Objective The purpose of this case report is to present the clinical presentation and physical therapist management for a patient with post–COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post–COVID syndrome. Methods (Case Description) A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms including dyspnea, headaches, and cognitive fog. On day 62, she participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of her age-predicted 6-minute walk distance (6MWD). She had minor reductions in muscle strength and cognitive function. Self-reported quality of life (QoL) was 50, and she scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). Results The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task (METS) levels increased with variability over the course of the program. The patient’s muscle strength, physical function, and exercise capacity improved. 6MWD increased by 199 m, equating to 80% of her age-predicted distance. QoL and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. Conclusion This case report described the clinical presentation and physical therapist management of a person with post–COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post–COVID syndromes. Impact This case alerts physical therapists to post–COVID syndrome—which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction—and to the role that therapists can play in assessing these symptoms and managing these patients.

OBJECTIVES: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019. DESIGN: Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways. SETTING: ICU Recovery Clinic in an academic medical center. PATIENTS: Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019. INTERVENTIONS: Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training. MEASUREMENTS AND MAIN RESULTS: Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life. CONCLUSIONS: A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Purpose: Survivors of acute respiratory failure develop persistent muscle weakness and deficits in cardiopulmonary endurance leading to limited physical function. Early data from the COVID-19 pandemic suggest a high incidence of critically ill patients admitted to intensive care units (ICU) will require mechanical ventilation for acute respiratory failure. Patients with COVID-19 that survive an admission to the ICU are expected to suffer from physical and cognitive impairments that will limit quality of life and return to prehospital level of function. The primary aim of this study is to evaluate the safety and feasibility of providing combined ICU aftercare (ICU Recovery Clinic) and 8 weeks of physical therapy treatment for patients surviving an admission to ICU for COVID-19. The secondary aims will be to explore trends of effect on physical, mental, and cognitive recovery as well as the impact on return to work, readmission rates, and mortality. Methods: This is a protocol to describe a single-center, prospective phase I feasibility study in patients surviving ICU admission for COVID-19. We hypothesize that this novel combination is (1) feasible to provide for patients surviving COVID-19, will (2) improve physical function and exercise capacity measured by performance on 6-minute walk test and Short Performance Physical Battery, and (3) reduce incidence of anxiety, depression, and post-traumatic stress assessed with Hospital Anxiety and Depression Scale and the Impact of Events Scale-Revised. Safety will be assessed based on occurrence of adverse events and feasibility will be measured by adherence and attrition. Repeated measures analysis of variance will be used to assess change in outcomes from baseline to 3- and 6-months after institutional discharge. Results: We present the protocol of this study that has already received ethics approval at the University of Kentucky with enrollment commenced on May 1, 2020. Conclusions: The results of this study will support the feasibility of providing ICU follow-up treatment and physical therapy treatment for patients surviving critical illness for COVID-19 and will assess the effectiveness. We plan to disseminate study results in peer-reviewed journals as well as presentation at physical therapy and critical care national and international conferences.

Objective The purpose was to examine Dual Task (DT) performance in patients surviving severe and critical COVID-19 compared to patients with chronic lung disease (CLD). Secondarily, we aimed to determine the psychometric properties of the Timed Up and Go (TUG) test in patients surviving COVID-19. Design Prospective, cross-sectional, observational study. Setting Academic medical center within United States. Patients Ninety-two patients including 36 survivors of critical COVID-19 that required mechanical ventilation (critical-COVID), 20 patients recovering from COVID-19 that required supplemental oxygen with hospitalization (severe-COVID), and 36 patients with CLD serving as a control group. Measurements and Main Results Patients completed the TUG, DT-TUG, Short Physical Performance Battery (SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A subset of patients returned at 3-months and repeated testing to determine the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3) performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s; P = .024) and Severe-COVID group (13.1 ± 5.1 s; P = .025). Within-subject difference between TUG and DT-TUG was also significantly worse in critical-COVID group (−21%) compared to CLD (−10%; P = .012), even despite CLD patients having a higher comorbid burden ( P < .003) and older age ( P < .001). TUG and DT-TUG demonstrated strong to excellent construct validity to the chair rise test, gait speed, and 6MWT for both COVID-19 groups (r = −0.84to 0.73, P < .05). One- and 3-months after hospital discharge there was a floor effect of 14% (n = 5/36) and 5.2% (n = 1/19), respectively for patients in the critical-COVID group. Ceiling effects were noted in four (11%) critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at 1-month. Conclusion The ability to maintain mobility performance in the presence of a cognitive DT is grossly impaired in patients surviving critical COVID-19. DT performance may subserve the understanding of impairments related to Post-intensive care syndrome (PICS) for survivors of critical illness.