Rehabilitation and In-Hospital Mortality in COVID-19 patients

Characteristics and healthcare utilization of COVID-19 rehabilitation patients during the first and second waves of the pandemic in Toronto, Canada

The objective of this study is to describe the healthcare utilization, and clinical and sociodemographic features of a cohort of 74 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary rehabilitation hospital in Toronto, Canada. A retrospective chart review was performed using 74 charts from patients admitted to a COVID-19 rehabilitation unit between 11 April 2020 and 30 April 2021. Measures of central tendency, SDs, interquartile ranges, frequencies, and proportions were calculated to analyze clinical and sociodemographic data. A total of 74 patients were included in this study, including 33 males and 41 females. The mean age was 72.8 years, with Wave 1 patients being younger than Wave 2 patients. Sixty-six percent of total patients experienced hypertension. Mean functional independence measure score across both waves was 78 at admission and 100 at discharge. Mean length of stay was 14.6 days in Wave 1 and 18.8 days in Wave 2. This study represents some of the first data on the characteristics and outcomes of COVID-19 patients admitted to inpatient rehabilitation in Toronto, Canada across the initial waves of the COVID-19 pandemic.

Clinical Outcomes and Prevalence of Sarcopenia in Patients with Moderate to Severe COVID-19

Background: The purpose of this study was to investigate the effectiveness and clinical outcomes of inpatient rehabilitation for patients with severe COVID-19 in Japan. Methods: Patients with severe COVID-19 who underwent rehabilitation during hospitalization were included. The Medical Research Council (MRC) score and short physical performance battery (SPPB), such as physical function assessment and the intensive care unit (ICU) mobility scale, the functional status score for the ICU, and Barthel index as activities of daily living (ADLs) were evaluated at admission and discharge or transfer from the hospital. The correlation between SPPB at discharge and each factor at admission were also analyzed. Furthermore, the prevalence of sarcopenia was evaluated by defining SPPB of <9 points at discharge as sarcopenia. Results: The median age of the total of 23 patients was 59 years (interquartile range (IQR): 47−67), 73.9% were male, and the median PaO2/FiO2 at admission was 172.0 (IQR: 123.0−209.0). All physical function and ADL parameters were significantly improved from the time of admission to discharge (p = 0.014 for the MRC score and p < 0.001 for all others). Moreover, SPPB at discharge significantly correlated with WBC (Spearman’s rho = −0.473, p = 0.041), C-reactive protein (Spearman’s rho = −0.468, p = 0.044), and exhibited a significant trend with PaO2/FiO2 (Spearman’s rho = 0.429, p = 0.067) and age (Spearman’s rho = 0.409, p = 0.083). Although the median Barthel index at discharge was 90 points, 47% of patients had sarcopenia as defined by an SPPB of <9 points. Conclusions: Early rehabilitation for patients with severe COVID-19 improved physical function and ADLs during hospitalization. However, 47% of patients had the same level of sarcopenia at discharge.

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

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.

Proprietary Model of Qualification for In-Hospital Rehabilitation after COVID-19

BACKGROUND

Since the beginning of the SARS-CoV-2 epidemic in Poland, 6,128,006 people have been diagnosed, of which 116,798 died. Patients who recovered from COVID-19 and require rehabilitation due to varied impairments should be provided an opportunity to participate in an individualized, complex rehabilitation program starting from acute care and being continued in the post-acute and long-term rehabilitation phase. It is recommended to offer out-patient and in-hospital rehabilitation procedures depending on the type and persistence of symptoms and dysfunctions. The aim of this paper is to present the qualification process of post-COVID19 patients for an in-hospital complex rehabilitation program developed on the basis of pulmonary physical therapy.

METHODS

The presented qualification program was developed on the basis of clinical experience of over 2000 patients participating in the pilot program of in-hospital rehabilitation launched in September 2020 and based on the Regulation of the Polish Minister of Health of 13 July 2020.

RESULTS

The proposed model of patients' qualification rests on well-known and validated tools for functional assessment: exercise tolerance assessment, dyspnea intensity assessment, functional fitness assessment, assessment of arterial blood saturation, lung ventilation function assessment, assessment of long-lasting COVID-19 symptoms, and patient's basic mental health condition.

CONCLUSIONS

The proposed qualification model for the post-COVID rehabilitation program allows us to introduce adequate qualifications followed by much needed assessment of the health effects.

Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study

Background/Aims

Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic.

Methods

A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March–12 June 2020 and 2 November 2020–9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge.

Results

Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O.

Conclusions

Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.