EFFECT OF PHYSICAL THERAPY ON IMPAIRMENTS IN COVID-19 PATIENTS FROM INTENSIVE CARE TO HOME REHABILITATION: A RAPID REVIEW

Ruben Debeuf, MSc1,2,3, Eva Swinnen, PhD1,2,3, Tine Plattiau, BSc1, Ann De Smedt, MD, PhD2,4,5, Elisabeth De Waele, MD, PhD6, Stijn Roggeman, MD, PhD4, Marc Schiltz, MD, PhD4, David Beckwée, PhD1,3,7 and Emma De Keersmaecker, MSc1,2,3

From the 1Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium, 2Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium, 3Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium, 4Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Brussels, Belgium 5STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Brussels, Belgium, 6Intensive Care Unit, Universitair Ziekenhuis Brussel, Brussels, Belgium and 7Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium

ABSTRACT

Objective: Guidelines regarding physical therapy for COVID-19 patients are often based on expert opinion.
Recent clinical trials have reported effects on sever­al rehabilitation outcomes in COVID-19 patients. This review summarizes the effects of physical therapy in COVID-19 patients.

Data sources: PubMed, Web of Science and Scopus databases were systematically searched for stud­ies investigating the effect of any physical therapy modal­ity on impairments in adult COVID-19 patients. Included studies were (non)-randomized controlled trials, pre-experimental studies, and cohort studies in which a pre–post analysis was performed.

Data extraction: After the screening process, data of interest were extracted from eligible studies and their risk of bias was assessed. Included outcome mea­sures were divided into 3 groups: pulmonary func­tion, physical function, and psychosocial function.

Data synthesis: A total of 15 studies were included in this review. Physical therapy seems to have positive effects on pulmonary function, physical function, and psychosocial function. However, these effects differ between clinical settings (e.g. home care, intensive care unit, inpatient units). Due to the low-to-moderate quality of the included studies, no robust conclusions can be drawn.

Conclusion: Further high-quality research is requir­ed, taking into account the different clinical settings, in order to draw conclusions about the effectiveness of physical therapy on impairments in COVID-19
patients.

Key words: COVID-19; physical therapy; rehabilitation.

Accepted Sep 21, 2021; Epub ahead of print Oct 11, 2021

J Rehabil Med 2022; 54: jrm00242

Correspondence address: Emma De Keersmaecker, Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium. E-mail: emma.de.keersmaecker@vub.be

LAY ABSTRACT

Guidelines regarding physical therapy for COVID-19 patients are often based on expert opinion or on evidence from studies of physical therapy in patients with other diseases. More and more clinical studies are investigat­ing the effect of physical therapy on the recovery of
COVID-19 patients. Prior to this review, the importance of physical therapy for COVID-19 patients was not clear. This review summarizes the effects of physical therapy in COVID-19 patients. We reviewed and assessed the
quality of the existing literature on this topic. Fifteen studies with a total of 1,341 COVID-19 patients were included in this review. Physical therapy appears to improve lung function, physical function, and psychosocial func­tion in COVID-19 patients. However, the effect can differ between clinical settings; for example, home care, intensive care unit, or other inpatient units. Due to the low-to-moderate quality of the included studies, no robust conclusion can be drawn. Further high-quality research is needed, taking into account the different clinical settings.

INTRODUCTION

Guidelines regarding physical therapy for COVID-19 patients are often based on expert opinion or on evidence from studies of physical therapy in patients with other diseases. More and more clinical studies are investigat­ing the effect of physical therapy on the recovery of
COVID-19 patients. Prior to this review, the importance of physical therapy for COVID-19 patients was not clear. This review summarizes the effects of physical therapy in COVID-19 patients. We reviewed and assessed the
quality of the existing literature on this topic. Fifteen studies with a total of 1,341 COVID-19 patients were included in this review. Physical therapy appears to improve lung function, physical function, and psychosocial func­tion in COVID-19 patients. However, the effect can differ between clinical settings; for example, home care, intensive care unit, or other inpatient units. Due to the low-to-moderate quality of the included studies, no robust conclusion can be drawn. Further high-quality research is needed, taking into account the different clinical settings.The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been endangering global health since early 2020. Worldwide, over 237 million cases of COVID-19 have been registered, of whom over 4.8 million have died (1). However, this is probably an underestimation, as COVID-19 patients can be asymptomatic and thus remain unnoticed (1).

COVID-19 impacts, among other things, both the physical and mental well-being of patients. Approximately 14% of COVID-19 patients will require hospitalization, and extremely severe cases will need intensive care. Such patients can develop a range of dysfunctions, such as lung function impairments, neurological impairments, reduced physical capacity, muscle weakness, and psychological and cognitive impairments (2). Clinical practice guidelines state that these complications can be countered with appropriate physical therapy management as part of a multidisciplinary approach (3, 4). Research prior to the COVID-19 pandemic has shown that patients with acute lung injury may still have significant physical impairments, such as balance problems and muscle weakness, even years after discharge, which, in turn, can increase the risk of falls (5). Baricich et al.’s cross-sectional study (6) found that, 3–6 months after discharge, 32% of COVID-19
patients still had impaired physical performance. These findings emphasize the importance of rehabilitation, even after patients are discharged from hospital.

Several reviews and guidelines have summarized the role of physical therapy in rehabilitation of COVID-19 patients (7–9); however, due to the urgent need for guidelines on how to treat these patients, these are mostly based on expert opinion or on evidence from patients with other lung diseases, and not on evidence from recent literature concerning COVID-19. Meanwhile, many clinical trials about the rehabilitation of COVID-19 patients have already been conducted and published, highlighting the need for an update of the current guidelines. To the best of our knowledge, no systematic review has described the role of physical therapy in the rehabilitation of COVID-19 patients in both the acute and subacute phases of the disease. Therefore, the aim of this systematic review is to describe the role of physical therapy in the rehabilitation of COVID-19 patients in all phases of recovery.

METHODS

Study design

This rapid review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reporting systematic reviews.

Eligibility criteria

Studies were included in this review if they met following inclusion criteria: