Considerations for Postacute Rehabilitation for Survivors of COVID-19

Lisa Mary Sheehy, Lisa Mary Sheehy

Abstract

Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question "What rehabilitation services do survivors of COVID-19 require?" The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.

Keywords: covid-19; geriatric; infectious disease; inpatient rehabilitation; patient outcome; public health; recovery; rehabilitation; subacute care; treatment; virus.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lisa Mary Sheehy. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 08.05.2020.

References

    1. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AY, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, van der Lee L. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Mar 30; doi: 10.1016/j.jphys.2020.03.011.
    1. World Health Organization. 2020. [2020-05-05]. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected .
    1. Chinese Association of Rehabilitation Medicine. Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine. Cardiopulmonary Rehabilitation Group of Chinese Society of Physicai MedicineRehabilitation Recommendations for respiratory rehabilitation of COVID-19 in adult. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 03;43:E029. doi: 10.3760/cma.j.cn112147-20200228-00206.
    1. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system. JAMA Cardiol. 2020 Mar 27; doi: 10.1001/jamacardio.2020.1286.
    1. McNeary L, Maltser S, Verduzco-Gutierrez M. Navigating coronavirus disease 2019 (Covid-19) in physiatry: a CAN report for inpatient rehabilitation facilities. PM R. 2020 May;12(5):512–515. doi: 10.1002/pmrj.12369.
    1. Spruit M, Holland A, Singh S. European Respiratory Society. 2020. Apr 03, [2020-05-05]. Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors .
    1. Vitacca M, Carone M, Clini E, Paneroni M, Lazzeri M, Lanza A, Privitera E, Pasqua F, Gigliotti F, Castellana G, Banfi P, Guffanti E, Santus P, Ambrosino N. L'Associazione Riabilitatori dell'Insufficienza Respiratoria. 2020. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper .
    1. Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA. 2020 Jan 23;323(8):707–708. doi: 10.1001/jama.2020.0757.
    1. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, Cani DS, Cerini M, Farina D, Gavazzi E, Maroldi R, Adamo M, Ammirati E, Sinagra G, Lombardi CM, Metra M. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020 Mar 27; doi: 10.1001/jamacardio.2020.1096.
    1. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19) Cureus. 2020 Apr 06;12(4):e7560. doi: 10.7759/cureus.7560.
    1. Wang L, He W, Yu X, Hu D, Bao M, Liu H, Zhou J, Jiang H. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020 Mar 30; doi: 10.1016/j.jinf.2020.03.019.
    1. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020 Mar 30; doi: 10.1016/j.bbi.2020.03.031.
    1. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020 Mar 25; doi: 10.1001/jamacardio.2020.0950.
    1. Connolly B, O'Neill B, Salisbury L, Blackwood B, Enhanced Recovery After Critical Illness Programme Group Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews. Thorax. 2016 Oct;71(10):881–90. doi: 10.1136/thoraxjnl-2015-208273.
    1. Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med. 2016 May;42(5):725–738. doi: 10.1007/s00134-016-4321-8.
    1. Shepherd S, Batra A, Lerner DP. Review of critical illness myopathy and neuropathy. Neurohospitalist. 2017 Jan;7(1):41–48. doi: 10.1177/1941874416663279.
    1. Ohtake PJ, Lee AC, Scott JC, Hinman RS, Ali NA, Hinkson CR, Needham DM, Shutter L, Smith-Gabai H, Spires MC, Thiele A, Wiencek C, Smith JM. Physical impairments associated with post–intensive care syndrome: systematic review based on the World Health Organization’s International Classification of Functioning, Disability and Health Framework. Phys Ther. 2018 Aug 01;98(8):631–645. doi: 10.1093/ptj/pzy059.
    1. Lan L, Xu D, Ye G, Xia C, Wang S, Li Y, Xu H. Positive RT-PCR test results in patients recovered from COVID-19. JAMA. 2020 Feb 27;323(15):1502–1503. doi: 10.1001/jama.2020.2783.
    1. Ling Y, Xu S, Lin Y, Tian D, Zhu Z, Dai F, Wu F, Song Z, Huang W, Chen J, Hu B, Wang S, Mao E, Zhu L, Zhang W, Lu H. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl) 2020 May 05;133(9):1039–1043. doi: 10.1097/CM9.0000000000000774.
    1. Zhang J, Yan K, Ye H, Lin J, Zheng J, Cai T. SARS-CoV-2 turned positive in a discharged patient with COVID-19 arouses concern regarding the present standard for discharge. Int J Infect Dis. 2020 Mar 18; doi: 10.1016/j.ijid.2020.03.007.
    1. Chang MC, Park D. How should rehabilitative departments of hospitals prepare for coronavirus disease 2019? Am J Phys Med Rehabil. 2020 Mar 24; doi: 10.1097/PHM.0000000000001428.
    1. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, Liu S, Zhao P, Liu H, Zhu L, Tai Y, Bai C, Gao T, Song J, Xia P, Dong J, Zhao J, Wang F. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Resp Med. 2020 Apr;8(4):420–422. doi: 10.1016/s2213-2600(20)30076-x.
    1. Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020 May;19(5):383–384. doi: 10.1016/S1474-4422(20)30109-5.
    1. Tsai L, Hsieh S, Chang Y. Neurological manifestations in severe acute respiratory syndrome. Acta Neurol Taiwan. 2005 Sep;14(3):113–9.
    1. Kim J, Heo J, Kim H, Song S, Park S, Park T, Ahn J, Kim M, Choi J. Neurological complications during treatment of Middle East respiratory syndrome. J Clin Neurol. 2017 Jul;13(3):227–233. doi: 10.3988/jcn.2017.13.3.227.
    1. Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA, Selim MA, Al Mutairi Mohammed, Al Nakhli Daifullah, Al Aidaroos Amal Y, Al Sherbeeni Nisreen, Al-Khashan HI, Memish ZA, Albarrak AM. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. Int J Infect Dis. 2014 Dec;29:301–6. doi: 10.1016/j.ijid.2014.09.003.
    1. Li Y, Wang S, Gao H, Wang J, Wei C, Chen L, Hui W, Yuan S, Jiao Z, Yang Z, Su B. Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence. Zhonghua Yi Xue Za Zhi. 2004 Aug 17;84(16):1348–53.
    1. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW, BRAIN-ICU Study Investigators Long-term cognitive impairment after critical illness. N Engl J Med. 2013 Oct 03;369(14):1306–16. doi: 10.1056/NEJMoa1301372.
    1. Grabowski DC, Joynt Maddox KE. Postacute care preparedness for COVID-19: thinking ahead. JAMA. 2020 Mar 25; doi: 10.1001/jama.2020.4686.
    1. Choon-Huat Koh G, Hoenig H. How should the rehabilitation community prepare for 2019-nCoV? Arch Phys Med Rehabil. 2020 Mar 16; doi: 10.1016/j.apmr.2020.03.003.
    1. Negrini S, Ferriero G, Kiekens C, Boldrini P. Facing in real time the challenges of the Covid-19 epidemic for rehabilitation. Eur J Phys Rehabil Med. 2020 Mar 30; doi: 10.23736/S1973-9087.20.06286-3.
    1. Lim Peter A, Ng Yee Sien, Tay Boon Keng. Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome. Arch Phys Med Rehabil. 2004 Aug 30;85(8):1365–70. doi: 10.1016/j.apmr.2004.01.022.
    1. Boldrini P, Bernetti A, Fiore P, SIMFER Executive Committee and SIMFER Committee for international affairs Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine (PRM) physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER) Eur J Phys Rehabil Med. 2020 Mar 16; doi: 10.23736/S1973-9087.20.06256-5.
    1. Landry MD, Tupetz A, Jalovcic D, Sheppard P, Jesus TS, Raman SR. The Novel Coronavirus (COVID-19): Making a Connection between Infectious Disease Outbreaks and Rehabilitation. Physiother Can. 2020 Mar 23;:e20200019. doi: 10.3138/ptc-2020-0019.
    1. World Health Organization. [2020-05-05]. International Classification of Functioning, Disability and Health (ICF)
    1. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin. 2020 May;39:101166. doi: 10.1016/j.ctcp.2020.101166.
    1. Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, D'Abrosca F, Del Monaco C, Gaudiello Giuseppe, Paneroni M, Privitera E, Retucci M, Rossi V, Santambrogio M, Sommariva M, Frigerio P. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) Monaldi Arch Chest Dis. 2020 Mar 26;90(1):1285. doi: 10.4081/monaldi.2020.1285. doi: 10.4081/monaldi.2020.1285.
    1. Zhao H, Xie Y, Wang C. Recommendations for respiratory rehabilitation in adults with COVID-19. Chin Med J (Engl) 2020 Apr 09; doi: 10.1097/CM9.0000000000000848.
    1. Liang T. The First Affiliated Hospital, Zhejiang University School of Medicine. [2020-05-05]. Handbook of COVID-19 Prevention and Treatment .
    1. Lau HM, Ng GY, Jones AY, Lee EW, Siu EH, Hui DS. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother. 2005;51(4):213–9. doi: 10.1016/s0004-9514(05)70002-7.
    1. Kho M, Brooks D, Namasivayam-MacDonald A. Rehabilitation for Patients with COVID-19: Guidance for Occupational Therapists, Physical Therapists, Speech-Language Pathologists, and Assistants. [2020-05-05]. McMaster School of Rehabilitation Science .

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