Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

Violaine Piquet, Cédric Luczak, Fabien Seiler, Jordan Monaury, Alexandre Martini, Anthony B Ward, Jean-Michel Gracies, Damien Motavasseli, Covid Rehabilitation Study Group, Violaine Piquet, Cédric Luczak, Fabien Seiler, Jordan Monaury, Estelle Lépine, Lucile Chambard, Marjolaine Baude, Emilie Hutin, Alexandre Martini, Andrés Samaniego, Nicolas Bayle, Anthony B Ward, Jean-Michel Gracies, Damien Motavasseli, Violaine Piquet, Cédric Luczak, Fabien Seiler, Jordan Monaury, Alexandre Martini, Anthony B Ward, Jean-Michel Gracies, Damien Motavasseli, Covid Rehabilitation Study Group, Violaine Piquet, Cédric Luczak, Fabien Seiler, Jordan Monaury, Estelle Lépine, Lucile Chambard, Marjolaine Baude, Emilie Hutin, Alexandre Martini, Andrés Samaniego, Nicolas Bayle, Anthony B Ward, Jean-Michel Gracies, Damien Motavasseli

Abstract

Objective: To determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients.

Design: Retrospective chart review.

Setting: A newly created specialized rehabilitation unit in a tertiary care medical center.

Participants: Consecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation.

Intervention: Inpatient rehabilitation for postacute care COVID-19 patients.

Main outcome measures: Measurements at admission and discharge comprised a Barthel Activities of Daily Living Index (including baseline value before COVID-19 infection), time to perform 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in the intensive care unit (ICU) were explored.

Results: Upon admission to rehabilitation, 66% of the patients were men, the age was 66±22 years, mean delay from symptom onset was 20.4±10.0 days, body mass index was 26.0±5.4 kg/m2, 49% had hypertension, 29% had diabetes, and 26% had more than 50% pulmonary damage on computed tomographic scans. The mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index increased from 77.3±26.7 to 88.8±24.5 (P<.001), without recovering baseline values (94.5±16.2; P<.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; P<.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; P=.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; P<.001). At both admission and discharge, Barthel score correlated with grip strength (ρ=0.39-0.66; P<.01), which negatively correlated with time spent in the ICU (ρ=-0.57 to -0.49; P<.05).

Conclusions: Inpatient rehabilitation for COVID-19 patients was associated with substantial motor, respiratory, and functional improvement, especially in severe cases, although there remained mild persistent autonomy loss upon discharge. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.

Keywords: COVID-19; Pandemics; Rehabilitation.

Copyright © 2021 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1
Fig 1
Changes in Barthel index (n=89). (A) Barthel index items; items laid out to highlight motor tasks. (B) Barthel index total score. Data expressed in mean ± standard error of the mean. ∗P<.05. †P<.01. ‡P<.001.
Fig 2
Fig 2
Functional data upon admission and at discharge. (A) Sit-to-stand parameters; (B) Borg scale before and after sit-to-stand test; (C) Grip strength in right-handed patients. Data expressed in mean ± standard error of the mean. ∗P<.05. †P<.01. ‡P<.001.
Fig 3
Fig 3
Correlations between motor and functional tests and Barthel index or number of ICU days. (A) Barthel total score and sit-to-stand frequency at admission and discharge. (B) Barthel total score and mean grip strength at admission and discharge. (C) Grip strength and number of days spent in the ICU at admission and discharge. Spearman or Pearson tests were used according to conditions of normality on Shapiro–Wilk tests. Outliers beyond 2 standard deviations on Z-tests were excluded.

References

    1. Simpson R., Robinson L. Rehabilitation after critical illness in people with COVID-19 infection. Am J Phys Med Rehabil. 2020;99:470–474.
    1. Grabowski D.C., Joynt Maddox K.E. Post-acute care preparedness for COVID-19: thinking ahead. JAMA. 2020;323:2007–2008.
    1. Carda S., Invernizzi M., Bavikatte G., et al. The role of physical and rehabilitation medicine in the COVID-19 pandemic: the clinician's view. Ann Phys Rehabil Med. 2020;63:554–556.
    1. Andrenelli E., Negrini F., De Sire A., et al. Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020. Eur J Phys Rehabil Med. 2020;56:846–852.
    1. Iannaccone S., Castellazzi P., Tettamanti A., et al. Role of rehabilitation department for adult individuals with COVID-19: the experience of the San Raffaele Hospital of Milan. Arch Phys Med Rehabil. 2020;101:1656–1661.
    1. Puchner B., Sahanic S., Kirchmair R., et al. Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19 - an observational cohort study. Eur J Phys Rehabil Med. 2021 Jan 15 [Epub ahead of print]
    1. Curci C., Negrini F., Ferrillo M., et al. Functional outcome after inpatient rehabilitation in post-intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021 Jan 4 [Epub ahead of print]
    1. Ngai J.C., Ko F.W., Ng S.S., To K.-W., Tong M., Hui D.S. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15:543–550.
    1. Herridge M.S., Tansey C.M., Matté A., et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304.
    1. Herridge M.S., Moss M., Hough C.L., et al. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med. 2016;42:725–738.
    1. Fuke R., Hifumi T., Kondo Y., et al. Early rehabilitation to prevent post-intensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open. 2018;8
    1. To K.K.-W., Tsang O.T.-Y., Leung W.-S., et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20:565–574.
    1. Ai T., Yang Z., Hou H., et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296:E32–E40.
    1. Wade D.T., Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud. 1988;10:64–67.
    1. Collin C., Wade D.T., Davies S., Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10:61–63.
    1. Csuka M., McCarty D.J. Simple method for measurement of lower extremity muscle strength. Am J Med. 1985;78:77–81.
    1. Mateos-Angulo A., Galán-Mercant A., Cuesta-Vargas A.I. Muscle thickness contribution to sit-to-stand ability in institutionalized older adults. Aging Clin Exp Res. 2020;32:1477–1483.
    1. Scherr J., Wolfarth B., Christle J.W., Pressler A., Wagenpfeil S., Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol. 2013;113:147–155.
    1. Bohannon R.W. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18:465–470.
    1. Pan P.-J., Lin C.-H., Yang N.-P., et al. Normative data and associated factors of hand grip strength among elderly individuals: The Yilan Study, Taiwan. Sci Rep. 2020;10:6611.
    1. Navas-Blanco J.R., Dudaryk R. Management of respiratory distress syndrome due to COVID-19 infection. BMC Anesthesiol. 2020;20:177.
    1. Boldrini P., Kiekens C., Bargellesi S., et al. First impact of COVID-19 on services and their preparation. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency. Eur J Phys Rehabil Med. 2020;56:319–322.
    1. Curci C., Pisano F., Bonacci E., et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med. 2020;56:633–641.
    1. Saeki T., Ogawa F., Chiba R., et al. Rehabilitation therapy for a COVID-19 patient who received mechanical ventilation in Japan. Am J Phys Med Rehabil. 2020;99:873–887.
    1. Guan W., Ni Z., Hu Y., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
    1. Guo L., Wei D., Zhang X., et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol. 2019;10:2752.
    1. Fang L., Karakiulakis G., Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8:e21.
    1. Billy L., Martini A., Savard E., Cosme S., Gracies J.M. Intra- and inter-rater reliability and validity of a clinical and quantifying test of the sit-to-stand task in Parkinsonian syndromes. Ann Phys Rehabil Med. 2018;61:e253.
    1. Baig A.M., Khaleeq A., Ali U., Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020;11:995–998.
    1. Montalvan V., Lee J., Bueso T., De Toledo J., Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020;194:105921.
    1. Fernandez-Gonzalo R., Tesch P.A., Lundberg T.R., Alkner B.A., Rullman E., Gustafsson T. Three months of bed rest induce a residual transcriptomic signature resilient to resistance exercise countermeasures. FASEB J. 2020;34:7958–7969.
    1. Brower R.G. Consequences of bed rest. Crit Care Med. 2009;37(10 Suppl):S422–S428.
    1. Arentson-Lantz E.J., English K.L., Paddon-Jones D., Fry C.S. Fourteen days of bed rest induces a decline in satellite cell content and robust atrophy of skeletal muscle fibers in middle-aged adults. J Appl Physiol (1985) 2016;120:965–975.
    1. Abdullahi A., Candan S.A., Abba M.A., et al. Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 2020;11:687.
    1. Gracies J.M. Springer International Publishing; Cham, Switzerland: 2016. Guided self-rehabilitation contract in spastic paresis.

Source: PubMed

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