Changes in Stroke Rehabilitation during the Sars-Cov-2 Shutdown in Switzerland

Authors

  • Jeremia P. O. Held Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
  • Anne Schwarz
  • Johannes Pohl
  • Eva Thürlimann
  • Silvan Porrtmann
  • Meret Branscheidt
  • Madalina Fratian
  • Jannie van Duinen
  • Janne M. Veerbeek
  • Andreas R. Luft

DOI:

https://doi.org/10.2340/jrm.v53.1118

Keywords:

stroke, rehabilitation, COVID-19, shutdown, outcome, assessment, physical activities

Abstract

Introduction: Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independ­ence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2
infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood.
Methods: A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor func­tion, anxiety, and depression were assessed.
Results: Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-­stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently report­ed on self-directed training during shutdown.
Conclusion: The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-­stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.

Lay abstract
In Switzerland and in many other countries, the shutdown to contain SARS-CoV-2 infections led to a reduc­ed mobility and a reduction in therapy delivery. The impact of the shutdown on stroke survivors’ access to therapy, physical functioning, and mood was investigat­ed in an observational study. Before, during, and after shutdown, the amount of therapy, motor functioning, and anxiety and depression were collected. Thirty-six commun­ity dwelling subjects were enrolled at a median of 10 months post-stroke. Therapy reductions related to the shutdown were reported in 72% of subjects. This was associated with an increased sedentary time and minimal deterioration in motor functioning, which improved after reopening. Depression increased slightly during the observation. Patients more frequently reported on self-directed training during shutdown. The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except depression. In fact, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.

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Published

2022-03-01

How to Cite

Held, J. P. O., Schwarz, A., Pohl, J. ., Thürlimann, E., Porrtmann, S., Branscheidt, M., Fratian, M., van Duinen, J., Veerbeek, J. M., & Luft, A. R. (2022). Changes in Stroke Rehabilitation during the Sars-Cov-2 Shutdown in Switzerland . Journal of Rehabilitation Medicine, 54, jrm00272. https://doi.org/10.2340/jrm.v53.1118

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