Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

Abstract

Objective To determine the benefits associated with brief inpatient rehabilitation for Covid-19 patients. Design Retrospective chart review. Setting A newly created specialized rehabilitation unit in a tertiary care medical center Participants Consecutive sample of the first 100 patients with Covid-19 infection admitted to rehabilitation. Intervention Inpatient rehabilitation for post-acute care Covid-19 patients Main Outcome Measures Measurements, at admission and discharge, comprised a Barthel Activities of Daily Living Index (including baseline value before Covid-19 infection), time to perform 10 sit-to-stands with associated cardio-respiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in ICU were explored. Results Patient characteristics upon admission to rehabilitation were: men 66%, age 66±22 years, mean delay from symptom onset 20.4±10.0 days, BMI 26.0±5.4 kg/m 2 , hypertension 49%, diabetes 29%, with 26% having >50% pulmonary damage on CT-scans. Mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index (/100) increased from 77.3±26.7 to 88.8±24.5 ( p <0.001), without recovering baseline values (94.5±16.2; p <0.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; p <0.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; p =0.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; p <0.001). At both admission and discharge, Barthel score correlated with grip strength (rho=0.39-0.66; p <0.01), which negatively correlated with time spent in ICU (rho=-0.57 to -0.49, p <0.05). Conclusions Inpatient rehabilitation for Covid-19 patients was associated with substantial motor, respiratory and functional improvement, especially in severe cases, even though there remained mild persistent autonomy loss upon discharge. Following acute stages, Covid-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.

Grip strength as a predictor of disease severity in hospitalized COVID-19 patients

“…A recent study conducted in 100 COVID-19 patients (mean age of 66 years) evaluated the inpatient rehabilitation for post-acute care and reported that grip strength was positively/moderately correlated with Barthel index (assessing overall strength and physical functioning), and negatively/moderately correlated with the duration of intensive care unit stay. 19 Another study recruiting 150 hospitalized COVID-19 patients (mean age of 53 years) compared the musculoskeletal findings (including grip strength) and revealed that female (but not male) patients with severe COVID-19 disease had lower grip strength as compared to nonsevere ones. 20 In our relatively larger study (N=312) with younger subjects (mean age of 46 years), we found that low grip strength independently increased (about three times) the risk of severe disease course in COVID-19.…”

Effectiveness of Pulmonary Rehabilitation in Severe and Critically Ill COVID-19 Patients: A Controlled Study

“…Hermann et al first reported that current pulmonary rehabilitation (PR) developed for pneumonia patients can improve physical performance in the six-min walk test (6MWT) of critical COVID-19 patients taken from a Swiss cohort of 28 patients who have been admitted to the ICU between March and May 2020 [8]. Subsequent studies on post COVID-19 patients reported on more variable PR outcomes probably because many of these studies focused on patients' characteristics after acute illness [3,9], used different outcome assessments (e.g., 6MWT vs. sit-to-stand test, Functional Independence Measure (FIM) vs. Barthel Index) [10][11][12][13][14], different PR settings (e.g., immediately post-ICU [12] vs. discharged from acute hospitalization [10,14]), and had a lack of control groups. In addition, the assessment of the minimal clinically important difference (MCID) is missing in most of previous studies, making it difficult to estimate the relevance of clinical improvement [15,16].…”

Exercise in an Overweight Patient with Covid-19: A Case Study

“…It is not possible to recommend moderate-intensity exercise activities to patients with COVID-19. However, it has been reported that one of the most effective intensities for increasing endorphins and reducing stress during exercise is moderate intensity, as regular exercise training can modulate some stress hormones and immunity [12]. Moderate exercise increases stress hormones, such as cortisol levels, which can suppress the immune function in a short time [15,16].…”

“…In the study by Piquet et al (2021) on rehabilitation time in patients with COVID-19, the researchers included two sessions of exercise in their rehabilitation program (with a researcher-made protocol). The first exercise program was intended to strengthen the overall movement related to body weight.…”

“…In this regard, a study conducted on the rehabilitation of patients with COVID-19 found that low-intensity exercise could improve their respiratory and motor status. The mentioned study estimated the activity time in rehabilitation to be less than 20 min [12].…”