Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge

OBJECTIVES

To analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors.

DESIGN

Prospective observational multicenter study.

SETTING

Demographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward.

PATIENTS

Patients with functional independence before COVID-19 diagnosis were recruited from four hospitals and followed up until hospital discharge.

MEASUREMENTS AND MAIN RESULTS

Three groups of functional recovery were described for 328 patients: functional independence ( n = 144; 44%), which included patients who preserved their functional status during hospitalization; recovered functionality ( n = 109; 33.2%), which included patients who showed dependence at ICU discharge but recovered their independence by hospital discharge; and functional dependency ( n = 75; 22.8%), which included patients who were dependent at ICU discharge and had not recovered their functional status at hospital discharge. The factors associated with becoming functionally dependent at ICU discharge were time to out-of-bed patient mobilization (odds ratio [OR], 1.20; 95% CI, 1.11-1.29), age (OR, 1.02; 95% CI, 1.01-1.04), hyperglycemia (OR, 2.52; 95% CI, 1.56-4.07), and Simplified Acute Physiology Score (OR, 1.022; 95% CI, 1.01-1.04). Recovery to baseline independence during ward stays was associated with ICU length of stay (OR, 0.97; 95% CI, 0.94-0.99) and muscle strength (Medical Research Council test) at ICU discharge (OR, 1.13; 95% CI, 1.08-1.18).

CONCLUSIONS

Age, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay.

Rehabilitation through virtual reality: physical activity of patients admitted to the intensive care unit

Objective

To evaluate the level of activity that Nintendo Wii^TM can elicit in intensive care unit patients and its associated safety and patient satisfaction.

Methods

Experimental, single-center study performed at a tertiary care hospital. Patients ≥ 18 years old who were admitted to the intensive care unit, participated in videogames as part of their physical therapy sessions and did not have mobility restrictions were included. Th exclusion criteria were the inability to comprehend instructions and the inability to follow simple commands. We included n = 60 patients and performed 100 sessions. We used the Nintendo Wii^TM gaming system in the sessions. An accelerometer measured the level of physical activity of patients while they played videogames. We evaluated the level of activity, the modified Borg scale scores, the adverse events and the responses to a questionnaire on satisfaction with the activity.

Results

One hundred physical therapy sessions were analyzed. When the patients played the videogame, they reached a light level of activity for 59% of the session duration and a moderate level of activity for 38% of the session duration. No adverse events occurred. A total of 86% of the patients reported that they would like to play the videogame in their future physical therapy sessions.

Conclusion

Virtual rehabilitation elicited light to moderate levels of activity in intensive care unit patients. This therapy is a safe tool and is likely to be chosen by the patient during physical therapy.

Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial

OBJECTIVES

The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy.

DESIGN

Randomized controlled trial.

SETTING

Blind evaluation.

PATIENTS

Adults with previous functional independence and without contraindications for mobilization were eligible.

INTERVENTIONS

The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge.

MEASUREMENTS AND MAIN RESULTS

We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up.

CONCLUSIONS

Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.