Dataset Information

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

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.

SUBMITTER: Piquet V

PROVIDER: S-EPMC7857995 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

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

Piquet Violaine V Luczak Cédric C Seiler Fabien F Monaury Jordan J Martini Alexandre A Ward Anthony B AB Gracies Jean-Michel JM Motavasseli Damien D

Archives of physical medicine and rehabilitation 20210204 6

<h4>Objective</h4>To determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients.<h4>Design</h4>Retrospective chart review.<h4>Setting</h4>A newly created specialized rehabilitation unit in a tertiary care medical center.<h4>Participants</h4>Consecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation.<h4>Intervention</h4>Inpatient rehabilitation for postacute care COVID-19 patients.<h4>Main outcome measures</h4>Meas ...[more]

PMID: 33548208

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Project description:BackgroundThe time-course of the coronavirus disease 2019 (COVID-19) pandemic was characterized by subsequent waves identified by peaks of intensive care unit (ICU) admission rates. During these periods, progressive knowledge of the disease led to the development of specific therapeutic strategies. This retrospective study investigates whether this led to improvement in outcomes of COVID-19 patients admitted to ICU.MethodsOutcomes were evaluated in consecutive adult COVID-19 patients admitted to our ICU, divided into three waves based on the admission period: the first wave from February 25th, 2020, to July 6th, 2020; the second wave from September 20th, 2020, to February 13th, 2021; the third wave from February 14th, 2021 to April 30th, 2021. Differences were assessed comparing outcomes and by using different multivariable Cox models adjusted for variables related to outcome. Further sensitivity analysis was performed in patients undergoing invasive mechanical ventilation (IMV).ResultsOverall, 428 patients were included in the analysis: 102, 169, and 157 patients in the first, second, and third wave. The ICU and in-hospital crude mortalities were lower by 7% and 10% in the third wave compared to the other two waves (P>0.05). A higher number of ICU- and hospital-free days at day 90 was found in the third wave when compared to the other two waves (P=0.001). Overall, 62.6% underwent invasive ventilation, with decreasing requirement during the waves (P=0.002). The adjusted Cox model showed no difference in the hazard ratio (HR) for mortality among the waves. In the propensity-matched analysis the hospital mortality rate was reduced by 11% in the third wave (P=0.044).ConclusionsWith application of best practice as known by the time of the first three waves of the pandemic, our study failed to identify a significant improvement in mortality rate when comparing the different waves of the COVID-19 pandemic, notwithstanding, the sub-analyses showed a trend in mortality reduction in the third wave. Rather, our study identified a possible positive effect of dexamethasone on mortality rate reduction and the increased risk of death related to bacterial infections in the three waves.

Dataset Information

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

Objective

Design

Setting

Participants

Intervention

Main outcome measures

Results

Conclusions

Publications

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

Similar Datasets

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