Post-COVID Care Center to Address Rehabilitation Needs in COVID-19 Survivors: A Model of Care

Long COVID Definitions and Models of Care : A Scoping Review

BACKGROUND

Definitions of long COVID are evolving, and optimal models of care are uncertain.

PURPOSE

To perform a scoping review on definitions of long COVID and provide an overview of care models, including a proposed framework to describe and distinguish models.

DATA SOURCES

English-language articles from Ovid MEDLINE, PsycINFO, the Cochrane Library, SocINDEX, Scopus, Embase, and CINAHL published between January 2021 and November 2023; gray literature; and discussions with 18 key informants.

STUDY SELECTION

Publications describing long COVID definitions or models of care, supplemented by models described by key informants.

DATA EXTRACTION

Data were extracted by one reviewer and verified for accuracy by another reviewer.

DATA SYNTHESIS

Of 1960 screened citations, 38 were included. Five clinical definitions of long COVID varied with regard to timing since symptom onset and the minimum duration required for diagnosis; 1 additional definition was symptom score-based. Forty-nine long COVID care models were informed by 5 key principles: a core "lead" team, multidisciplinary expertise, comprehensive access to diagnostic and therapeutic services, a patient-centered approach, and providing capacity to meet demand. Seven characteristics provided a framework for distinguishing models: home department or clinical setting, clinical lead, collocation of other specialties, primary care role, population managed, use of teleservices, and whether the model was practice- or systems-based. Using this framework, 10 representative practice-based and 3 systems-based models of care were identified.

LIMITATIONS

Published literature often lacked key model details, data were insufficient to assess model outcomes, and there was overlap between and variability within models.

CONCLUSION

Definitions of long COVID and care models are evolving. Research is needed to optimize models and evaluate outcomes of different models.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (Protocol posted at https://effectivehealthcare.ahrq.gov/products/long-covid-models-care/protocol.).

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)

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.

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.

Efficacy and safety of acupuncture for post-COVID-19 depression: a protocol for systematic review and meta-analysis

INTRODUCTION

Post-COVID-19 depression (PCD) is a possible sequela of COVID-19. Some doctors have used acupuncture to treat PCD, but no systematic review or meta-analysis has yet evaluated its efficacy and safety for the treatment of PCD. The aim of this systematic review is to assess the efficacy and safety of acupuncture therapy for PCD.

METHODS AND ANALYSIS

Two reviewers will independently search the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (PubMed), Excerpt Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP) and Wan-Fang Database from inception to 24 January 2023. Study selection, data extraction and assessment of study quality will be independently performed by two reviewers. If a meta-analysis is appropriate, Review Manager V.5.3 will be used for data synthesis; otherwise, a descriptive analysis will be conducted. Data will be synthesised using a fixed-effects or random-effects model, according to the results of a heterogeneity test. The results will be presented as risk ratios with 95% CIs for dichotomous data, and weighted mean differences or standardised mean differences with 95% CIs for continuous data.

ETHICS AND DISSEMINATION

The entire process used for this systematic review does not use private information, so ethical approval is not required. The results of this meta-analysis will be disseminated through publication in a peer-reviewed journal and/or conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42022379312.

Scoping review of rehabilitation care models for post COVID-19 condition

Objective

To systematically map the current evidence about the characteristics of health systems, providers and patients to design rehabilitation care for post coronavirus disease 2019 (COVID-19) condition.

Methods

We conducted a scoping review by searching the databases: MEDLINE®, Embase®, Web of Science, Cochrane COVID-19 Registry and Cochrane Central Register of Controlled Trials, from inception to 22 April 2022. The search strategy included terms related to (i) post COVID-19 condition and other currently known terminologies; (ii) care models and pathways; and (iii) rehabilitation. We applied no language or study design restrictions. Two pairs of researchers independently screened title, abstracts and full-text articles and extracted data. We charted the evidence according to five topics: (i) care model components and functions; (ii) safe delivery of rehabilitation; (iii) referral principles; (iv) service delivery settings; and (v) health-care professionals.

Findings

We screened 13 753 titles and abstracts, read 154 full-text articles, and included 37 articles. The current evidence is conceptual and expert based. Care model components included multidisciplinary teams, continuity or coordination of care, people-centred care and shared decision-making between clinicians and patients. Care model functions included standardized symptoms assessment, telehealth and virtual care and follow-up system. Rehabilitation services were integrated at all levels of a health system from primary care to tertiary hospital-based care. Health-care workers delivering services within a multidisciplinary team included mostly physiotherapists, occupational therapists and psychologists.

Conclusion

Key policy messages include implementing a multilevel and multiprofessional model; leveraging country health systems' strengths and learning from other conditions; financing rehabilitation research providing standardized outcomes; and guidance to increase patient safety.

The association between objective cognitive measures and ecological-functional outcomes in COVID-19

Background

Cognitive dysfunctions, both subjective and detectable at psychometric testing, may follow SARS-CoV-2 infection. However, the ecological-functional relevance of such objective deficits is currently under-investigated. This study thus aimed at investigating the association between objective cognitive measures and both physical and cognitive, ecological-functional outcomes in post-COVID-19.

Methods

Forty-two COVID-19-recovered individuals were administered the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The Functional Independence Measure (FIM) was adopted to assess functional-ecological, motor/physical (FIM-Motor) and cognitive (FIM-Cognitive) outcomes at admission (T0) and discharge (T1).

Results

When predicting both T0/T1 FIM-total and-Motor scores based on MMSE/MoCA scores, premorbid risk for cognitive decline (RCD) and disease-related features, no model yielded a significant fit. However, the MoCA - but not the MMSE significantly predicted T0/T1 FIM-Cognitive scores. The MoCA was significantly related only to T0/T1 FIM-Cognitive Memory items.

Discussion

Cognitive measures are not associated with physical/motor everyday-life outcomes in post-COVID-19 patients. The MoCA may provide an ecological estimate of cognitive functioning in this population.

Characteristics of COVID-19 Inpatients in Rehabilitation Units during the First Pandemic Wave: A Cohort Study from a Large Hospital in Champagne Region

Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units (p = 0.001). Conclusions: Almost one-third of COVID-19 patients required post-acute care, but only one-fifth had access to PRM units. The optimal strategy for post-acute management of COVID-19 patients remains to be determined. The need for rehabilitation wards during a pandemic is a primary concern in enabling the long-term functioning of infected patients.

Update of the Potential Treatments for Psychiatric and Neuropsychiatric Symptoms in the Context of the Post-COVID-19 Condition: Still a Lot of Suffering and Many More Things to Learn

Background: The World Health Organization (WHO) has defined a post-COVID-19 condition. Some of these symptoms can be categorized as psychiatric long COVID-19 if they appeared in the aftermath of COVID-19, including depression, anxiety, post-traumatic stress disorder, somatic symptoms disorders such as hyperventilation syndrome, fatigue, cognitive and sleep disorders. Psychiatric and neuropsychiatric post-COVID-19 present mental health specialists with difficult challenges because of its complexity and the multiple ways in which it integrates into a singular somatic context. Methods: We conducted a systematic research paradigm from SARS-CoV-2 using LitCOVID and Web of Science to search management strategies and potential treatments for psychiatric post-COVID-19 symptoms. Results: Management strategies must be based on a multidisciplinary approach to promote the global evaluation of psychiatric and physical symptoms, systematic detection and prevention. Selective serotonin reuptake inhibitors appear to be the best choice to treat post-COVID-19 depression and anxiety disorders, and tofisopam could be helpful for anxiety. Cognitive behavioral therapy techniques adjusted to post-COVID-19 fatigue, functional remediation, extracorporeal apheresis, transcutaneous auricular vagus nerve stimulation, monoclonal antibodies, flavonoids, oxytocin or L-carnitine all represent hypothetical therapeutic avenues that remain to be evaluated in clinical trials. Conclusions: Psychiatric and neuropsychiatric post-COVID-19 symptoms occur frequently and are debilitating. Attention should be paid to this condition and studies undertaken to specify the effective treatments.