1
|
Mayer KP, Haezebrouck E, Ginoza LM, Martinez C, Jan M, Michener LA, Fresenko LE, Montgomery-Yates AA, Kalema AG, Pastva AM, Biehl M, Mart MF, Johnson JK. Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19. Crit Care 2024; 28:248. [PMID: 39026370 PMCID: PMC11256579 DOI: 10.1186/s13054-024-05035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. DESIGN Retrospective practice analysis from March 5, 2020, to April 15, 2021. SETTING Intensive care units (ICU) at four medical institutions. PATIENTS n = 3780 adults with ICU admission and diagnosis of COVID-19. INTERVENTIONS We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) "6-Clicks" (6-24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). MEASUREMENTS AND MAIN RESULTS The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2 = 0.68, p < 0.001) demonstrates mechanical ventilation (β = - 0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p < 0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS. CONCLUSIONS Greater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.
Collapse
Affiliation(s)
- Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA.
| | - Evan Haezebrouck
- University of Michigan Hospital, University of Michigan Health, Ann Arbor, MI, USA
| | - Lori M Ginoza
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Clarisa Martinez
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Minnie Jan
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lindsey E Fresenko
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA
| | | | - Anna G Kalema
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Amy M Pastva
- Division of Physical Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Michelle Biehl
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, USA
| | - Joshua K Johnson
- Division of Physical Therapy, Duke University School of Medicine, Durham, NC, USA
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
2
|
Young DL, Hannum SM, Engels R, Colantuoni E, Friedman LA, Hoyer EH. Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients. J Am Med Dir Assoc 2024; 25:104939. [PMID: 38387858 DOI: 10.1016/j.jamda.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge. DESIGN Retrospective cohort analysis of electronic medical records. SETTING AND PARTICIPANTS Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service. METHODS Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF. RESULTS There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%. CONCLUSIONS AND IMPLICATIONS Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.
Collapse
Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Engels
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Johnson JK, Sullivan JL, Trinkley KE, Lapin B, Passek S, Asp V, Ford B, Rabin BA. Use of the iPRISM webtool in a learning community to assess implementation context and fit of a novel clinical decision support tool for physical therapy triage in acute care hospitals. PM R 2024. [PMID: 38934486 DOI: 10.1002/pmrj.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The iPRISM webtool is an interactive tool designed to aid the process of applying the Practical, Robust Implementation and Sustainability Model (PRISM) for the assessment of and fit with context. A learning community (LC) is a multidisciplinary group of partners addressing a complex problem. Our LC coproduced the Physical TheraPy frEqueNcy Clinical decIsion support tooL (PT-PENCIL) to guide the use of physical therapist services in acute care hospitals. OBJECTIVE To describe our LC's activities to co-produce the PT-PENCIL, use of the iPRISM webtool to assess its preimplementation context and fit, and develop a multicomponent implementation strategy for the PT-PENCIL. DESIGN A descriptive research design. SETTING Three tertiary care hospitals. PARTICIPANTS Thirteen LC partners: six clinical physical therapists, three rehabilitation managers, three researchers, and a bioinformaticist. INTERVENTIONS Not applicable. OUTCOME MEASURES Using the iPRISM webtool, expected fit of the PT-PENCIL was rated 1 (not aligned) to 6 (well aligned) for each PRISM domain and expected reach, effectiveness, adoption, implementation, and maintenance were rated 1 (not likely at all) to 6 (very likely). Discrete implementation strategies were identified from the Expert Recommendations for Implementing Change. RESULTS The process spanned 18 meetings over 8 months. Ten LC partners completed the iPRISM webtool. PRISM domains with the lowest expected alignment were the "implementation and sustainability infrastructure" (mean = 4.7 out of 6; range = 3-6) and the "external environment" (mean = 4.9 of 6; range = 4-6). Adoption was the outcome with the lowest expected likelihood (mean = 4.5 out of 6; range = 1-6). Six discrete implementation strategies were identified and combined into a multicomponent strategy. CONCLUSIONS Within a LC, we used existing implementation science resources to co-produce a novel clinical decision support tool for acute care physical therapists and develop a strategy for its implementation. Our methodology can be replicated for similar projects given the public availability of each resource used.
Collapse
Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
| | - Jennifer L Sullivan
- Department of Health Services, Policy, & Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
- Long Term Services and Support Center of Innovation (LTSS COIN), Virginia Providence Healthcare System, Providence, Rhode Island, USA
| | - Katy E Trinkley
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brittany Lapin
- Department of Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sandra Passek
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Valerie Asp
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Ford
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Borsika A Rabin
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| |
Collapse
|
4
|
Mayer KP, Haezebrouck E, Ginoza LM, Martinez C, Jan M, Michener LA, Fresenko L, Montgomery-Yates AA, Kalema AG, Pastva AM, Biehl M, Mart MF, Johnson JK. Early physical rehabilitation dosage in the IntensiveCare Unit predicts hospital outcomes after criticalCOVID-19. RESEARCH SQUARE 2024:rs.3.rs-4319133. [PMID: 38798477 PMCID: PMC11118711 DOI: 10.21203/rs.3.rs-4319133/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Objective to examine the relationship between physical rehabilitation parameters including a novel approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3,780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: 1) mortality; 2) discharge disposition; and 3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) "6-Clicks" (6-24, 24=greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and Main Results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n=1739) required mechanical ventilation. For 2191 patients with complete data, rehabilitation dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2= 0.68, p <0.001) demonstrates mechanical ventilation (β = -0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p <0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS. Conclusions Greater physical rehabilitation exposure early in the ICU is associated with physical function at hospital discharge.
Collapse
|
5
|
Jain S, Murphy TE, Falvey JR, Leo-Summers L, O’Leary JR, Zang E, Gill TM, Krumholz HM, Ferrante LE. Social Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization. JAMA Netw Open 2024; 7:e2410713. [PMID: 38728030 PMCID: PMC11087837 DOI: 10.1001/jamanetworkopen.2024.10713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/09/2024] [Indexed: 05/13/2024] Open
Abstract
Importance Older adults with socioeconomic disadvantage develop a greater burden of disability after critical illness than those without socioeconomic disadvantage. The delivery of in-hospital rehabilitation that can mitigate functional decline may be influenced by social determinants of health (SDOH). Whether rehabilitation delivery differs by SDOH during critical illness hospitalization is not known. Objective To evaluate whether SDOH are associated with the delivery of skilled rehabilitation during critical illness hospitalization among older adults. Design, Setting, and Participants This cohort study used data from the National Health and Aging Trends Study linked with Medicare claims (2011-2018). Participants included older adults hospitalized with a stay in the intensive care unit (ICU). Data were analyzed from August 2022 to September 2023. Exposures Dual eligibility for Medicare and Medicaid, education, income, limited English proficiency (LEP), and rural residence. Main Outcome and Measures The primary outcome was delivery of physical therapy (PT) and/or occupational therapy (OT) during ICU hospitalization, characterized as any in-hospital PT or OT and rate of in-hospital PT or OT, calculated as total number of units divided by length of stay. Results In the sample of 1618 ICU hospitalizations (median [IQR] patient age, 81.0 [75.0-86.0] years; 842 [52.0%] female), 371 hospitalizations (22.9%) were among patients with dual Medicare and Medicaid eligibility, 523 hospitalizations (32.6%) were among patients with less than high school education, 320 hospitalizations (19.8%) were for patients with rural residence, and 56 hospitalizations (3.5%) were among patients with LEP. A total of 1076 hospitalized patients (68.5%) received any PT or OT, with a mean rate of 0.94 (95% CI, 0.86-1.02) units/d. After adjustment for age, sex, prehospitalization disability, mechanical ventilation, and organ dysfunction, factors associated with lower odds of receipt of PT or OT included dual Medicare and Medicaid eligibility (adjusted odds ratio, 0.70 [95% CI, 0.50-0.97]) and rural residence (adjusted odds ratio, 0.65 [95% CI, 0.48-0.87]). LEP was associated with a lower rate of PT or OT (adjusted rate ratio, 0.55 [95% CI, 0.32-0.94]). Conclusions and Relevance These findings highlight the need to consider SDOH in efforts to promote rehabilitation delivery during ICU hospitalization and to investigate factors underlying inequities in this practice.
Collapse
Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terrence E. Murphy
- Department of Public Health Sciences, Pennsylvania State University, State College
| | - Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
| | | | - John R. O’Leary
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Emma Zang
- Department of Sociology, Yale University, New Haven, Connecticut
| | - Thomas M. Gill
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
6
|
Mayer KP, Silva S, Beaty A, Davenport A, Minniti M, Dorn SU, White LS, Sabol VK, Pastva AM. Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness. Arch Rehabil Res Clin Transl 2023; 5:100305. [PMID: 38163032 PMCID: PMC10757188 DOI: 10.1016/j.arrct.2023.100305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill. Design Retrospective, observational cohort study. Setting Medical Intensive Care Unit (MICU). Participants Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU. Interventions Not applicable. Measurements and Main Results Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03). Conclusion Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.
Collapse
Affiliation(s)
- Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Susan Silva
- Duke University School of Nursing, Duke University, Durham, NC
| | - Amanda Beaty
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Rehabilitation Services, Duke Health, Durham, NC
| | - Anne Davenport
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Rehabilitation Therapy, Sky Lakes Medical Center, Klamath Falls, OR
| | - Melissa Minniti
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Physical Medicine and Rehabilitation Services, James A Haley VA, Tampa, FL
| | - Sara Uribe Dorn
- Department of Rehabilitation Services, Duke Health, Durham, NC
| | - Lane S. White
- Department of Rehabilitation Services, Duke Health, Durham, NC
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | | | - Amy M. Pastva
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Duke Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC
| |
Collapse
|
7
|
Ceravolo MG, Anwar F, Andrenelli E, Udensi C, Qureshi J, Sivan M, Kiekens C, Zampolini M. Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2023; 59:789-799. [PMID: 38214046 DOI: 10.23736/s1973-9087.23.08315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.
Collapse
Affiliation(s)
- Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy -
| | - Cynthia Udensi
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jawaria Qureshi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, University of Leeds, Leeds, UK
| | | | - Mauro Zampolini
- Department of Rehabilitation, Hospital of Foligno, USL Umbria2, Perugia, Italy
| |
Collapse
|
8
|
Bayuo J, Wong FKY. Transitional and aftercare needs of persons recovering from COVID-19 using the Omaha System: A Scoping Review. J Clin Nurs 2023; 32:6894-6916. [PMID: 37353967 DOI: 10.1111/jocn.16798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 08/09/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
AIM To identify and classify the transitional and aftercare needs of persons hospitalised with and recovering from COVID-19. BACKGROUND Several studies exist that describe the patient needs at the acute phase of COVID-19. The transitional and aftercare needs that emerge during recovery, however, remain vague. METHODS A scoping review was conducted and reported according to the PRISMA extension guidelines for scoping reviews (PRISMA-ScR). Primary studies were identified from database search. Narrative synthesis was undertaken, with the Omaha System as a framework. RESULTS Forty studies were included. Persons recovering from the infection may have several needs in all domains of the Omaha System. Although the severity and persistence of the needs may be unrelated to the severity of the initial infection, they may vary based on factors such as age and pre-morbid factors. CONCLUSION Recovering from COVID-19 is associated with varied biopsychosocial-environmental needs which can adversely affect the quality-of-life experience. The review findings represent an inventory of needs that can guide the development of multi-disciplinary post-acute or aftercare programmes. RELEVANCE TO CLINICAL PRACTICE Recovering from COVID-19 can be a protracted process requiring ongoing professional support after discharge. Policies are required to support the development and implementation of post-acute programmes of care. Comprehensive transitional and aftercare rehabilitative programmes are needed to support the recovery process.
Collapse
Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | |
Collapse
|
9
|
Yamamoto H, Tanaka S, Kasugai D, Shimizu M, Tsuchikawa Y, Hori Y, Fugane Y, Inoue T, Nagaya M, Omote N, Higashi M, Yamamoto T, Jingushi N, Numaguchi A, Goto Y, Nishida Y. Physical function and mental health trajectories in COVID-19 patients following invasive mechanical ventilation: a prospective observational study. Sci Rep 2023; 13:14529. [PMID: 37666912 PMCID: PMC10477337 DOI: 10.1038/s41598-023-41684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
This prospective observational cohort study was performed to investigate the physical function and mental health trajectories of novel coronavirus disease 2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after discharge from the intensive care unit (ICU). The study population consisted of 64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum score < 48 points, and prolonged IMV was significantly associated with lower MRC sum score and handgrip strength. Symptoms were similar between groups at ICU discharge, and the symptoms most commonly reported as moderate-to-severe were impaired well-being (52%), anxiety (43%), tiredness (41%), and depression (35%). Although muscle strength and mobility status were significantly improved after ICU discharge, Edmonton Symptom Assessment System score did not improve significantly in the prolonged IMV group. EuroQol five-dimension five-level summary index was significantly lower in the prolonged than short IMV group at 6 months after ICU discharge. We found substantial negative physical function and mental health consequences in the majority of surviving COVID-19 patients requiring IMV, with prolonged period of IMV showing greater negative effects not only immediately but also at 6 months after discharge from the ICU.
Collapse
Affiliation(s)
- Hiromasa Yamamoto
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan.
| | - Miho Shimizu
- Department of Rehabilitation, Mie University Hospital, Tsu, Japan
| | - Yohei Tsuchikawa
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Yuto Hori
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Yuki Fugane
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Norihito Omote
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiko Higashi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan
| | - Takanori Yamamoto
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan
| | - Naruhiro Jingushi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan
| | - Yukari Goto
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
10
|
Johnson JK, Young DL, Guo N, Tereshchenko LG, Martinez M, Hohman JA, Rothberg MB. Physical therapy provision for patients with pneumonia in US hospitals. J Hosp Med 2023; 18:787-794. [PMID: 37602532 DOI: 10.1002/jhm.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Physical therapy (PT) appears beneficial for hospitalized patients. Little is known about PT practice patterns and costs across hospitals. OBJECTIVE To examine whether receiving PT is associated with specific patient and hospital characteristics for patients with pneumonia. We also explored the variability in PT service provision and costs between hospitals. METHODS We included administrative claims from 2010 to 2015 in the Premier Healthcare Database, inclusive of 644 US hospitals. We examined associations between receiving at least one PT visit and patient (age, race, insurance, intensive care utilization, comorbidity status, and length of stay) and hospital (academic status, rurality, size, and location) characteristics. Exploratory measures included timing and proportion of days with PT visits, and per-visit and per-admission costs. RESULTS Of 768,010 patients, 49% had PT. After adjustment, older age most significantly increased the probability of receiving PT (+38.0% if >80 vs. ≤50 years). Higher comorbidity burden, longer length of stay, and hospitalization in an urban setting were also associated with higher probability. Hospitalization in the South most significantly decreased the probability (-9.1% vs. Midwest). Patients without Medicare and Non-White patients also had lower probability. Median (interquartile range) days to first visit was 2 (1-4). Mean proportion of days with a visit was 35% ± 20%. Median per-visit cost was $88.90 [$56.70-$130.90] and per-admission was $224.00 [$137.80-$369.20]. CONCLUSION Both clinical (intensive care utilization and comorbidity status) and non-clinical (age, race, rurality, location) factors were associated with receiving PT. Within and between hospitals, there was high variability in the number and frequency of visits, and costs.
Collapse
Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jessica A Hohman
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Young DL, Johnson JK, Guo N, Tereshchenko LG, Martinez M, Rothberg MB. Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia. J Hosp Med 2023; 18:803-811. [PMID: 37545436 DOI: 10.1002/jhm.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges. OBJECTIVE Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia. DESIGNS Observational cohort study. SETTING Acute care hospital. PARTICIPANTS Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5. INTERVENTION Physical therapy visit frequency. MAIN OUTCOME AND MEASURES Discharge disposition (home or postacute care). RESULTS We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.
Collapse
Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Joshua K Johnson
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Drazich BF, Resnick B, Boltz M, Galik E, Kim N, McPherson R, Ellis J, Phun J, Kuzmik A. Factors Associated With Physical Activity in Hospitalized Patients With Dementia. J Aging Phys Act 2023; 31:658-665. [PMID: 36746152 PMCID: PMC10517697 DOI: 10.1123/japa.2022-0210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 02/08/2023]
Abstract
Older adults continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to (a) describe activity among hospitalized older adults with dementia and (b) identify the association between specific factors (gender, ambulation independence, comorbidities, race, and hospital setting) and their physical activity. This descriptive study utilized baseline data on the first 79 participants from the Function Focused Care for Acute Care using the Evidence Integration Triangle. Multiple linear regression models were run using accelerometry data from the first full day of hospitalization. The participants spent an average of 83.7% of their time being sedentary. Male gender, ambulation independence, and hospital setting (the hospital in which the patient was admitted) were associated with greater activity. This study reports on the limited time spent in activity for older adults with dementia when hospitalized and highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital setting.
Collapse
Affiliation(s)
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Marie Boltz
- School of Nursing, Penn State University, College State, PA,USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Nayeon Kim
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Jasmine Phun
- School of Medicine, Thomas Jefferson University, Philadelphia, PA,USA
| | - Ashley Kuzmik
- School of Nursing, Penn State University, College State, PA,USA
| |
Collapse
|
13
|
Johnson JK, Hamilton AC, Hu B, Pack QR, Lindenauer PK, Fox RJ, Hashmi A, Siegmund LA, Burchill CN, Taksler GB, Goto T, Stilphen M, Rothberg MB. Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial. Trials 2023; 24:471. [PMID: 37488588 PMCID: PMC10367239 DOI: 10.1186/s13063-023-07501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hospitalized older adults spend as much as 95% of their time in bed, which can result in adverse events and delay recovery while increasing costs. Observational studies have shown that general mobility interventions (e.g., ambulation) can mitigate adverse events and improve patients' functional status. Mobility technicians (MTs) may address the need for patients to engage in mobility interventions without overburdening nurses. There is no data, however, on the effect of MT-assisted ambulation on adverse events or functional status, or on the cost tradeoffs if a MT were employed. The AMBULATE study aims to determine whether MT-assisted ambulation improves mobility status and decreases adverse events for older medical inpatients. It will also include analyses to identify the patients that benefit most from MT-assisted mobility and assess the cost-effectiveness of employing a MT. METHODS The AMBULATE study is a multicenter, single-blind, parallel control design, individual-level randomized trial. It will include patients admitted to a medical service in five hospitals in two regions of the USA. Patients over age 65 with mild functional deficits will be randomized using a block randomization scheme. Those in the intervention group will ambulate with the MT up to three times daily, guided by the Johns Hopkins Mobility Goal Calculator. The intervention will conclude at hospital discharge, or after 10 days if the hospitalization is prolonged. The primary outcome is the Short Physical Performance Battery score at discharge. Secondary outcomes are discharge disposition, length of stay, hospital-acquired complications (falls, venous thromboembolism, pressure ulcers, and hospital-acquired pneumonia), and post-hospital functional status. DISCUSSION While functional decline in the hospital is multifactorial, ambulation is a modifiable factor for many patients. The AMBULATE study will be the largest randomized controlled trial to test the clinical effects of dedicating a single care team member to facilitating mobility for older hospitalized patients. It will also provide a useful estimation of cost implications to help hospital administrators assess the feasibility and utility of employing MTs. TRIAL REGISTRATION Registered in the United States National Library of Medicine clinicaltrials.gov (# NCT05725928). February 13, 2023.
Collapse
Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Aaron C Hamilton
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Robert J Fox
- Mellen Center for Treatment and Research in Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ardeshir Hashmi
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, and Consultant Staff, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Glen B Taksler
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Population Health Research Institute, Case Western Reserve University at MetroHealth System, Cleveland, OH, USA
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
14
|
Briggs MS, Kolbus ES, Patterson KM, Harmon-Matthews LE, McGrath SL, Quatman-Yates CC, Meirelles C, Salsberry MJ. How oral intake, mobility, and activity measures can inform discharge recommendations: A retrospective analysis of hospitalized inmate and non-inmate COVID-19 patients. JMIR Rehabil Assist Technol 2023. [PMID: 37224276 DOI: 10.2196/43250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Patients who were incarcerated were disproportionately impacted by COVID-19 compared to the general public. Further, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. OBJECTIVE To compare functional outcomes of oral intake, mobility, and activity between inmates and non-inmates who were diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. METHODS A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including Functional Oral Intake Scale (FOIS) and Activity Measure for Post-Acute Care (AM-PAC) were collected and compared between inmates and non-inmates. Binary logistic regression models were used to evaluate the odds of 1) whether patients were discharged to the same place they were admitted and 2) patients being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 83 patients (inmates, n=38; non-inmates, n=45) were included in the final analysis. There were no differences between inmates and non-inmates on initial (P=.39) and final FOIS scores (P=.35) or on initial, final, or change scores (P>.05) on the AM-PAC. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR=0.922; 95%CI=0.875 to 0.972 and OR=0.918; 95%CI=0.871 to 0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR=5.285; 95%CI= 1.334 to 20.931) and (OR=6.083; 95%CI=1.548 to 23.912); "Other" race (OR=7.596; 95%CI=1.203 to 47.968) and (OR=8.515; 95%CI=1.311 to 55.291); and female sex (OR=4.671; 95%CI=1.086 to 20.092) and (OR=4.977; 95%CI=1.146 to 21.615). CONCLUSIONS Results from this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and non-inmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. CLINICALTRIAL
Collapse
Affiliation(s)
- Matthew Scott Briggs
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, US
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, US
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
| | - Erin Shevawn Kolbus
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Kevin Michael Patterson
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | | | - Shana Lee McGrath
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Catherine Celeste Quatman-Yates
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Cristiane Meirelles
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Marka Jean Salsberry
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| |
Collapse
|
15
|
Lee SW, Ma D, Davoodian A, Ayutyanont N, Werner B. COVID-19 vaccination decreased COVID-19 hospital length of stay, in-hospital death, and increased home discharge. Prev Med Rep 2023; 32:102152. [PMID: 36811076 PMCID: PMC9933576 DOI: 10.1016/j.pmedr.2023.102152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/16/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
COVID-19 vaccination impact on hospital outcome metrics among patients hospitalized with COVID-19 is not well known. We evaluated if covid-19 vaccination was associated with better hospital outcomes such as in-hospital mortality, overall length of stay, and home discharge. This retrospective study analyzed data from the electronic health records of 29,732 patients admitted with COVID-19 with or without vaccination (21,525 unvaccinated and 8207 vaccinated) from January to December 2021. The association of COVID-19 vaccination status with overall length of hospitalization, in-hospital mortality rate, home discharge after hospitalization was investigated using a multivariate logistic regression and a generalized linear model. The mean age of all groups was 58.16 ± 17.39 years. The unvaccinated group was younger (54.95 ± 16.75) and had less comorbidities compared to the vaccinated group. Patients that had received COVID-19 vaccination exhibited decreased in-hospital mortality (OR 0.666, 95 % CI 0.580-0.764), decreased length of stay (-2.13 days, CI 2.73-1.55 days), and increased rate of home discharge (OR 1.168, CI 1.037-1.315). Older age and cerebrovascular accident diagnosis at admission demonstrated a negative effect on hospital outcomes with decreased home discharge (OR 0.950 per 1 year, CI 0.946-0.953 and OR 0.415, CI 0.202-0.854) and increased inhospital mortality (OR 1.04 per 1 year, CI 1.036-1.045 and OR 3.005, CI 1.961-4.604). This study shows the additional positive impact of COVID-19 vaccination has not just on in-hospital mortality but also in reducing overall length of stay and improved hospital outcome metrics including increasing likelihood of home discharge after hospitalization.
Collapse
Affiliation(s)
- Se Won Lee
- Corresponding authors at: Sunrise Health GME Consortium, Mt. View Medical Center, HCA Healthcare, 2880 N Tenaya Way, 2nd floor, Las Vegas, NV, United States
| | | | | | | | | |
Collapse
|
16
|
Rauzi MR, Ridgeway KJ, Wilson MP, Jolley SE, Nordon-Craft A, Stevens-Lapsley JE, Erlandson KM. Rehabilitation Therapy Allocation and Changes in Physical Function Among Patients Hospitalized Due to COVID-19: A Retrospective Cohort Analysis. Phys Ther 2023; 103:pzad007. [PMID: 37172130 PMCID: PMC10071586 DOI: 10.1093/ptj/pzad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/03/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Limited staffing and initial transmission concerns have limited rehabilitation services during the COVID-19 pandemic. The purpose of this analysis was to determine the associations between Activity Measure for Post-Acute Care (AM-PAC) mobility categories and allocation of rehabilitation, and in-hospital AM-PAC score change and receipt of rehabilitation services for patients with COVID-19. METHODS This was a retrospective cohort study of electronic health record data from 1 urban hospital, including adults with a COVID-19 diagnosis, admitted August 2020 to April 2021. Patients were stratified by level of medical care (intensive care unit [ICU] and floor). Therapy allocation (referral for rehabilitation, receipt of rehabilitation, and visit frequency) was the primary outcome; change in AM-PAC score was secondary. AM-PAC Basic Mobility categories (None [21-24], Minimum [18-21], Moderate [10-17], and Maximum [6-9]) were the main predictor variable. Primary analysis included logistic and linear regression, adjusted for covariates. RESULTS A total of 1397 patients (ICU: n = 360; floor: n = 1037) were included. AM-PAC mobility category was associated with therapy allocation outcomes for floor but not patients in the ICU: the Moderate category had greater adjusted odds of referral (adjusted odds ratio [aOR] = 10.88; 95% CI = 5.71-21.91), receipt of at least 1 visit (aOR = 3.45; 95% CI = 1.51-8.55), and visit frequency (percentage mean difference) (aOR = 42.14; 95% CI = 12.45-79.67). The secondary outcome of AM-PAC score improvement was highest for patients in the ICU who were given at least 1 rehabilitation therapy visit (aOR = 5.31; 95% CI = 1.90-15.52). CONCLUSION AM-PAC mobility categories were associated with rehabilitation allocation outcomes for floor patients. AM-PAC score improvement was highest among patients requiring ICU-level care with at least 1 rehabilitation therapy visit. IMPACT Use of AM-PAC Basic Mobility categories may help improve decisions for rehabilitation therapy allocation among patients who do not require critical care, particularly during times of limited resources.
Collapse
Affiliation(s)
- Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Kyle J Ridgeway
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, Colorado, USA
| | - Melissa P Wilson
- Department of Biomedical Informatics, University of Colorado, Aurora, Colorado, USA
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Amy Nordon-Craft
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
17
|
Al-Nassan S, Alshallan A, Hawamdeh M. Physiotherapy interventions and profile of practice for COVID-19 patients in Jordan. Work 2023; 74:47-57. [PMID: 36245354 DOI: 10.3233/wor-211460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Physiotherapy plays an essential role in combating the complications of coronavirus disease 2019 (COVID-19). Profiling the experiences and challenges of physiotherapy practice in a country will help in customizing the competencies needed for physiotherapy education and regulations of practice. OBJECTIVE To explore the experiences, knowledge, training, and barriers of practice for Jordanian physiotherapists who worked with COVID-19 cases at different work settings. METHODS An online survey was distributed to physiotherapists working at different Jordanian rehabilitation settings. Physiotherapists who had experience in dealing with COVID-19 cases were eligible to participate in the study. RESULTS The survey showed that only 38% of participants had received specialized training in dealing with COVID-19. Respiratory exercises were mostly used in the intensive care units or isolation wards (60%), and with patients having long-term complications (74%). Inadequate patients' referral to physiotherapy was reported by 88.6% of eligible participants. The majority of participants (68%) reported lack of adequate personal protective equipment (PPE) for physiotherapists. Challenges at the level of treatment skills, techniques, and communication were the most frequently reported by participants (44%), followed by challenges at the level of work policies (32%), then by challenges at the level of knowledge about the disease (28%). CONCLUSION The study showed gaps in knowledge, training, and work-related policies that all created challenges for physiotherapists dealing with COVID-19 cases in Jordan. We hope our data can help in providing a basis for developing educational and training programs, in addition to revising work-related policies, to promote physiotherapy management of COVID-19 in Jordan.
Collapse
Affiliation(s)
- Saad Al-Nassan
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Amjad Alshallan
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Mohannad Hawamdeh
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
18
|
Coakley K, Friedman L, McLoughlin K, Wozniak A, Hutchison P. Acute Occupational and Physical Therapy for Patients With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2023; 104:27-33. [PMID: 35926570 PMCID: PMC9340124 DOI: 10.1016/j.apmr.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the function of patients with COVID-19 admitted to an acute care hospital early in the pandemic and to characterize change in function among those admitted to intensive care units (ICU) and to non-critical care services. DESIGN This descriptive, retrospective cohort study examined patients infected with SARS-CoV-2 admitted to a tertiary care medical center during the first wave of the pandemic in 2020. Included patients were stratified into 4 cohorts based on whether or not they received therapy during their hospitalization and whether or not their hospitalization included time in the ICU. Data on demographic characteristics, functional impairments, medical interventions, and functional outcomes were collected. SETTING Hospital. PARTICIPANTS 432 adult patients were included in this study (N=432). RESULTS ICU patients receiving therapy were more likely to have impaired cognition, impaired strength, and impaired sensation than non-ICU patients receiving therapy. Patients made improvements from evaluation to discharge on the Functional Status Score for the ICU, Activity Measure for Post-Acute Care Daily Activity, and AM-PAC Basic Mobility Short Forms. CONCLUSION Patients admitted with COVID-19 experienced significant functional impairments but also demonstrated improvement during the course of their hospitalizations. This study can facilitate health care provider awareness of the detrimental functional effects of COVID-19 and the potential role of rehabilitation services for these patients.
Collapse
Affiliation(s)
- Katie Coakley
- Corresponding author Katie Coakley, OTR/L, Loyola University Medical Center, Maywood, IL
| | | | | | | | | |
Collapse
|
19
|
Almeida LVD, Garcia-Araujo A, Lopez M, Rocha DS, Mendes RG, Borghi-Silva A, Dibai-Filho AV, Dibai DB. Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities. CIENCIA & SAUDE COLETIVA 2022; 27:2963-2972. [PMID: 35894310 DOI: 10.1590/1413-81232022278.18672021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/06/2021] [Indexed: 01/08/2023] Open
Abstract
The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.
Collapse
Affiliation(s)
- Lucivalda Viegas de Almeida
- Programa de Pós-Graduação em Gestão de Programas e Serviços de Saúde, Universidade Ceuma. São Luís MA Brasil
| | - Adriana Garcia-Araujo
- Departmento de Fisioterapia, Universidade Federal de São Carlos. São Carlos SP Brasil
| | - Mildred Lopez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud. Monterrey México
| | - Daniel Santos Rocha
- Departmento de Fisioterapia, Centro de Ciências da Saúde, Universidade Ceuma. Rua Josué Montello 1, Jardim Renascença. 65075-120 São Luís MA Brasil.
| | | | - Audrey Borghi-Silva
- Departmento de Fisioterapia, Universidade Federal de São Carlos. São Carlos SP Brasil
| | | | - Daniela Bassi Dibai
- Programa de Pós-Graduação em Gestão de Programas e Serviços de Saúde, Universidade Ceuma. São Luís MA Brasil.,Departmento de Fisioterapia, Centro de Ciências da Saúde, Universidade Ceuma. Rua Josué Montello 1, Jardim Renascença. 65075-120 São Luís MA Brasil.
| |
Collapse
|
20
|
Grove K, Edgar DW, Chih H, Harrold M, Natarajan V, Mohd S, Hurn E, Cavalheri V. Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19. J Clin Med 2022; 11:jcm11133602. [PMID: 35806891 PMCID: PMC9267535 DOI: 10.3390/jcm11133602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022] Open
Abstract
↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected COVID-19 was recruited. Participants were grouped according to their polymerase chain reaction (PCR) test result into COVID-19 positive (COVID+) and COVID-19 negative (COVID−) groups. Between-group comparisons of characteristics of the participants and hospital admission data were performed. Sixty-five participants were included (38 COVID+ and 27 COVID−; 36 females [55%]). Participants in the COVID+ group had greater acute hospital length of stay (LOS) (median [25−75th percentile] 10 [5−21] vs. 3 [2−5] days; p < 0.05] and only those with COVID+ required mechanical ventilation (8 [21%] participants). Twenty-one percent of the COVID+ participants were discharged to inpatient rehabilitation (7% of the COVID− participants). Of note, pre-existing pulmonary disease was more prevalent in the COVID− group (59% vs. 13%; p < 0.05). Within the COVID+ group, when compared to participants discharged home, those who required inpatient rehabilitation had worse peripheral oxygen saturation (SpO2) on admission (86 ± 5.7% vs. 93 ± 3.8%; p < 0.05) and longer median LOS (30 [23−37] vs. 7 [4−13] days; p < 0.05). Despite having less people with pre-existing pulmonary disease, the COVID+ group required more care and rehabilitation than the COVID− group. In the COVID+ group, SpO2 on hospital presentation was associated with LOS, critical care needs, mechanical ventilation duration and the need for inpatient rehabilitation.
Collapse
Affiliation(s)
- Kristen Grove
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
| | - Dale W. Edgar
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
- Burn Injury Research Node, University of Notre Dame Australia, Fremantle, WA 6160, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Meg Harrold
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
| | - Varsha Natarajan
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
| | - Sheeraz Mohd
- Department of Cardiology, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia;
| | - Elizabeth Hurn
- Department of Physiotherapy, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA 6009, Australia;
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- Allied Health, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Correspondence:
| |
Collapse
|
21
|
Silva CA, Lopes AJ, Papathanasiou J, Reis LFF, Ferreira AS. Association of Functional Characteristics and Physiotherapy with COVID-19 Mortality in Intensive Care Unit in Inpatients with Cardiovascular Diseases. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060823. [PMID: 35744086 PMCID: PMC9229782 DOI: 10.3390/medicina58060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: To estimate the association between admission functional outcomes and exposure to physiotherapy interventions with mortality rate in intensive care unit (ICU) inpatients with cardiovascular diseases and new coronavirus disease (COVID-19). Materials and Methods: Retrospective cohort including 100 ICU inpatients (mean (standard deviation), age 75 (16) years) split into COVID-19+ or COVID-19−. The association of in-ICU death with admission functional outcomes and physiotherapy interventions was investigated using univariable and multivariable regression models. Results: In total, 42 (42%) patients tested positive for COVID-19. In-ICU mortality rate was 37%, being higher for the COVID-19+ group (odds ratio, OR (95% CI): 3.15 (1.37−7.47), p = 0.008). In-ICU death was associated with lower admission ICU Mobility Scale score (0.81 (0.71−0.91), p = 0.001). Restricted mobility (24.90 (6.77−161.94), p < 0.001) and passive kinesiotherapy (30.67 (9.49−139.52), p < 0.001) were associated with in-ICU death, whereas active kinesiotherapy (0.13 (0.05−0.32), p < 0.001), standing (0.12 (0.05−0.30), p < 0.001), or walking (0.10 (0.03−0.27), p < 0.001) were associated with in-ICU discharge. Conclusions: In-ICU mortality was higher for inpatients with cardiovascular diseases who had COVID-19+, were exposed to invasive mechanical ventilation, or presented with low admission mobility scores. Restricted mobility or passive kinesiotherapy were associated with in-ICU death, whereas active mobilizations (kinesiotherapy, standing, or walking) were associated with in-ICU discharge in this population.
Collapse
Affiliation(s)
- Chiara Andrade Silva
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Agnaldo José Lopes
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department of Kinesitherapy, Faculty of Public Health “Prof. Dr. Tzecomir Vodenicharov, DSc.”, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Luis Felipe Fonseca Reis
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Arthur Sá Ferreira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
- Correspondence: ; Tel.: +5521-38829797 (ext. 2012)
| |
Collapse
|
22
|
Johnson JK, Rothberg MB, Adams K, Lapin B, Keeney T, Stilphen M, Bethoux F, Freburger J. Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home. Med Care 2022; 60:444-452. [PMID: 35293885 PMCID: PMC9106906 DOI: 10.1097/mlr.0000000000001708] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical therapists (PTs) are consulted to address functional deficits during hospitalization, but the effect of PT visit frequency on patients' outcomes is not clear. OBJECTIVE The objective of this study was to examine whether PT visit frequency is independently associated with functional improvement, discharge home, and both outcomes combined. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS Patients discharged from hospitals in 1 health system between 2017 and 2020, stratified by diagnostic subgroup: cardiothoracic and vascular, general medical/surgical, neurological, oncology, and orthopedic. MEASURES PT visit frequency was categorized as ≤2, >2-4, >4-7, >7 visits/week. Functional improvement was defined as ≥5-point improvement in Activity Measure for Post-Acute Care mobility score. Other outcomes were discharge home and both outcomes combined. RESULTS There were 243,779 patients included. Proportions within frequency categories ranged from 11.0% (>7 visits/wk) to 40.5% (≤2 visits/wk) and varied by subgroup. In the full sample, 36% of patients improved function, 64% were discharged home, and 27% achieved both outcomes. In adjusted analyses, relative to ≤2 visits/week, the adjusted relative risk (aRR) for functional improvement increased incrementally with higher frequency (aRR=1.20, 95% confidence interval: 1.14-1.26 for >2-4 visits to aRR=1.78, 95% confidence interval: 1.55-2.03 for >7 visits). For all patients and within subgroups, the higher frequency was also associated with a greater likelihood of discharging home and achieving both outcomes. CONCLUSIONS More frequent PT visits during hospitalization may facilitate functional improvement and discharge home. Most patients, however, receive infrequent visits. Further research is needed to determine the optimal delivery of PT services to meet individual patient needs.
Collapse
Affiliation(s)
- Joshua K. Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
- Department of Geriatric and Internal Medicine, Community Care, Cleveland Clinic
| | - Kellie Adams
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Tamra Keeney
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
| |
Collapse
|
23
|
Ricotti S, Petrucci L, Carenzio G, Carlisi E, DI Natali G, DE Silvestri A, Lisi C. Functional assessment and rehabilitation protocol in acute patients affected by SARS-CoV-2 infection hospitalized in the Intensive Care Unit and in the Medical Care Unit. Eur J Phys Rehabil Med 2022; 58:316-323. [PMID: 34605619 PMCID: PMC9980591 DOI: 10.23736/s1973-9087.21.06897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Coronavirus disease (COVID-19) is characterized by different clinical pictures that may require prolonged hospitalization and produce disabilities challenging the recovery of previous independence. AIM The aim is to evaluate the impact of an early assisted rehabilitation program on the functional status of an acutely hospitalized population affected by COVID-19. DESIGN Single-institution retrospective longitudinal study. SETTING Inpatient intensive care units (ICU) and medical care units (MCU). POPULATION Acute COVID-19 patients. METHODS General information was collected; age-adjusted Charlson Comorbidity Index was used for comorbidities. Duration of hospital stay, the length of stay in ICU and/or MCU, the length of the rehabilitative treatment, and the destination at the discharge were collected. Evaluation was performed when patients were clinically stable (T0), and at hospital discharge (T1); for subjects enrolled in ICU functional status was assessed at the time of transfer to the MCU. Muscle strength of the four limbs was measured with the Medical Research Council (MRC) sum-score. Functional status was assessed using the 3-item Barthel Index (BI-3) and the General Physical Mobility Score (GPMS). Early assisted-tailored rehabilitation protocol was applied in ICU and in MCU: the aims were the maintenance (or recovery) of the range of motion and of the strength and the recovery of sitting/standing position and gait. RESULTS We evaluated 116 patients (mean age 65, SD 11) (65% male), 68 in ICU (mean age 60, SD 10), 48 in MCU (mean age 73, SD 9). At discharge, BI-3 and GPMS significantly improved in both ICU (P<0.001) and MCU (P<0.001) subgroups of patients. MRC sum-score significantly improved in ICU patients (P<0.001). Patients hospitalized in ICU had a significantly longer hospital stay. At discharge, patients admitted to the ICU reach a functional state that is close to that of patients admitted to the MCU. CONCLUSIONS The results suggest that an early assisted rehabilitation program may be helpful in improving the short-term functional status of an acutely hospitalized population affected by COVID-19, with discharge at home of 48% CLINICAL REHABILITATION IMPACT: this study focuses on a functional assessment method to be used to identify the rehabilitation needs and verify the results of an early rehabilitation protocol applied to the acute COVID-19 patient admitted to ICU and MCU.
Collapse
Affiliation(s)
- Susanna Ricotti
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy -
| | - Lucia Petrucci
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Gabriella Carenzio
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Ettore Carlisi
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Giuseppe DI Natali
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Annalisa DE Silvestri
- Unit of Clinical Epidemiology and Biometrics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Claudio Lisi
- Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | | |
Collapse
|
24
|
Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Rocheleau G, Russell JA. Organ dysfunction and death in patients admitted to hospital with COVID-19 in pandemic waves 1 to 3 in British Columbia, Ontario and Quebec, Canada: a cohort study. CMAJ Open 2022; 10:E379-E389. [PMID: 35440485 PMCID: PMC9022939 DOI: 10.9778/cmajo.20210216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated β regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04510623.
Collapse
Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - François Lamontagne
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Maslove
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Genevieve Rocheleau
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| |
Collapse
|
25
|
Jolley S, Nordon‐Craft A, Wilson MP, Ridgeway K, Rauzi MR, Capin J, Heery LM, Stevens‐Lapsley J, Erlandson KM. Disparities in the allocation of inpatient physical and occupational therapy services for patients with COVID-19. J Hosp Med 2022; 17:88-95. [PMID: 35446466 PMCID: PMC9088325 DOI: 10.1002/jhm.12785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Survivors of the novel coronavirus (COVID-19) experience significant morbidity with reduced physical function and impairments in activities of daily living. The use of in-hospital rehabilitation therapy may reduce long-term impairments. OBJECTIVE To determine the frequency of therapy referral and treatment amongst hospitalized COVID-19 patients, assess for disparities in referral and receipt of therapy, and identify potentially modifiable factors contributing to disparities in therapy allocation. DESIGN, SETTING AND PARTICIPANTS Retrospective cohort study using data collected from the University of Colorado Health Data Compass data warehouse assessing therapy referral rates and estimated delivery based on available administrative billing. MEASUREMENTS Multivariable logistic regression was used to determine the association between sex and/or underrepresented minority race with therapy referral or delivery. RESULTS Amongst 6239 COVID-19-related hospitalization, a therapy referral was present in 3952 patients (51.9%). Hispanic ethnicity was independently associated with lower odds of receipt of therapy referral (adjusted OR [aOR]: 0.78, 95% confidence interval [CI]: 0.67-0.93, p = .001). Advanced age (aOR: 1.53, 95% CI: 1.46-1.62, p < .001), greater COVID illness severity (aOR for intensive care unit admission: 1.63, 95% CI: 1.37-1.94, p < .01) and hospital stay (aOR: 1.14, 95% CI: 1.12-1.15, p < .01) were positively associated with referral. CONCLUSIONS AND RELEVANCE In a cohort of patients hospitalized for COVID-19 across a multicenter healthcare system, we found that referral rates and delivery of physical therapy and/or occupational therapy sessions were significantly reduced for patients of Hispanic identity compared with patients of non-Hispanic, Caucasian identity after adjustment for potential confounding by available demographic and illness severity variables.
Collapse
Affiliation(s)
- Sarah Jolley
- Division of Pulmonary and Critical Care MedicineAuroraColardoUSA
| | - Amy Nordon‐Craft
- Physical Therapy ProgramDepartment of Physical Medicine and RehabilitationAuroraColoradoUSA
| | - Melissa P. Wilson
- Division of Bioinformatics and Personalized MedicineAuroraColoradoUSA
| | - Kyle Ridgeway
- Physical Therapy ProgramDepartment of Physical Medicine and RehabilitationAuroraColoradoUSA
- Inpatient Rehabilitation Therapy DepartmentUniversity of Colorado HospitalAuroraColoradoUSA
| | - Michelle R. Rauzi
- Physical Therapy ProgramDepartment of Physical Medicine and RehabilitationAuroraColoradoUSA
| | - Jacob Capin
- Physical Therapy ProgramDepartment of Physical Medicine and RehabilitationAuroraColoradoUSA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC)AuroraColoradoUSA
| | | | - Jennifer Stevens‐Lapsley
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC)AuroraColoradoUSA
- Division of Infectious DiseasesUniversity of ColoradoAuroraColoradoUSA
| | | |
Collapse
|
26
|
Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations. J Physiother 2022; 68:8-25. [PMID: 34953756 PMCID: PMC8695547 DOI: 10.1016/j.jphys.2021.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatments and personal protective equipment. New advice and recommendations are provided on: workload management; staff health, including vaccination; providing clinical education; personal protective equipment; interventions, including awake proning, mobilisation and rehabilitation in patients with hypoxaemia. Additionally, recommendations for recovery after COVID-19 have been added, including roles that physiotherapy can offer in the management of post-COVID syndrome. The updated guidelines are intended for use by physiotherapists and other relevant stakeholders caring for adult patients with confirmed or suspected COVID-19 in the acute care setting and beyond.
Collapse
|
27
|
Musheyev B, Janowicz R, Borg L, Matarlo M, Boyle H, Hou W, Duong TQ. Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation. Sci Rep 2021; 11:21039. [PMID: 34702883 PMCID: PMC8548441 DOI: 10.1038/s41598-021-00246-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022] Open
Abstract
This study investigated pre-COVID-19 admission dependency, discharge assistive equipment, discharge medical follow-up recommendation, and functional status at hospital discharge of non-critically ill COVID-19 survivors, stratified by those with (N = 155) and without (N = 162) in-hospital rehabilitation. “Mental Status”, intensive-care-unit (ICU) Mobility, and modified Barthel Index scores were assessed at hospital discharge. Relative to the non-rehabilitation patients, rehabilitation patients were older, had more comorbidities, worse pre-admission dependency, were discharged with more assistive equipment and supplemental oxygen, spent more days in the hospital, and had more hospital-acquired acute kidney injury, acute respiratory failure, and more follow-up referrals (p < 0.05 for all). Cardiology, vascular medicine, urology, and endocrinology were amongst the top referrals. Functional scores of many non-critically ill COVID-19 survivors were abnormal at discharge (p < 0.05) and were associated with pre-admission dependency (p < 0.05). Some functional scores were negatively correlated with age, hypertension, coronary artery disease, chronic kidney disease, psychiatric disease, anemia, and neurological disorders (p < 0.05). In-hospital rehabilitation providing restorative therapies and assisting discharge planning were challenging in COVID-19 circumstances. Knowledge of the functional status, discharge assistive equipment, and follow-up medical recommendations at discharge could enable appropriate and timely post-discharge care. Follow-up studies of COVID-19 survivors are warranted as many will likely have significant post-acute COVID-19 sequela.
Collapse
Affiliation(s)
- Benjamin Musheyev
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.,Renaissance School of Medicine at Stony Brook University, Stony Brook University, Stony Brook, NY, USA
| | - Rebeca Janowicz
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook Medicine, Stony Brook, NY, USA
| | - Lara Borg
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook Medicine, Stony Brook, NY, USA
| | - Michael Matarlo
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook Medicine, Stony Brook, NY, USA
| | - Hayle Boyle
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook Medicine, Stony Brook, NY, USA
| | - Wei Hou
- Department of Family, Population and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
| |
Collapse
|
28
|
Ceruti S, Glotta A, Biggiogero M, Bona G, Saporito A, Faldarini N, Olivieri D, Molteni C, Petazzi S, Capdevila X. Multidisciplinary team approach in critically ill COVID-19 patients reduced pronation-related complications rate: A retrospective cohort study. Ann Med Surg (Lond) 2021; 70:102836. [PMID: 34518782 PMCID: PMC8427910 DOI: 10.1016/j.amsu.2021.102836] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Background In the pandemic scenario, critically ill COVID-19 patients' management presented an increased workload for Intensive Care Unit (ICU) nursing staff, particularly during pronation maneuvers, with high risk of complications. In this contest, some authors described an increase in complications incidence after pronation. An ICU Pronation Team (IPT) was implemented to support this maneuver. Material and methods Retrospective analysis was conducted on consecutive critically ill COVID-19 patients in COVID-19 Center in southern Switzerland, between March and April 2020. Aim of the study was to determine rates and characteristics of pronation-related complications managed by IPT according to standard protocols. Results Forty-two patients undergoing mechanical ventilation (MV) were enrolled; 296 prone/supine positioning were performed, with 3.52 cycles/patient. All patients were equipped with arterial line, central venous catheter, urinary catheter, 28 (66%) endotracheal tube, 8 (19%), tracheostomy, 6 (14%) dialysis catheter, 3 (7%) abdominal drainage and 8 (19%) femoral thermodilution catheter; mean BMI was 28.3 kg/m2. One (0.3%) major complication was observed, while fourteen (33.3%) patients developed minor complications (pressure injuries). ICU length-of-stay and MV days correlated with both incidence (p = 0.029 and p = 0.015 respectively) and number (p = 0.001 and p = 0.001 respectively) of pressure sores (n = 27). Propensity matching score analysis did not show any protective factor of pronation regarding pressure injuries (p = 0.448). No other significant correlation was found. Conclusion Multidisciplinary healthcare professional management can reduce most severe complication related to pronation in critical care setting. Rather than from pronation, the persistent high rate of minor complications appeared to be related to disease severity.
Collapse
Affiliation(s)
- Samuele Ceruti
- Clinica Luganese Moncucco, Critical Care Department, Lugano, Switzerland
| | - Andrea Glotta
- Clinica Luganese Moncucco, Critical Care Department, Lugano, Switzerland
| | - Maira Biggiogero
- Clinica Luganese Moncucco, Clinical Research Unit, Lugano, Switzerland
| | - Giovanni Bona
- Clinica Luganese Moncucco, Clinical Research Unit, Lugano, Switzerland
| | - Andrea Saporito
- Ente Ospedaliero Cantonale, Bellinzona Regional Hospital, Service of Anaesthesia, Switzerland
| | - Nicola Faldarini
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Diana Olivieri
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Claudia Molteni
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Stefano Petazzi
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Xavier Capdevila
- Centre Hospitalier Universitaire de Montpellier, Department of Anesthesia and Intensive Care, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| |
Collapse
|
29
|
Vickory F, Ridgeway K, Falvey J, Houwer B, Gunlikson J, Payne K, Niehaus W. Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility After Prolonged Hospitalization for Severe COVID-19: An Observational Study. Phys Ther 2021; 101:6365140. [PMID: 34499165 PMCID: PMC8499953 DOI: 10.1093/ptj/pzab208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE he objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe Coronavirus Disease 19 (COVID-19) infection. METHODS This was an observational study of 30 patients (ages 26-80 years) within a large, metropolitan, academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care, and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long-duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. RESULTS The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4-22 days). Patients averaged 165 min/d (ranging from 140-205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty-eight of the 30 patients (93%) were discharged to the community. One patient required readmission from an inpatient rehabilitation facility to an acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. CONCLUSION In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long-duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long-duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. IMPACT Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.
Collapse
Affiliation(s)
- Frank Vickory
- Address all correspondence to Dr. Frank Vickory at: Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave. Aurora, CO 80045. (850) 509-0112,
| | - Kyle Ridgeway
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045. Physical Therapy Program, University of Colorado Anschutz Medical Campus: School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 100 Penn St. Baltimore, MD 21201
| | - Beth Houwer
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045
| | - Jennifer Gunlikson
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045
| | - Katherine Payne
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, University of Colorado Hospital. 12631 E 17 Ave, Mail Stop F493 Aurora, CO 80045
| | - William Niehaus
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, University of Colorado Hospital. 12631 E 17 Ave, Mail Stop F493 Aurora, CO 80045
| |
Collapse
|
30
|
Tevald MA, Clancy MJ, Butler K, Drollinger M, Adler J, Malone D. Activity Measure for Post-Acute Care "6-Clicks" for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2021; 102:2300-2308.e3. [PMID: 34496269 PMCID: PMC8418699 DOI: 10.1016/j.apmr.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design Retrospective cohort study. Setting An academic health system in the United States consisting of 5 inpatient hospitals. Participants Adult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment. Interventions Not applicable. Main Outcome Measures Discharge destination, hospital length of stay, in-hospital mortality, and readmission. Results A total of 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (odds ratio, 0.867 and 0.833, respectively) and activity scores (odds ratio, 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (area under the curve [AUC]=0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, whereas specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (odds ratio, 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged length of stay (odds ratio, 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC=0.659-0.679). AM-PAC scores did not predict rehospitalization. Conclusions Functional status as measured by the AM-PAC “6-Clicks” mobility and activity scores are independent predictors of key clinical outcomes individual hospitalized with COVID-19.
Collapse
Affiliation(s)
- Michael A Tevald
- Department of Physical Therapy, Arcadia University, Glenside, PA.
| | - Malachy J Clancy
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kelly Butler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Megan Drollinger
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joe Adler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
31
|
Wasilewski MB, Cimino SR, Kokorelias KM, Simpson R, Hitzig SL, Robinson L. Providing Rehabilitation to Patients Recovering from COVID-19: A Scoping Review. PM R 2021; 14:239-258. [PMID: 34240576 PMCID: PMC8441670 DOI: 10.1002/pmrj.12669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
Objective To synthesize the nature and extent of research on rehabilitation care provision to patients with COVID‐19. Specifically, we aimed to (1) describe the impact of COVID on patients and associated rehabilitation needs, (2) outline the adaptations and preparations required to enable the provision of COVID rehabilitation, (3) describe the types of rehabilitation services and treatments provided to COVID patients, and (4) identify barriers and facilitators to delivering COVID rehabilitation. Literature Survey We searched Medline, PsychINFO, Embase, and CINAHL on June 26, 2020 using key words such as “rehabilitation,” “physical medicine,” “allied health professionals,” and variations of “COVID.” The search was updated on October 13, 2020. We included articles published in English and that focused on some aspect of COVID rehabilitation for adults. We excluded articles focused on pediatric populations and those not focused (or minimally focused) on rehabilitation for COVID patients. Methodology Data were charted based on article type (ie, primary data, secondary data, guidelines). Key information extracted included (1) COVID sequelae; (2) rehabilitation adaptations; (3) structure, function, and content of rehabilitation services/programs; (4) facilitators and/or barriers to providing COVID rehabilitation; and (5) recommendations for COVID rehabilitation programming. Data were synthesized narratively. Synthesis In total, 128 articles were included in the review that reported primary data (n = 33), secondary data (n = 82), and clinical practice/patient self‐management guidelines (n = 13). Evidence begins to suggest that rehabilitation is necessary and valuable for addressing COVID‐related declines in health, function, and well‐being. Most articles recommended that an individualized rehabilitation program be provided across the continuum of care by an interdisciplinary team of professionals and that the nature and extent of rehabilitation be informed by the care setting and COVID severity. Most issues that challenged COVID rehabilitation delivery were directly addressed by the facilitators and adaptations identified. Conclusions Future recommendations include a greater emphasis on the psychosocial aspects of COVID rehabilitation, inclusion of families in rehabilitation planning, and the use of qualitative approaches to complement clinical data.
Collapse
|
32
|
Gustavson AM, Toonstra A, Johnson JK, Ensrud KE. Reframing Hospital to Home Discharge from "Should We?" to "How Can We?": COVID-19 and Beyond. J Am Geriatr Soc 2021; 69:608-609. [PMID: 33470419 PMCID: PMC8014114 DOI: 10.1111/jgs.17036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Amy Toonstra
- Department of Physical Therapy, Concordia University, St. Paul, Minnesota, USA
| | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kristine E Ensrud
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| |
Collapse
|
33
|
Andrenelli E, Negrini F, De Sire A, Patrini M, Lazzarini SG, Ceravolo MG. Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020. Eur J Phys Rehabil Med 2020; 56:846-852. [PMID: 33118719 DOI: 10.23736/s1973-9087.20.06672-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The COVID-19 outbreak response requires identifying and understanding the long-term consequences of this new pathology and how to manage these. This living systematic review presents the most current and seminal information coming from the scientific literature. It is the monthly update of the second edition of the rapid living systematic review 2020 conducted by Cochrane Rehabilitation REH-COVER Action Steering Committee. The aim of this review was to update the monthly COVID-19 and rehabilitation literature research up to September 30, 2020. EVIDENCE ACQUISITION Methodology described in the second edition of the rapid living systematic review 2020 conducted by Cochrane Rehabilitation REH-COVER action was applied. The most important medical databases were searched, and papers related to COVID-19 and rehabilitation were retrieved and summarized descriptively. EVIDENCE SYNTHESIS The database search retrieved 2526 publications. Duplicates were removed, and 1150 unique records were screened for inclusion. After screening titles, abstracts and full-texts, 37 papers were included in the present review. According to OCEBM 2011 levels of evidence table, most studies (78.4%) fall within the level of evidence 4 category, while the remainder (22.6%) are categorized as level of evidence 3. Most studies described patients in acute (51.4%) or subacute (35.0%) phase, while no studies described the chronic consequences of COVID-19. Just one study dealt with rehabilitation interventions regarding COVID-19, and two discussed reorganization of rehabilitative services. CONCLUSIONS The most recently published COVID-19 research focuses more on describing the clinical presentations and the natural history of the pathology, rather than rehabilitation interventions or service delivery. Studies with high levels of evidence regarding the efficacy of interventions, long-term monitoring, or new organization models remain lacking.
Collapse
Affiliation(s)
- Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | | | - Alessandro De Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
| | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | | |
Collapse
|