Rehabilitative management of post-acute COVID-19: clinical pictures and outcomes

Abstract

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O 2 ) requirement and daily living activities were assessed before and after rehabilitation. Eightyfive patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m 2 . The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O 2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O 2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O 2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

Systematic Review of COVID-19-Related Physical Activity-Based Rehabilitations: Benefits to Be Confirmed by More Robust Methodological Approaches

“…Among the 159 full-text articles assessed for eligibility, 124 were removed for different reasons further detailed in Figure 1 . Finally, 35 studies [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] remained at the end of the study selection. As detailed in Figure 2 , the global score for the risks of bias in-between studies were found to be heterogeneous, ranging from 31% [ 65 ] to 88% [ 40 , 47 , 57 , 68 ].…”

“…Finally, 35 studies [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] remained at the end of the study selection. As detailed in Figure 2 , the global score for the risks of bias in-between studies were found to be heterogeneous, ranging from 31% [ 65 ] to 88% [ 40 , 47 , 57 , 68 ]. The higher risk of bias was observed for the ‘blinding of participants/personnel’ parameter assessed as ‘moderate risk’ for 94% [ 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ,…”

“…The higher risk of bias was observed for the ‘blinding of participants/personnel’ parameter assessed as ‘moderate risk’ for 94% [ 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] of the studies, and as ‘high risk’ for 6% of them [ 36 , 48 ]. The ‘analysis bias’ was the second most important bias, with 29% [ 35 , 39 , 40 , 47 , 48 , 51 , 57 , 58 , 63 , 68 ] of the studies considered ‘low risk’, 34% [ 37 , 41 , 42 , 43 , 45 , 49 , 54 , ...…”

“…The ‘analysis bias’ was the second most important bias, with 29% [ 35 , 39 , 40 , 47 , 48 , 51 , 57 , 58 , 63 , 68 ] of the studies considered ‘low risk’, 34% [ 37 , 41 , 42 , 43 , 45 , 49 , 54 , 59 , 60 , 61 , 64 , 69 ] ‘moderate risk’, and 37% [ 36 , 38 , 44 , 46 , 50 , 52 , 53 , 55 , 56 , 62 , 65 , 66 , 67 ] ‘high risk’. The lowest risk of bias was found for the detection bias with 100% [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53...…”

“…As reported in Table S2 , 23 [ 36 , 37 , 38 , 41 , 43 , 44 , 45 , 46 , 48 , 49 , 53 , 54 , 55 , 59 , 60 , 61 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] studies were prospective, while 12 [ 35 , 39 , 40 , 42 , 47 , 50 , 51 , 52 , 56 , 57 , 58 , 62 ] were retrospective. Concerning the constitutions of the groups, 16 [ 36 , 37 , 38 , 40 , 41 , 43 , 47 , 51 , 52 , 57 , 58 , 59 , 64 , 66 , 68 , 69 ] studies were only constituted by a single group of COVID-19 patients during or the after acute phase (COV+), 5 [ 45 ,…”