COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force

Abstract

BackgroundPatients with COVID-19 or post-COVID-19 will most probably have a need for rehabilitation during and directly after the hospitalisation. Data on safety and efficacy are lacking. Healthcare professionals cannot wait for published randomised controlled trials before they can start these rehabilitative interventions in daily clinical practice, as the number of post-COVID-19 patients increases rapidly. The Convergence of Opinion on Recommendations and Evidence process was used to make interim recommendation for the rehabilitation in the hospital and post-hospital phase in COVID-19 and post-COVID-19 patients, respectively.Methods93 experts were asked to fill out 13 multiple choice questions. Agreement of directionality was tabulated for each question. At least 70% agreement on directionality was necessary to make consensus suggestions.Results76 experts (82%) reached consensus on all questions based upon indirect evidence and clinical experience on the need for early rehabilitation during the hospital admission, the screening for treatable traits with rehabilitation in all patients at discharge and 6–8 weeks after discharge, and around the content of rehabilitation for these patients. It advocates for assessment of oxygen needs at discharge and more comprehensive assessment of rehabilitation needs including physical as well as mental aspects 6–8 weeks after discharge. Based on the deficits identified multidisciplinary rehabilitation should be offered with attention for skeletal muscle and functional as well as mental restoration.ConclusionsThis multinational task force recommends early, bedside rehabilitation for patients affected by severe COVID-19. The model of pulmonary rehabilitation may suit as a framework, particularly in a subset of patients with long term respiratory consequences.

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

“…It is noteworthy that the International Task Force made no suggestion for or against routine referral for pulmonary rehabilitation, pulmonary function testing, or mental health testing within 30-60 days after discharge despite an ERS/ATS Task Force on pulmonary rehabilitation making suggestions in favour of these actions within 6-8 weeks in a recently published report that used similar methods [92]. In studies that validated the CORE process, the rare discordant recommendations were typically attributable to different panels with varying interpretations of scarce or low quality evidence [4,5].…”

COVID‐19 rehabilitation delivered via a telehealth pulmonary rehabilitation model: a case series

“…For patients who are recovering from longer intensive care unit (ICU) stays and who may present with post-ICU syndrome [14], more intensive face-to-face rehabilitation may be required. A recent guideline provides expert consensus around rehabilitation, including a suggested core set of outcomes for people recovering from COVID-19 and this should be referred to when planning future COVID-19 rehabilitation programmes [2]. This is a single-centre report and the number of cases is limited; however, the case series indicates that rehabilitation via telehealth for people recovering from COVID-19 is feasible and safe when provided by experienced PR clinicians.…”

“…In the Australian healthcare context, it is early days in our understanding of the short and longer term rehabilitation needs of those recovering from coronavirus disease 2019 (COVID-19) (novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)). There is strong evidence for the efficacy of pulmonary rehabilitation (PR) for people with chronic respiratory disease [1] and previous literature has also demonstrated the benefits of PR in terms of improvements in exercise capacity and quality of life in survivors of adult respiratory distress syndrome and influenza A (H1N1) pneumonitis [2]. International statements have now suggested that the PR setting may be an appropriate rehabilitation pathway for patients recovering from COVID-19 who have persistent pulmonary and extra-pulmonary symptoms and functional limitations [2][3][4][5].…”

Guidance production before evidence generation for critical issues: the example of COVID-19

“…The next questions address post-hospital follow-up and referral for rehabilitation. Interestingly, this topic was also tackled in a previously published ERS/ATS coordinated Task Force using the same methodology [21]. For both Task Forces, the number of voters was above 90.…”

“…For both Task Forces, the number of voters was above 90. Despite being released within a short period of time and using similar methods, some apparent discrepancies can be identified in these documents: the ATS/ERS coordinated taskforce on COVID-19 management published in this issue of the ERR could not make any recommendation on post-hospital respiratory follow-up and rehabilitation due to lack of consensus, while the ERS/ATS coordinated Task Force on rehabilitation suggested that "patients with COVID-19 should have a formal assessment of physical and emotional functioning at 6-8 weeks following discharge, to identify unmet rehabilitation needs" [21]. In addition, this Task Force suggested that "follow up of a hospitalised patient with COVID-19 should include measures of respiratory function and exercise-capacity at 6-8 weeks following hospital discharge" [21].…”