1.11–1.33; p < .001) and a significantly higher incidence of post COVID‐19 fatigue. Conclusions In this large nationally representative study, African American/Black race was associated with lower utilization of outpatient rehabilitation services despite a similar incidence of post COVID‐19 condition symptoms. Further research is needed to better understand access barriers to rehabilitation services for post COVID‐19 condition recovery care and address racial inequalities in receipt of care.

Quality of Life after Coronavirus Disease 2019 Hospitalization and Rehabilitation Needs

“…Awareness was raised early on with physical medicine and rehabilitation recommendations, in an effort to minimize disability, improve QoL and ensure the quickest return to everyday life ( 18 , 19 ). However, a recent large-scale nationwide study from the United States concluded that use of rehabilitation services was associated with race, although the incidence of post-COVID symptoms was no different, with black and Latino patients being underrepresented in the group of people seeking post-COVID help ( 20 ). A Latino American study revealed a heterogeneous pattern of rehabilitation provision within the region, with most of the programmes focusing on physiotherapy ( 21 ).…”

Utilization of Pulmonary Rehabilitation Following Hospitalization for COVID-19

“…During the COVID-19 pandemic, investigators from Greece reported 145 patients hospitalized for COVID-19, of whom 46.7% had severe disease and at 4 mo 4.3% had been referred to rehabilitation services 5. Hentschel and colleagues6 examined use of outpatient rehabilitative services in 8724 individuals diagnosed with COVID-19 and reported that 0.86% of previously hospitalized patients participated in rehabilitative services. Although PR services were limited during the pandemic, single-center reports described improvements in PR participants with post-COVID syndrome 7,8.…”

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

“…Although referral for ongoing outpatient physical and occupational therapy is beneficial, there remain significant gaps in health equity for certain populations. In a recent large national case–control study, African‐American/Black individuals were significantly less likely to receive outpatient rehabilitation than their white counterparts (odds ratio = 0.89) 88 . Specific to pain management, African‐American persons continue to experience disparities in the prevalence, management, progression, and outcomes of chronic, nonmalignant pain‐related conditions 89 …”