Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19

Abstract

Objective For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients’ mobility status at discharge and probability of discharging home. Methods This retrospective study included patients with COVID-19 admitted to any of eleven hospitals in one health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility (JH-HLM) scales. Discharge to home vs. to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models. Results For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI = 1.54–5.71) and JH-HLM scores (b = 1.15; 95% CI = 0.37–1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI = 1.25–2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed. Conclusion Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. Impact Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread.

Reframing Hospital to Home Discharge from “Should We?” to “How Can We?”: COVID‐19 and Beyond

“…This is especially important for older adults who are at the greatest risk for complications and mortality if they contract COVID‐19 3,4 . Rehabilitation providers contribute uniquely to interdisciplinary discharge planning by providing critical evaluation of a patient's functional abilities and rehabilitation prognosis in the context of the individual's medical complexity, hospital course, psychosocial factors, and environmental features (i.e., home set‐up) 5,6 . The COVID‐19 pandemic has retained these elements as critical to discharge planning 7 .…”

Role of physiotherapy team in critically ill COVID-19 patients pronation: can a multidisciplinary management reduce the complications rate?

“…To date, several groups have approached the problem regarding the creation of a dedicated team in order to better manage the high number of pronations in critically ill COVID-19 patients (Cotton et al, 2020;Doussot et al, 2020;Johnson et al, 2021;Ng et al, 2020;Short et al, 2020). However, no studies reported data concerning the impact of a physiotherapy team on the incidence of pronation-induced complications.…”

Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020

“…The studies published in September 2020 were conducted in the following World Health Organization regions: 16 in Europe (Italy [4][5][6][7][8][9][10][11][12] , United Kingdom [13][14][15] , Belgium 16 , Germany 17 , Switzerland 18 , and Netherlands and Belgium together 19 ), 14 in the Americas (11 in the United States of America (USA) [27][28][29][30][31][32][33][34][35][36][37] , 2 in Brazil 38,39 and 1 in Canada 40 ), 6 in Western Pacific (China 20 -21 , Japan 22 , Republic of Korea 23 ,Singapore 24 , Australia 25 ), and one in the South-East Asia region (India 26 ).…”

“…COPYRIGHT© EDIZIONI MINERVA MEDICA historical cohort 5,7,16,26,31,32,35 ), whereas the remainder 8 papers (21.6%) were Level 3 (4 cohort 9,13,14,22 and 4 cross sectional studies 10,19,33,37 ) (Table I). No RCT or QRCT were found.…”

“…Five descriptive papers reported epidemiological data on the clinical presentation of COVID-19 infection 4,6,27,30,39 , and 3 described disease prevalence (2 cross sectional studies 10,19 , and 1 case series 21 ). Finally, 2 papers described data on health service organization (1 cohort study 22 and 1 cross-sectional study 37 ) and only 1 historical cohort study speculated about intervention efficacy 31 .…”