Effects of Early Physical Therapy and Follow-Up in Acute Severe Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Study

Abstract

BackgroundRehabilitation in subjects with severe coronavirus disease 2019 (COVID-19) pneumonia has been widely recommended. However, data regarding the starting time of rehabilitation, subjects and healthcare workers’ safety, as well as rehabilitation program features are limited. We aimed to assess the safety and characterize the effect of early and non-early physiotherapy on severe COVID-19 pneumonia subjects.MethodsA retrospective cohort study, including a consecutive sample of surviving subjects admitted to an acute care hospital due to severe COVID-19 pneumonia from March 13th to May 15th of 2020, is made. Subjects were separated into three groups: non-physical therapy, early physiotherapy (onset <7 days of admission), and non-early physiotherapy. Subject and therapist safety and length of hospital stay were the main evaluated outcomes.ResultsA total of 159 subjects were included (72% men; median age 62 years). Rehabilitation was performed on 108 subjects (32 early and 76 non-early physiotherapies). The length of hospital stay was 19 [interquartile range (IQR) 36.25] and 34 days (IQR 27.25) (p = 0.001) for early and non-early physiotherapy groups, respectively. No physiotherapist was infected and no subject adverse effect was identified. Multivariate analysis of subjects receiving physiotherapy during admission identified obesity [odds ratio (OR) 3.21; p-value 0.028], invasive mechanical ventilation (OR 6.25; p-value <0.001), and non-early physiotherapy (OR 3.54; p-value 0.017) as independent factors associated with a higher risk of prolonged hospital stay. Survivors’ follow-up after hospital discharge at 8 weeks was completed by 54% of subjects.ConclusionRehabilitation in acute severe COVID-19 pneumonia is safe for subjects and healthcare workers and could reduce the length of hospitalization stay, especially in those that may start early.

Efectos de un programa de tele-rehabilitación en la capacidad física y disnea en atención primaria en salud, posterior al alta hospitalaria por COVID-19: estudio observacional

“…Uno de nuestros sesgos de muestra puede considerarse que algunos pacientes reportaron haber recibido intervención kinésica precoz previo al alta hospitalaria, a partir de distintas estrategias y protocolos de intervención, sin embargo, por no ser una conducta homogeneizada entre los participantes, no se consideró en las variables a evaluar. Este factor deja en ventaja a quienes recibieron ese tipo de atención, y desventaja a quienes no recibieron ningún tipo de intervención 27,28 , de la misma forma que algunos iniciaron de forma tardía el programa, posterior a su alta hospitalaria.…”

Early pulmonary rehabilitation of COVID-19 patients in an isolation ward and intensive care unit

“…The goals of PR include improved exercise capacity, health-related quality of life, and reduced admissions [ 8 ]. The “early” PR in patients with COVID-19 was defined as the initiation of PR within 7 days of admission [ 9 ]. For the early PR of patients with COVID-19, intervention is still based on the above principles to improve dyspnea, relieve anxiety, reduce complications, maintain function, and improve the health-related quality of life [ 10 ].…”

“…If direct supervision is required for PR, medical staff must have complete protective equipment, including gloves, masks, gowns, and facial masks or goggles to reduce the risk of infection [ 13 ]. One study showed that no physiotherapists were infected and no subject adverse effects were found in the patients [ 9 ]. Early PR in COVID-19 is suggested to be safe for patients and health-care workers [ 9 ].…”

“…One study showed that no physiotherapists were infected and no subject adverse effects were found in the patients [ 9 ]. Early PR in COVID-19 is suggested to be safe for patients and health-care workers [ 9 ].…”

“…Previous studies on bronchiectasis have shown that ACTs can effectively increase the volume of sputum expectoration [ 17 ], and patients have good acceptance and tolerance using ACTs without serious adverse reactions [ 15 ]. For patients with COVID-19, ACTs were also included in the PR programs [ 9 , 10 ].…”