What Now for Rehabilitation Specialists? Coronavirus Disease 2019 Questions and Answers

Abstract

Recognizing a need for more guidance on the SARS-CoV-2 (COVID-19) pandemic, members of the Archives of Physical Medicine and Rehabilitation Editorial Board invited several clinicians with early experience managing the disease to collaborate on a document to help guide rehabilitation clinicians in the community. This consensus document is written in a “question and answer” format and contains information on the following items: common manifestations of the disease; rehabilitation recommendations in the acute hospital setting, recommendations for inpatient rehabilitation and special considerations. These suggestions are intended for use by rehabilitation clinicians in the inpatient setting caring for patients with confirmed or suspected COVID-19. The text represents the authors’ best judgment at the time it was written. However, our knowledge of COVID-19 is growing rapidly. The reader should take advantage of the most up to date information when making clinical decisions.

Providing rehabilitation to patients recovering fromCOVID‐19: A scoping review

“…In total, we included 128 articles in our review (see Figure 1 for PRISMA diagram) 3,4,13‐138 . With respect to article type, 33 were primary data articles (ie, observational studies, case reports), 22,24,33,41,51,55,57,63,69,78‐89,115,117,119,127‐129,131,132,134,136‐138 82 were secondary articles (ie, reviews, letters to the editor that did not report results of an original research project, commentaries)…”

Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic

“…Best practice guidelines strongly endorse interprofessional stroke rehabilitation programs for mitigating post-stroke health complications, 11 but in light of the COVID-19 pandemic, mitigating risk factors and morbidity associated with the shortand long-term consequences of COVID-19 is critical. 12,13 Exercise training is a recommended core component of stroke rehabilitation. 14,15 The majority of literature in individuals with stroke focuses on aerobic exercise training, but resistance and neuromuscular training are also critical aspects of a comprehensive program.…”

“…Exercise training can facilitate functional recovery (e.g., mobility and cognitive function), 16,17 improved cardiorespiratory fitness, 16 cardiovascular risk factors, 18 muscular strength, 19 and markers of neurorecovery. 20 Despite this substantial body of evidence, there are new challenges in the implementation of exercise training that are associated with the current COVID-19 pandemic, 12 and there is a lack of specific guidance for stroke rehabilitation service delivery. Indeed, the pandemic has led to significant changes in the delivery of all aspects of evidence-based stroke care, 12 where in-person and center-based activities are limited and physical distancing ensured to limit viral transmission.…”

“…20 Despite this substantial body of evidence, there are new challenges in the implementation of exercise training that are associated with the current COVID-19 pandemic, 12 and there is a lack of specific guidance for stroke rehabilitation service delivery. Indeed, the pandemic has led to significant changes in the delivery of all aspects of evidence-based stroke care, 12 where in-person and center-based activities are limited and physical distancing ensured to limit viral transmission. 21 Specific to exercise following COVID-19 infection, guidelines and clinical decision making tools are available for return to play for athletes, [22][23][24][25] cardiac rehabilitation, 26,27 general rehabilitation, 13 and acute stroke medical practices, 21 but there is no guidance explicitly focused on exercise in the context of stroke rehabilitation.…”

“…Best practice guidelines strongly endorse interprofessional stroke rehabilitation programs for mitigating post-stroke health complications, 11 but in light of the COVID-19 pandemic, mitigating risk factors and morbidity associated with the short- and long-term consequences of COVID-19 is critical. 12 , 13 …”