Multidisciplinary rehabilitation in intensive care for COVID-19: randomised controlled trial

Abstract

The coronavirus disease 2019 (COVID-19) has led to an increasing number of patients in the intensive care units (ICU). The size of this post-ICU cohort will be unprecedented, with many patients vulnerable to post-intensive care syndrome. We analysed the respiratory and functional effects of a multidisciplinary rehabilitation program on functional performance, in patients hospitalized in ICU due to COVID-19.We conducted a randomized controlled clinical trial. Ninety-six patients, who fulfilled the eligible criteria, were randomized into control or intervention group. The control group received standard of care in the ICU, and the intervention group received a functional and respiratory rehabilitation protocol, that included medical, nursing, physiotherapy, and occupational therapy interventions.At discharge, the intervention group showed significantly better muscular strength and respiratory capacity, and significantly less days of hospitalization (12.90±5.8versus15.60±6.7 days, p=0.037). At the 4- and 12-week follow-up we applied our main outcome measure – 6-minute walking test. The intervention group had significantly better results than the control group on the 6-minute walking test at the 4-week follow-up (604±67versus571±57 m, p=0.018) and at the 12-week follow-up (639±53 37versus611±67, p=0.025).These results support the role of a multidisciplinary rehabilitation program in COVID-19 patients hospitalized in ICU and adds evidence that the implementation of rehabilitation programs in ICU could result in beneficial outcomes for the critical ill patients.

Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis

“…Exercise capacity outcomes, including the Six-Minute Walk Test (6MWD) and the Sit-To-Stand Test (STS), were synthesized from data obtained in 16 RCTs. Out of these, 12 RCTs 31,[43][44][45][46][47]49,54,56,60,61,63,64 assessed 6MWD, revealing moderate-level evidence of improved walking outcomes in patients who underwent rehabilitation interventions compared to those receiving standard care (MD 38.18 [25.33, 51.03], I² = 88%) (Figure 4). Subgroup analysis by delivery mode indicated that tele-rehabilitation (MD 66.89 [32.15, 101.62], I² = 90%) appeared more effective than in-person rehabilitation 93.21], I² = 92%).…”

“…Twelve studies 38,51,[59][60][61]85,87,91,94,[99][100][101] reported length of ICU or hospital stay (LOS) for patients. Among them, eight studies 38,[59][60][61]85,87,94,100 did not demonstrate a shorter average LOS following rehabilitation interventions. This may be due to the inclusion of older patients (over 65 years) compared to studies with positive outcomes.…”

“…147,148 Tailored interventions can shorten ICU stays and reduce invasive ventilation needs, showing early respiratory benefits. 60,80,104,149 Typically lasting up to 12 weeks, rehabilitation interventions yield early improvements in exercise capacity and physical function, enhancing quality of life and reducing fatigue over time. Studies 77,95 indicate decreased re-hospitalization rates and anxiety, underscoring the benefits of a phased, personalized rehabilitation approach across recovery stages.…”

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

“…The 6MWT is a functional performance test previously used in the follow-up of COVID-19 ( 40 , 41 ). Our results indicate a moderate reduction in distance and oxygen saturation, which could be related to the severity of lung disease.…”

The influence of a physiotherapeutic intervention program for patients with post-COVID-19 syndrome: a quasi-experimental study

“…A melhora dessas condições contribui com a recuperação da qualidade de vida dos pacientes e o reflexo da reabilitação, incide nos índices de vigilância em saúde, diminui o impacto negativo na vida das pessoas e nas atividades econômicas. [18][19][20][21]…”