Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge*

Abstract

OBJECTIVES: To analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors. DESIGN: Prospective observational multicenter study. SETTING: Demographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward. PATIENTS: Patients with functional independence before COVID-19 diagnosis were recruited from four hospitals and followed up until hospital discharge. MEASUREMENTS AND MAIN RESULTS: Three groups of functional recovery were described for 328 patients: functional independence ( n = 144; 44%), which included patients who preserved their functional status during hospitalization; recovered functionality ( n = 109; 33.2%), which included patients who showed dependence at ICU discharge but recovered their independence by hospital discharge; and functional dependency ( n = 75; 22.8%), which included patients who were dependent at ICU discharge and had not recovered their functional status at hospital discharge. The factors associated with becoming functionally dependent at ICU discharge were time to out-of-bed patient mobilization (odds ratio [OR], 1.20; 95% CI, 1.11–1.29), age (OR, 1.02; 95% CI, 1.01–1.04), hyperglycemia (OR, 2.52; 95% CI, 1.56–4.07), and Simplified Acute Physiology Score (OR, 1.022; 95% CI, 1.01–1.04). Recovery to baseline independence during ward stays was associated with ICU length of stay (OR, 0.97; 95% CI, 0.94–0.99) and muscle strength (Medical Research Council test) at ICU discharge (OR, 1.13; 95% CI, 1.08–1.18). CONCLUSIONS: Age, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay.

The Importance of Rehabilitation for Functional Recovery and Long-Term Outcomes for Recovery From Critical COVID-19 Illness*

“…Patients enrolled in the current study by Stripari Schujmann et al (1) had higher mean ( sd ) BI scores of 73 (24) at ICU discharge and 85 (19) at hospital discharge. Thus, in the study by Stripari Schujmann et al (1) of ICU COVID survivors, their functional status at ICU discharge was “better” than typical ICU patients and appeared “similar” at hospital discharge to those receiving early physical therapy in the pre-COVID era. However, the current study by Schujmann et al (1) restricted their analysis to survivors, which is different than Schweickert et al (4), who included decedents (and assigned a Barthel score of 0).…”

“…Thus, in the study by Stripari Schujmann et al (1) of ICU COVID survivors, their functional status at ICU discharge was “better” than typical ICU patients and appeared “similar” at hospital discharge to those receiving early physical therapy in the pre-COVID era. However, the current study by Schujmann et al (1) restricted their analysis to survivors, which is different than Schweickert et al (4), who included decedents (and assigned a Barthel score of 0). Of the patients “excluded” from the current study by Stripari Schujmann et al (1), 56 had poor outcomes (i.e., death or cognitive/functional impairment, Fig.…”

“…How does the study by Stripari Schujmann et al (1) compare with others measuring the BI? In a cohort of 122 general ICU patients from the pre-COVID era, the median (interquartile range [IQR]) BI score at ICU discharge was 25 (10–60; rater 1) (3).…”

“…In this issue of Critical Care Medicine , Stripari Schujmann et al (1) described a prospective, multicenter study analyzing the trajectory of critically ill patients with COVID-19 during their critical care illness. It described the disease course of 328 survivors admitted between July 2020 and July 2021 across four ICUs in Sao Paulo, Brazil.…”

“…It is valid and reliable for use in ICU survivors, the smallest detectable change at ICU discharge is 20 points, and scores greater than 85 reflect mild to no impairment (2). In the study by Stripari Schujmann et al (1), the authors found that 44% of included patients were functionally independent (BI score > 85 at ICU and hospital discharge), 33% recovered functionality (BI score < 85 at ICU discharge and > 85 at hospital discharge), and 22% were functionally dependent (BI score < 85 at both ICU and hospital discharge).…”