Correlations between Disease Severity and Rehabilitation Outcomes in Patients Recovering from Covid-19 Infection
DOI:
https://doi.org/10.2340/jrm.v54.3415Keywords:
interdisciplinary rehabilitation, COVID-19 infection, activities of daily living, Functional Independence MeasureAbstract
Objective: Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes.
Design: Observational cohort study.
Subjects: A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment.
Methods: The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness.
Results: Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation were correlated with lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between WHO-CPS, prolonged acute hospitalization and day of ventilation and funnctional level at discharge.
Conclusion: The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings show that even patients with severe acute COVID-19 infection may improve their daily functioning significantly during rehabilitation program.
LAY ABSTRACT
Many patients worldwide develop severe complications of recent infection with the coronavirus SARS-CoV-2 (COVID-19). These complications include respiratory, motor, cognitive, and functional symptoms. Rehabilitation plays an important role in the recovery of these patients. This study examined whether there is a correlation between the severity of acute COVID-19 infection and the functional level of survivors after rehabilitation. Study participants were 61 post-acute COVID-19 patients who received inpatient and outpatient rehabilitation. Most of the patients improved significantly in daily functions following rehabilitation, and most did not need oxygen support at discharge. Patients with severe COVID-19 infection started the rehabilitation period at a low functional level, but improved significantly during rehabilitation, and at discharge there was no difference between patients with more severe or less severe COVID-19 infections. These findings show that even patients with severe acute COVID-19 infection may improve significantly during rehabilitation program.
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Datta SD, Talwar A, Lee JT. A proposed framework and timeline of the spectrum of disease due to SARS-CoV-2 infection: illness beyond acute infection and public health implications. JAMA 2020; 324: 2251-2252.
https://doi.org/10.1001/jama.2020.22717 DOI: https://doi.org/10.1001/jama.2020.22717
Prescott HC, Girard TD. Recovery from severe COVID-19: leveraging the lessons of survival from sepsis. JAMA 2020; 324: 739-740. https://doi.org/10.1001/jama.2020.14103 DOI: https://doi.org/10.1001/jama.2020.14103
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26: 1017-1032.
https://doi.org/10.1038/s41591-020-0968-3 DOI: https://doi.org/10.1038/s41591-020-0968-3
Serafim RB, Póvoa P, Souza-Dantas V, Kalil AC, Salluh JIF. Clinical course and outcomes of critically ill patients with COVID-19 infection: a systematic review. Clin Microbiol Infect 2021; 27: 47-54.
https://doi.org/10.1016/j.cmi.2020.10.017 DOI: https://doi.org/10.1016/j.cmi.2020.10.017
Daste C, Ficarra S, Dumitrache A, Cariou A, Lefèbvre A, Pène F, et al. Post-intensive care syndrome in patients surviving COVID-19. Ann Phys Rehabil Med 2021; 64: 101549.
https://doi.org/10.1016/j.rehab.2021.101549 DOI: https://doi.org/10.1016/j.rehab.2021.101549
Han Q, Zheng B, Daines L, Sheikh A. Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms. Pathogens 2022; 19: 269.
https://doi.org/10.3390/pathogens11020269 DOI: https://doi.org/10.3390/pathogens11020269
Phillips M, Turner-Stokes L, Wade D, Walton K. Rehabilitation in the wake of Covid-19-a Phoenix from the ashes. British Society of Rehabilitation Medicine. 2020;1:1-20.
Chartered Society of Physiotherapy Rehabilitation and Covid-19 - CSP policy statement. CSP, 2020. [Accessed 4 May 2020]. https://www.csp.org.uk/professional-clinical/improvement-innovation/community-rehabilitation/rehab-covid-19-policy-statement.
Daynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition - a cohort study. Chron Respir Dis 2021; 18: 14799731211015691.
https://doi.org/10.1177/14799731211015691 DOI: https://doi.org/10.1177/14799731211015691
Stein J, Visco CJ, Barbuto S: Rehabilitation medicine response to the COVID-19 pandemic. Am J Phys Med Rehabil 2020; 99: 573-579.
https://doi.org/10.1097/PHM.0000000000001470 DOI: https://doi.org/10.1097/PHM.0000000000001470
Korupolu R, Francisco GE, Levin H, Needham DM. Rehabilitation of critically ill COVID-19 survivors. J Int Soc Phys Rehabil Med 2020; 3: 45.
https://doi.org/10.4103/jisprm.jisprm_8_20 DOI: https://doi.org/10.4103/jisprm.jisprm_8_20
Tay MRJ, Ong PL, Puah SH, Acute functional outcomes in critically ill COVID-19 patients. Front Med 2021; 7: 615-997.
https://doi.org/10.3389/fmed.2020.615997 DOI: https://doi.org/10.3389/fmed.2020.615997
Albu S, Rivas Zozaya N, Murillo N, García-Molina A, Figueroa Chacón CA, Kumru H. Multidisciplinary outpatient rehabilitation of physical and neurological sequelae and persistent symptoms of covid-19: a prospective, observational cohort study. Disabil Rehabil 2021; 24: 1-8.
https://doi.org/10.1080/09638288.2021.1977398 DOI: https://doi.org/10.1080/09638288.2021.1977398
Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: a 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med 2021; 18: e1003773.
https://doi.org/10.1371/journal.pmed.1003773 DOI: https://doi.org/10.1371/journal.pmed.1003773
Zorowitz RD. ICU-acquired weakness: a rehabilitation perspective of diagnosis, treatment, and functional management. Chest 2016; 150: 966-971.
https://doi.org/10.1016/j.chest.2016.06.006 DOI: https://doi.org/10.1016/j.chest.2016.06.006
Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM, et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007; 33:1876-1891.
https://doi.org/10.1007/s00134-007-0772-2 DOI: https://doi.org/10.1007/s00134-007-0772-2
Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, 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.
https://doi.org/10.1007/s00134-016-4321-8 DOI: https://doi.org/10.1007/s00134-016-4321-8
Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007; 131: 1541-1549.
https://doi.org/10.1378/chest.06-2065 DOI: https://doi.org/10.1378/chest.06-2065
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304: 1787-1794.
https://doi.org/10.1001/jama.2010.1553 DOI: https://doi.org/10.1001/jama.2010.1553
Mikkelsen ME, Lanken PE, Biester R, et al. Conservative fluide strategy is associated with neurocognitive deficits in survivors of acute lung injury. Paper presented at: American Thoracic Society; May 21, 2008; Toronto, ON.
Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004; 292: 2901-2908.
https://doi.org/10.1001/jama.292.23.2901 DOI: https://doi.org/10.1001/jama.292.23.2901
Kuo HK, Yen CJ, Chang CH, Kuo CK, Chen JH, Sorond F. Relation of C-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol 2005; 4: 371-380.
https://doi.org/10.1016/S1474-4422(05)70099-5 DOI: https://doi.org/10.1016/S1474-4422(05)70099-5
Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil 2017; 31:995-1004.
https://doi.org/10.1177/0269215517709890 DOI: https://doi.org/10.1177/0269215517709890
Wade DT. A teamwork approach to neurological rehabilitation. In: Dietz V, Ward NS, editors. Oxford textbook on neurorehabilitation. Oxford: Oxford University Press; 2020, p. 9-22.
https://doi.org/10.1093/med/9780198824954.003.0002 DOI: https://doi.org/10.1093/med/9780198824954.003.0002
Rehabilitation for patients in the acute care pathway following severe disabling illness or injury: BSRM core standards for specialist rehabilitation. London: British Society of Rehabilitation Medicine; 2014.
Marshall JC, Murthy S, Diaz J, Adhikari NK, Angus DC, Arabi YM, et al. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis 2020; 20: 192-197.
https://doi.org/10.1016/S1473-3099(20)30483-7 DOI: https://doi.org/10.1016/S1473-3099(20)30483-7
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-699.
https://doi.org/10.1111/j.1532-5415.2005.53221.x DOI: https://doi.org/10.1111/j.1532-5415.2005.53221.x
Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Arch Phys Rehabil Med 2011; 92: 792-798.
https://doi.org/10.1016/j.apmr.2010.12.034 DOI: https://doi.org/10.1016/j.apmr.2010.12.034
Carlsson, AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16: 87-101.
https://doi.org/10.1016/0304-3959(83)90088-X DOI: https://doi.org/10.1016/0304-3959(83)90088-X
Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008; 31:165-169.
https://doi.org/10.1097/MRR.0b013e3282fc0f93 DOI: https://doi.org/10.1097/MRR.0b013e3282fc0f93
Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res 2018; 11: 851-856.
https://doi.org/10.2147/JPR.S158847 DOI: https://doi.org/10.2147/JPR.S158847
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurology 1989; 46: 1121-1123.
https://doi.org/10.1001/archneur.1989.00520460115022 DOI: https://doi.org/10.1001/archneur.1989.00520460115022
Grace J, Mendelsohn A, Friedman JHA. Comparison of fatigue measures in Parkinson's disease. Parkinsonism Relat Disord 2007; 13: 443-445.
https://doi.org/10.1016/j.parkreldis.2006.09.001 DOI: https://doi.org/10.1016/j.parkreldis.2006.09.001
Lerdal A, Kottorp A. Psychometric properties of the Fatigue Severity Scale - Rasch analyses of individual responses in a Norwegian stroke cohort. Int J Nurs Stud 2011; 48: 1258-1265.
https://doi.org/10.1016/j.ijnurstu.2011.02.019 DOI: https://doi.org/10.1016/j.ijnurstu.2011.02.019
Ottenbacher KJ., Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996; 77: 1226-1232.
https://doi.org/10.1016/S0003-9993(96)90184-7 DOI: https://doi.org/10.1016/S0003-9993(96)90184-7
Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 1993; 74: 531-536.
https://doi.org/10.1016/0003-9993(93)90119-U DOI: https://doi.org/10.1016/0003-9993(93)90119-U
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006; 54: 743-749.
https://doi.org/10.1111/j.1532-5415.2006.00701.x DOI: https://doi.org/10.1111/j.1532-5415.2006.00701.x
Collen FM, Wade DT, Bradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disabil Stud 1990; 12: 6-9.
https://doi.org/10.3109/03790799009166594 DOI: https://doi.org/10.3109/03790799009166594
Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009; 23: 1018-1033.
https://doi.org/10.1177/0269215509339004 DOI: https://doi.org/10.1177/0269215509339004
Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005; 37: 75-82.
https://doi.org/10.1080/16501970410017215 DOI: https://doi.org/10.1080/16501970410017215
Harada ND, Chiu V, Stewart AL. Mobility-related function in older adults: assessment with a 6-minute walk test. Arch Phys Med Rehabil 1999; 80: 837-841.
https://doi.org/10.1016/S0003-9993(99)90236-8 DOI: https://doi.org/10.1016/S0003-9993(99)90236-8
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80: 896-903.
https://doi.org/10.1093/ptj/80.9.896 DOI: https://doi.org/10.1093/ptj/80.9.896
Hofheinz M, Schusterschitz C. Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements. Clin Rehabil 2010; 24: 831-842.
https://doi.org/10.1177/0269215510367993 DOI: https://doi.org/10.1177/0269215510367993
Mathiowetz V. Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int 2002; 9: 201-209.
https://doi.org/10.1002/oti.165 DOI: https://doi.org/10.1002/oti.165
Werle S, Goldhahns J, Drerup S, Simmen BR, Sprott, H, Herren, DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur 2009; 34: 76-84.
https://doi.org/10.1177/1753193408096763 DOI: https://doi.org/10.1177/1753193408096763
Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil 2008; 89: 1693-1700.
https://doi.org/10.1016/j.apmr.2008.02.022 DOI: https://doi.org/10.1016/j.apmr.2008.02.022
Bertrand AM, Mercier C, Bourbonnais D, Desrosiers J, Gravel D. Reliability of maximal static strength measurements of the arms in subjects with hemiparesis. Clin Rehabil 2007; 21: 248-257.
https://doi.org/10.1177/0269215506070792 DOI: https://doi.org/10.1177/0269215506070792
Bellace JV, Healy D, Besser MP, Byron T, Hohman L. Validity of the Dexter Evaluation System's Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther 2000; 13: 46-51.
https://doi.org/10.1016/S0894-1130(00)80052-6 DOI: https://doi.org/10.1016/S0894-1130(00)80052-6
Mathiowetz VG, Volland G, Kashman N, Weber K. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther 1985; 39: 386-391.
https://doi.org/10.5014/ajot.39.6.386 DOI: https://doi.org/10.5014/ajot.39.6.386
Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL. Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabil Neural Repair 2009; 23: 435-440.
https://doi.org/10.1177/1545968308331146 DOI: https://doi.org/10.1177/1545968308331146
Puchner B, Sahanic S, Kirchmair R, Pizzini A, Sonnweber B, Wöll E, et al. Beneficial effects of multi-disciplinary rehabilitation in postacute COVID-19: an observational cohort study. Eur J Phys Rehabil Med 2021; 57: 189-198.
https://doi.org/10.23736/S1973-9087.21.06549-7 DOI: https://doi.org/10.23736/S1973-9087.21.06549-7
Hameed F, Palatulan E, Jaywant A, Said R, Lau C, Sood V, et al. Outcomes of a COVID-19 recovery program for patients hospitalized with SARS-CoV-2 infection in New York City: a prospective cohort study. PM R 2021; 13: 609-617.
https://doi.org/10.1002/pmrj.12578 DOI: https://doi.org/10.1002/pmrj.12578
Groah S, Pham C, Rounds A, Semel J. COVID patients benefit from inpatient rehabilitation. The Lancet is part of SSRN 2021; 3751322.
https://doi.org/10.2139/ssrn.3751322 DOI: https://doi.org/10.2139/ssrn.3751322
Patel N, Steinberg C, Patel R, Chomali C, Doulatani G, Lindsay L, et al. Description and functional outcomes of a novel interdisciplinary rehabilitation program for hospitalized patients with COVID-19. Am J Phys Med Rehabil 2021; 100: 1124.
https://doi.org/10.1097/PHM.0000000000001897 DOI: https://doi.org/10.1097/PHM.0000000000001897
Vickory F, Ridgeway K, Falvey J, Houwer B, Gunlikson J, Payne K, et al. Safety, feasibility, and outcomes of frequent, long-duration rehabilitation in an inpatient rehabilitation facility after prolonged hospitalization for severe COVID-19: an observational study. Phys Ther 2021; 101: 208.
https://doi.org/10.1093/ptj/pzab208 DOI: https://doi.org/10.1093/ptj/pzab208
Abramoff BA, Dillingham TR, Caldera FE, Ritchie MD, Pezzin LE. Inpatient rehabilitation outcomes after severe COVID-19 infections: a retrospective cohort study. Am J Phys Med Rehabil 2021; 100: 1109-1114.
https://doi.org/10.1097/PHM.0000000000001885 DOI: https://doi.org/10.1097/PHM.0000000000001885
Imamura M, Mirisola AR, Pretto LR, De Pretto LR, Alfieri FM, Delgado VR, et al. Rehabilitation of patients after COVID-19 recovery: an experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute. Clinics 2021; 76: e2804.
https://doi.org/10.6061/clinics/2021/e2804 DOI: https://doi.org/10.6061/clinics/2021/e2804
Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: a COVID-rehabilitation unit experience. PLoS One 2021; 16: e0246590.
https://doi.org/10.1371/journal.pone.0246590 DOI: https://doi.org/10.1371/journal.pone.0246590
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