COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force

Martijn A Spruit, Anne E Holland, Sally J Singh, Thomy Tonia, Kevin C Wilson, Thierry Troosters, Martijn A Spruit, Anne E Holland, Sally J Singh, Thomy Tonia, Kevin C Wilson, Thierry Troosters

Abstract

Background: Patients with COVID-19 or post-COVID-19 will most probably have a need for rehabilitation during and directly after the hospitalisation. Data on safety and efficacy are lacking. Healthcare professionals cannot wait for published randomised controlled trials before they can start these rehabilitative interventions in daily clinical practice, as the number of post-COVID-19 patients increases rapidly. The Convergence of Opinion on Recommendations and Evidence process was used to make interim recommendation for the rehabilitation in the hospital and post-hospital phase in COVID-19 and post-COVID-19 patients, respectively.

Methods: 93 experts were asked to fill out 13 multiple choice questions. Agreement of directionality was tabulated for each question. At least 70% agreement on directionality was necessary to make consensus suggestions.

Results: 76 experts (82%) reached consensus on all questions based upon indirect evidence and clinical experience on the need for early rehabilitation during the hospital admission, the screening for treatable traits with rehabilitation in all patients at discharge and 6-8 weeks after discharge, and around the content of rehabilitation for these patients. It advocates for assessment of oxygen needs at discharge and more comprehensive assessment of rehabilitation needs including physical as well as mental aspects 6-8 weeks after discharge. Based on the deficits identified multidisciplinary rehabilitation should be offered with attention for skeletal muscle and functional as well as mental restoration.

Conclusions: This multinational task force recommends early, bedside rehabilitation for patients affected by severe COVID-19. The model of pulmonary rehabilitation may suit as a framework, particularly in a subset of patients with long term respiratory consequences.

Conflict of interest statement

Conflict of interest: Dr. Spruit reports grants from Netherlands Lung Foundation, grants from Stichting Astma Bestrijding, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingeheim, outside the submitted work. Conflict of interest: Dr. Holland has nothing to disclose. Conflict of interest: Dr. Singh has nothing to disclose. Conflict of interest: Dr. Tonia has nothing to disclose. Conflict of interest: Dr. Wilson reports other possible COI as ATS Chief of Guidelines and Documents, and as Developer of the CORE process, outside the submitted work. Conflict of interest: Dr. Troosters has nothing to disclose.

Copyright ©ERS 2020.

Figures

FIGURE 1
FIGURE 1
Experts’ responses to the 13 questions. COVID-19: coronavirus disease 2019; ++: strong recommendation for; +: conditional recommendation for; +/−: no recommendation for or against; −: conditional recommendation against; −−: strong recommendation against.

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