Complete table: Rehabilitation and COVID-19: the Cochrane Rehabilitation rapid living systematic review

Last updated June 18, 2021

ID Update Author DOI Year Country Dates Aim of the study Study Design Type of rehabilitation service Research Question LFRI COVID-19 Phases Population N° of participants Clinical presentation Intervention Comparator Outcomes Adverse events Diagnostic test Sensitivity Specifity Types of validity Attributes of reliability Main findings
1 June Aoyagi Y 10.1007/s00455-020-10140-z 2020 Japan N/R To report the first case of a patient with oropharyngeal dysphagia associated with COVID-19 and discuss the potential underlying cause. Descriptive: Case Report Rehabilitation in acute care Epidemiology - Clinical presentation Digestive functions (b510) Acute COVID-19 patient with dysphagia 1 At admission: - sore throat, cough, and high fever 20 day from admission: - dysphagia - persistent taste impairment - aspiration pneumonia antibiotics, mechanical ventilation dysphagia rehabilitation program including tongue-hold swallow, tongue base exercise, Shaker exercise, and transcutaneous electrical sensory stimulation using interferential current N/A - NRRSv - NRRSp - mesopharyngeal peak pressure - mesopharyngeal contractile integral - SRI N/A N/A N/A N/A N/A N/A
  • The authors report the case of a 70-year-old male who developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19
  • Glossopharyngeal and vagal neuropathy is suggested as possibile cause of dysphagia on the basis of the concomitan disgeusia, mesopharyngeal contraction disfuncion and silent aspiration
  • The patient followed a dysphagia rehabilitation program including tongue-hold swallow, tongue base exercise, Shaker exercise, and transcutaneous electrical sensory stimulation using interferential current
  • At follow-up
    1. the normalized residue ratio scale for valleculae and for piriform sinuses were slightly decresed
    2. mesopharyngeal contractile ability and swallow risk index were improved
  • The authors stress the importance of presuming neurologic involvement and concurrent dysphagia and alert that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.
2 June Assini A 10.1007/s10072-020-04484-5 2020 Italy N/R To report two different clinical manifestations of COVID-19 related GBS; one is a GBS/MF overlap syndrome, the other one an Acute Motor Sensory Axonal Neuropathy (AMSAN) with massive vegetative impairment, both highly responsive to intravenous immunoglobulins. Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients 2 > Case 1: - at admission: severe respiratory syndrome preceded by anosmia and ageusia, fever, and cough - 20 day from admission: bilateral eyelid ptosis, dysphagia, and dysphonia, bilateral masseter weakness, tongue protrusion deficit, and hyporeflexia of upper and lower limbs (without muscle weakness) and deficit of elevation of the soft palate. > Case 2: - at admission: fever and cough - during hospitalization: acute weakness in lower limbs with distal distribution and foot drop on the right side associated with massive gastroplegia, paralytic ileus, and loss of blood pressure control hydroxychloroquine, antiretroviral therapy, and tocilizumab, intravenous immunoglobulins N/A case 1: swallowing, speech, and tongue motility and strength, as well as on eyelid ptosis case 2: vegetative symptomatology, osteotendinous hyporeflexia, right foot drop N/A N/A N/A N/A N/A N/A The first patient was a 55-year-old man hospitalized for severe respiratory syndrome due to COVID-19
  • 20 days after admission he rapidly developed impairment of several cranial nerves, a demyelinating peripheral neuropathy
  • The clinical presentation, CSF exam results and four limb electroneurography suggested an overlap of Miller-Fisher and Guillain-Barré syndrome
The second patient was a 60-year-old man hospitalized for severe respiratory syndrome due to COVID-19
  • At day three his respiratory functions worsened and he needed tracheostomy and assisted ventilation
  • 20 days after he presented acute massive impairment of the vegetative nervous system with Acute Motor Sensory Axonal Neuropathy (AMSAN), confirmed by electrophysiological studies
Both patients showed an excellent response to immunoglobulin treatment, that coupled with the absence of COVID in CSF suggested an immuno-mediated inflammatory nature of neuropathy
3 June Bao Y 10.1007/s42399-020-00315-y 2020 China February-March 2020 To report a case of COVID-19 complicated with cerebral hemorrhage and summarize the relevant treatment experience. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 Sudden disturbance of consciousness - Craniotomy - Antiviral treatment and COVID-19 convalved patient plasma infusion N/A Symptoms, dyspnea, body temperature N/A N/A N/A N/A N/A N/A
  • Case report of a 38-year-old man whose first symptom was cerebral hemorrhage.
  • After craniotomy, the patient had a high fever, chest CT showed pulmonary interstitial inflammation and he was tested for COVID-19: firstly, the results were negative, but a second test showed positive results and COVID-19 infection could be confirmed.
  • Antiviral treatment and COVID-19 convalved patient plasma were used: the symptoms improved, the body temperature decreased, and the dyspnea decreased. Two COVID-19 nucleic acid test (24h interval) were negative. Days after, the patients developed hyperthermia again
  • SARS-CoV-2 can damage the neurovascular system and cause bleeding, and it can be followed by multiple system failure.
4 June Bracaglia M 10.1007/s00415-020-10014-2 2020 Italy March 15th, 2020 To describe a case of COVID-19 presenting with acute demyelinating polyneuritis in absence of respiratory symptoms common to SARS-CoV-2 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 The patient reported hyposthenia in the four limbs (MRC scale of 1/5 in distal and 2/5 in proximal lower extremities and 3/5 in distal and 4/5 in proximal upper extremities), distal tingling sensation, pronounced lumbar pain for about eight days, tendon reflexes abolished, inability to walk, difficulty in swallowing and speeching. N/A N/A N/A N/A N/A N/A N/A N/A N/A The case highlights the chance that COVID-19 manifests with neurological symptoms in absence of any usual infectious manifestations (fever....) probably as part of a dysimmune process.
5 June Brugliera L 10.1038/s41430-020-0664-x 2020 Italy March - April 2020 To discuss the efficacy of an interdisciplinary management of nutrition for COVID-19 patients. Analytical: Cohort study N/A Micro - Interventions (efficacy/harms) Digestive functions (b510) Acute COVID-19 patients 32 Dependence for motor or respiratory functions at FIM assessment and risk of malnutrition Three-step nutritional protocol N/A Malnutrition Universal Screen Tool (MUST), Body Mass Index (BMI) N/A N/A N/A N/A N/A N/A Cohort study assessing the efficacy of a three-step nutritional protocol:
  1. Nutritional assessment and malnutrition screening in all patients;
  2. Nutritional treatment plan;
  3. Continuous monitoring of body weight, nutrition intake, blood tests, and clinical condition with variable frequency.
In 32 out of 50 hospitalized patients (FIM 76.6; 90% with dysphagia; 45% at high risk and 26% at moderate risk of malnutrition), malnutrition improved in 15.3%, BMI improved in 43.7%.
6 June de Lima MS 10.6061/clinics/2020/e2021 2020 Brazil N/R To investigate the incidence of dysphagia, its time course, and its association with clinically relevant outcomes in extubated critically ill patients with COVID-19, compared to data of non-COVID-19 patients who were also subjected to prolonged orotracheal intubation. Analytical: Case-control study N/A Epidemiology - Clinical presentation Digestive functions (b510) Acute COVID-19 patients referred for a bedside swallowing assessment 101 COVID-19 vs 150 controls COVID-19 patients subjected to orotracheal intubation, Glasgow Come Scale ≥ 14, stable medical respiratory condition Exposure to COVID-19 Not exposure to COVID-19 - American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing level scale [Level 1 – the individual is not able to swallow safely orally. Nutrition and hydration are received through non-oral means; Level 7 – an individual’s ability to eat independently is not limited by the swallow function. Swallowing would be safe and efficient for all consistencies. Compensatory strategies are effectively used when needed], within 24 hours after extubation and at ICU discharge. - Days of intubation - Sessions for dysphagia resolution N/A N/A N/A N/A N/A N/A
  • 101 ICU patients diagnosed with COVID-19 and subjected to orotracheal intubation (median age 53.4±15.9 yr) were assessed for dysphagia and compared with a confirmatory cohort of 150 critical (not COVID-19) ICU patients subjected to prolonged orotracheal intubation (≥ 48 hours) (median age 54.0±18.6 yr).
  • Patients with COVID-19 remained intubated for more days and had higher incidences of neurological disorders, diabetes and hypertension than critical ICU patients, who presented with more pulmonary disorders
  • Groups differed in terms of functional level of swallowing 24 hours after extubation (COVID-19 vs ICU patients: 19.8 % vs 40.0 % ASHA levels 1-3; 53.5 % vs 26.0 % ASHA level 4-5), dysphagia resolution at ICU discharge (70.3 % vs 52.0 % ASHA levels 6-7) and number of swallowing rehabilitation sessions until dysphagia resolution (2.9±1.7 vs 10.5±9.3 sessions) in favour of COVID-19 patients.
  • Patients with COVID-19 remained intubated longer and needed fewer swallowing rehabilitation sessions to return to safe oral feeding.
7 June Decavel P 10.1212/WNL.0000000000010011 2020 France March 20, 2020 To describe a case of Tapia syndrome after prolonged intubation due to severe COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Any other body structure and function-generic (s/b) Post-acute COVID-19 patient 1 The patient presented dysphonia and swallowing difficulties after removal of orotracheal intubation. N/A N/A N/A N/A N/A N/A N/A N/A N/A The paper describe a case of a 62-year-old patient that required ventilatory assistance for 16 days. After removal of orotracheal intubation, the patient presented dysphonia and swallowing difficulties. Neurological evaluation and nasofybroscopy revelead a paralysis of left hypoglossal and vagus nerve. One month later the clinical status of the patient still was not improved.
8 June Efe IE 10.1016/j.wneu.2020.05.194 2020 Turkey N/R To present a patient with COVID-19-associated encephalitis mimicking a glial tumor Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 Headache, nausea, dizziness and drug-refractory seizures Left anterior temporal lobectomy N/A Neurologic symptoms N/A N/A N/A N/A N/A N/A
  • Case report of a 35-year-old woman with COVID-19-associated encephalitis mimicking a glial tumor.
  • Left anterior temporal lobectomy was performed due to unsatisfactory seizure control and clinical and radiological findings.
  • After surgery, the patient was tested positive for COVID-19 and referred to a designated infectious diseases clinic.
  • This case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors.
9 June Garg A 10.7759/cureus.8847 2020 USA N/R To describe a case of COVID-19 infection with delayed thromboembolic complication on Warfarin Descriptive: Case Report N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 1 One month after recovering from COVID-19 pneumonia he referred worsening shortness of breath and cough N/A N/A N/A N/A N/A N/A N/A N/A N/A This case highlights the risk of delayed thromboembolic complications (a month after recovering from pneumonia) in patients with COVID-19 and the need to identify and monitor the patients with a higher risk of thromboembolism ( those with underlying comorbid conditions that may require anticoagulation for a longer duration)
10 June Grimaud M 10.1186/s13613-020-00690-8 2020 France April 15th - 27th, 2020 To describe the characteristics, management and time course of 20 critically ill children admitted to the PICU with cardiogenic shock secondary to acute myocarditis and suspected SARS-CoV-2 infection. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Cardiovascular functions (Heart b410) Acute Critically ill children patients with suspected COVID-19 infection 20 Hypotensive shock, abdominal pain, vomiting, fever, acute myocarditis and arterial hypotension with mainly vasoplegic clinical presentation Exposure to COVID-19 N/A Clinical, biological and hemodynamic characteristics N/A N/A N/A N/A N/A N/A
  • 20 critically ill children admitted with hypotensive shock and fever to 4 academic tertiary care centers in Paris.
  • All the children were hypotensive and presented with a major systemic inflammation and an acute myocarditis.
  • Nineteen of the 20 patients had identified SARS-CoV-2 infection on PCR (n= 12) and/or by serology (n= 15).
  • All children but one needed an inotropic/vasoactive drug support and 8 were intubated.
  • All children survived and were discharged from the PICU with full left ventricular systolic function recovery and a substantial decrease of inflammatory biomarkers.
  • Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease is an emerging severe pediatric disease following SARS-CoV-2 infection
11 June Gutierrez-Ortiz C 10.1212/WNL.0000000000009619 2020 Spain N/R To report two COVID-19 patients presenting with Miller Fisher syndrome and polyneuritis cranialis, respectively. Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 patients 2 Patient 1: 50-year-old man presenting with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation and positive testing for GD1b-IgG antibodies. Patient 2: 39-year-old man presenting with ageusia, bilateral abducens palsy, areflexia and albuminocytologic dissociation. Patient 1: treated with intravenous immunoglobulin. Patient 2: treated with acetaminophen. N/A N/A N/A N/A N/A N/A N/A N/A These 2 cases highlight the occurrence of Miller Fisher syndrome and polyneuritis cranialis in COVID-19 patients. Neurological manifestations might occur because of an aberrant immune response to COVID-19
12 June Heman-Ackah SM 10.1093/neuros/nyaa198 2020 USA N/R To describe 2 patients who required ECMO for refractory hypoxia secondary to COVID-19 and developed neurologically devastating intraparenchymal hemorrhage (IPH) despite lacking the classical risk factors. Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 2 - Case 1: at admission: cough, fever, and shortness of breath acute event: nonreactive right pupil - Case 2: at admission: cough, fever, and shortness of breath acute event: fixed and dilated left pupil Case 1: intubation, ECMO, prone positioning, heparine Case2: intubation, ECMO, heparine N/A N/A N/A N/A N/A N/A N/A N/A
  • 2 patients who required ECMO for refractory hypoxia secondary to COVID-19 developed devastating intraparenchymal hemorrhage despite lacking the classical risk factors.
  • It is suggested that the microvascular thrombosis observed as a precipitator of COVID-19 respiratory pathology may underlie ischemia and subsequent hemorrhage in these patients. Moreover, the COVID-19 might cause cytokine storm resulting in platelet dysfunction.
  • The authors propose the use of head CT to identify neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.
13 June Iaccarino MA 10.1097/PHM.0000000000001502 2020 USA N/R To report the neurological symptoms associated with COVID-19 in hospitalized patients Descriptive: Historical cohort N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 214 Approximately one-third (36.4%) of patients had neurological manifestation of the disease. Of those with neurological manifestations, 67.9% had central nervous system symptoms, most commonly dizziness (46.2%) and headache (35.8%), and 24.4% had peripheral nervous system manifestations including impaired taste (15.4%) and smell (14.1%). Other notable manifestations included stroke (n=6) and altered mental status (n=16). Reporting prevalence of neurological clinical manifestations N/A N/A N/A N/A N/A N/A N/A N/A Approximately one-third of hospitalized patients with COVID-19 displayed neurological signs or symptoms, including a small subset of patients for which stroke-like symptoms were the primary presentation of infection.
14 June Iannaccone S 10.2340/16501977-2704. 2020 Italy 2 months of 2020 To describe the organizational needs and operational costs of COVID-19 rehabilitation units, by comparing its activity, organization, and costs with 2 other functional rehabilitation units (Cardiologic and the Motor Rehabilitation) Analytical: Case-control study Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A The COVID-19 Rehabilitation Unit had the same number of care beds as the Cardiac and Motor Rehabilitation Units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs.
15 June Kishfy L 10.1016/j.jns.2020.116943 2020 USA April 2020 To present the first case series of posterior reversible encephalopathy syndrome (PRES) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 2 Patients diagnosed with COVID-19 requiring mechanical ventilation due to acute hypoxic respiratory failure N/A N/A N/A N/A N/A N/A N/A N/A N/A
  • This report describes a case series of two patients with SARS-CoV-2 infection associated with posterior reversible encephalopathy syndrome (PRES), providing further evidence of the diverse neurological complications potentially associated with COVID-19
  • The authors advocate for tight blood pressure control in all COVID-19 patients as they may be at more risk for sequelae of hypertensive encephalopathy, which may be an unrealized contributory factor to the prolonged ventilation times observed in severe COVID-19
16 June Landes SD 10.1016/j.dhjo.2020.100969 2020 USA (New York State) Beginning of the pandemic through May 28, 2020 To describe COVID-19 outcomes among people with intellectual and developmental disabilities (IDD) living in residential groups homes in the state of New York and the general population of New York State. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) N/A COVID 19 patients with or without intellectual and developmental disabilities 1,602 people with IDD living in residential group homes versus 371,559 people without IDD N/A N/A N/A COVID-19 incidence COVID-19 case fatality N/A N/A N/A N/A N/A N/A COVID-19 case rate per 100000 is 7,841 for people with IDD compared to 1,910 for people without IDD; case fatality is 15.0% for people with IDD compared to 7.9% for people without IDD; mortality rate per 100,000 is 1,175 for people with IDD compared to 151 for people without IDD. COVID-19 appears to present a greater risk to people with IDD, especially those living in congregate settings.
17 June Liu K 10.1016/j.ctcp.2020.101166 2020 China Patient enrolment: January 1st to February 6th, 2020 To investigate the effects of respiratory rehabilitation on respiratory function, ADL, QoL, and psychological status in elderly patients with COVID-19 who were discharged from the hospital with satisfying results. Randomised controlled trial Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute Elderly patients with COVID-19 76 N/A (1) respiratory muscle training; (2) cough exercise; (3) diaphragmatic training; (4) stretching exercise; and (5) home exercise NR Primary: Respiratory function Secondary: Exercise endurance (6-min walk distance), ADL and QoL, psychological status assessment (anxiety, depression scores). N/A N/A N/A N/A N/A N/A
  • RCT of respiratory rehabilitation (36 cases) vs no treatment (36 cases)
  • Intervention:
    1. respiratory muscle training;
    2. cough exercise;
    3. diaphragmatic training;
    4. stretching exercise; and
    5. home exercise.
  • Respiratory training included 2 sessions/week for 6 weeks, each session lasting 10 min.
  • Significant increase in pulmonary function tests, 6 MWT, SF36 score and anxiety score, in the intervention group compared to controls
18 June Mo X 10.1183/13993003.01217-2020 2020 China Patient enrolment: February 5th to March 17th To describe the characteristics of pulmonary function in COVID-19 survivors after discharge from hospital Descriptive Study - Retrospective uncontrolled cohort N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 110 - mild illness: mild symptoms without radiographic appearance of pneumonia - pneumonia: having symptoms and the radiographic evidence of pneumonia, with no requirement for supplemental oxygen - severe pneumonia: having pneumonia, including one of the following: respiratory rate > 30 breaths/minute; severe respiratory distress; or SpO2 ≤ 93% on room air at rest COVID-19 N/A - SpO2% on room air - Spirometry:TLC%, FVC%, FEV1, FEV1/FVC - DLCO% - DLCO/VA N/A N/A N/A N/A N/A N/A
  • The first and second most common abnormalities of lung function in patient dischargerd after hospitalization for COVID-19 are:
    1. diffusion capacity
    2. restrictive ventilatory defect
  • both are linked to the severity of the disease
  • Follow-up of selected survivors - parcticularly those recovered from a severe form - should comprehend pulmonary function test (spirometry and diffusion capacity)
  • Pulmonary rehabilitation might be considered as an optional strategy
19 June Mukaino M 10.1097/PHM.0000000000001441 2020 Japan N/R To describe a preliminary attempt to use a telerehabilitation system to deliver exercise opportunities to individuals isolated because of SARS-CoV-2 infection. Descriptive: Case Series Rehabilitation in acute care Meso Level Products and technology (Products for communication e125) Acute Patients in need of rehabilitation 4 NR telerehabilitation N/A - satisfaction, - whether the patients felt it meaningful for their health to participate in the program - whether they would recommend this exercise to others No adverse events N/A N/A N/A N/A N/A
  • 4 patients underwent telerehabilitation using a tablet while in communication with the physical therapy and being monitored with a pulse oximeter.
  • Patients were overall satisfied with the exercise program (NRS ranged from 8 to 10 with a median of 10), felt meaningful for their health to participate in the program (range 7 to 10, median 10), and they would recommend this exercise to others (range 8 to 10, median 10).
20 June Novi G 10.1212/NXI.0000000000000797 2020 Italy N/R To report on a COVID-19 case presenting with ADEM, preceded by an influenza-like syndrome Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 patient 1 Before admission: influenza-like syndrome, anosmia and ageusia At admission: - mild behavioral abnormalities (irritability) - headache - bilateral relative afferent pupillary defect - ageusia and anosmia - severe visual loss - right abdominal sensory level - left-sided lower limb hyper-reflexia with positive Babinski sign - high-dose steroids (IV methylprednisolone 1 g/d for 5 days tapered with oral prednisone 75mg/d) associated with - IV immunoglobulins (2 g/kg in 5 T8days) N/A - Vision - Visual-evoked potential - MRI Gd-enhancing lesions. N/A N/A N/A N/A N/A N/A
  • The patient was a 64-year-old woman with a history of vitiligo, hypertension, and monoclonal gammopathy of undetermined significance who developed an influenza-like syndrome in mid- March 2020, 2 weeks before she reached emergency department due to worsening visual symptoms
  • She underwent a brain and spine MRI scan and a lumbar puncure
  • PCR for COVID-19 tested negative on nasal swab and positive on CSF, her serum was positive for anti-SARS-CoV-2 IgG
  • ADEM disease was suspected on these findings, high-dose of steroids were administered and the patient reported significant improvements in visual symptoms
  • The authors stress the importance of being aware of the possible autoimmune neurologic complications in COVID-19, whose prompt recognition and treatment is needed to reduce permanent neurological disability
21 June Pancera S 10.1097/HCR.0000000000000529 2020 Italy March 27th - April 21st, 2020 To describe the respiratory rehabilitation program in a patient with severe COVID-19, referred to a tertiary subacute rehabilitation center Descriptive: Case Report Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 1 Barthel index based on dyspnea: 61/100; EuroQol questionnaire—5 dimensions, 3 levels: 12/15; Short Physical Performance Battery= 0/12 COVID-19 ward: Early mobilization; Leg/arm cranking; neuromuscular electrical stimulation; seat-to-stand training; Walking training; Weaning from mechanical ventilation. COVID-19 free ward: Aerobic training (cycle ergometer); Resistance training (elastic bands/free weights); Stair climbing. N/A BI, Barthel index; BID, Barthel index based on dyspnea; EQ-5D-3L, EuroQol questionnaire—5 dimensions, 3 levels; MRC sum score, Medical Research Council sum score; Q girth, quadriceps size (taken 10 cm above patella); SPPB, Short Physical Performance Battery; N/A N/A N/A N/A N/A N/A A 51-year-old man with acute respiratory distress syndrome (ARDS) related to coronavirus disease-2019 (COVID-19) infection. The patient achieved autonomous walking within 1 week from intensive care unit (ICU) discharge. After 38 days of hospitalization , the patient recovered muscle function and increased quadriceps size (13%). Maximal inspiratory pressure and maximal expiratory pressure results showed a 7% improvement.
22 June Patelli G 10.1016/j.ejrad.2020.109121 2020 Italy April 15th-30th, 2020 To review lung CT findings and report the preliminary results in relation to lung perfusion conditions more than one month after remission of the symptoms Analytical: Case-control study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 20 + 4 controls Patients observed 40 +/- 13 days after fever resolution, in the phase where they were asymptomatic or slightly dyspnoic and with negative swab Exposure to COVID-19 Not exposure to COVID-19 Volume of low perfusion tissue at chest CT N/A N/A N/A N/A N/A N/A
  • Out of 20 COVID-19 patients, with negative swab, only 8 reported residual dyspnea, 3 of whom with minimal effort.
  • Persistent dyspnea was not associated with signs of interstitial pneumonia.
  • Five patients underwent angioCT with contrast media whose findings were compared with those of 4 patients not affected by COVID-19: hypoperfused lung volume ranged from 21.0% % to 48.4 %, in COVID-19 patients with dyspnea, compared to 8.5 % in patients not affected by COVID-19
  • In COVID-19 patients who are still dyspnoic one month after remission from fever, extended hypoperfused areas of lung parenchyma are still present, despite the absence of residual pulmonary fibrous stripes. CT should be used to quantify the presence of lung perfusion dysfunction during the recovery phase of COVID-19
23 June Pattanakuhar S 10.1097/phm.0000000000001485 2020 Thailand N/R To present a patient with cervical traumatic SCI who developed COVID-19 in the acute phase and to describe the consequences at the individual and service level Descriptive: Case Report Specialized postacute rehabilitation Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute SCI patient developing COVID-19 1 At admission: - weakness and numbness of upper and lower extremities bilaterally - grade 5 of biceps brachialis and grade 0 of all muscles below the C5 myotome of both sides - absent deep anal pressure and voluntary anal contraction - absent anal and bulbocavernosus reflexes At day 4: - 39°C fever, with mild dyspnea - anterior cervical discectomy, and fusion with plates and screws and iliac bone grafting - Daily subcutaneous injection of 0.6 ml (60 mg) of enoxaparin - rehabilitation program: range of motion and isometric strengthening exercises of bilateral elbow flexors - hydroxychloroquine and azithromycin - lopinavir/ritonavir - oxygen therapy N/A - SaO2 - body temperature - heart rate - blood pressure N/A N/A N/A N/A N/A N/A
  • The patient was a 28-year-old admitted after a motorcycle accident and diagnosed with C5-6 burst fracture with SCI resulting in complete C5 tetraplegia AIS A
  • COVID-19 screening consisted in history of exposure and symptoms and ruled out the suspicion of infection
  • On day 4 he was found positive to SARS-CoV-2, on day 6 he was diagnosed with a mild degree of COVID-19 pneumonia, the patient died on day 10 and cause of death remains uncertain
  • 104 hospital personnel were quarantined after close contact with the patient
  • The authors present four issues related to the case and suggest that:
    1. patients with SCI and concomitant COVID-19 might be at a higher risk of developing venous thromboembolism, including pulmonary embolism
    2. COVID-19 patients with cervical cord injury might develop dyspnea and respiratory failure earlier than those without SCI
    3. all SCI patients eligible for surgical and rehabilitation therapy should be screened for COVID-19 and rehabilitative personnel should use PPE
    4. rehabilitation management should be reorganized during the epidemic, social distancing policies should be implemented for in-person rehabilitation and alternative methods, such as telerehabilitation, should be adopted whenever possible
24 June Poussardin C 10.1016/j.accpm.2020.06.002 2020 France February 24th - April 15th, 2020 To provide an immediate feedback on a specialised ICU, allowing to increase knowledge and understanding of follow-up care requirements Analytical: Cross-sectional study N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 51 48/51 (94%) patients reported severe respiratory symptoms: 39/51 (76%) required orotracheal intubation and 9/51 (18%) tracheotomy. 13/51 patients (26%) exhibited neurologic disorders. Reporting prevalence of clinical manifestations in COVID-19 patients admitted to the ICU N/A N/A N/A N/A N/A N/A N/A N/A The authors estimated that among the 51 patients, 5 (11%) patients will die within the ICU. If the 46 remaining patients should be weaned from ICU life support, 5 patients will need active post-resuscitation care (APRC) and 45 follow-up care. From the hospital perspective, it was estimated that 14 patients will need APRC and 205 follow-up care. From a population-based perspective, it was estimated that the need for APRC and follow-up care were respectively four and 40 per 100 000 inhabitants. Therefore, this study provides immediate patients’ characteristics and a first rough estimation of requirements for COVID-19 post-resuscitation care.
25 June Prada V 10.1097/MRR.0000000000000418 2020 Italy March 2020 To describe the case of a patient with Charcot-Marie -Tooth who developed COVID-19 during the rehabilitation following tendon transfer surgery and was managed postoperatively by telemedicine. Descriptive: Case Report Rehabilitation services at home Meso Level Products and technology (Products for communication e125) Post-acute Charcot-Marie-Tooth patient developing COVID-19 1 Headache, constant leg pain, and fever Eight telerehabilitation sessions N/A Thumb Opposition Test, ad-hoc developed dexterity tests N/A N/A N/A N/A N/A N/A
  • A 28-year old male with Charcot-Marie-Tooth underwent a tendon transfer surgery in the left hand.
  • He developed COVID-19 during the rehabilitation period, 3 months after surgery.
  • To accomplish rehabilitation goals, the patient underwent 8 telerehabilitation sessions in the following month.
  • Thanks to telerehabilitation, the recovery process did not cause any appreciable setback.
26 June Righi G 10.1038/s41394-020-0274-9 2020 Italy N/A To present the clinical manifestation of COVID-19 in a person affected by tetraplegia. Descriptive: Case Report N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Acute Tetraplegia patient developing COVID-19 1 - AIS A C4 tetraplegia since 2013 - Fever - mild dyspnea - home therapy: oxybutynin, rivaroxaban, gabapentin, tramadol - before admission: trimethoprim/sulfamethoxazole - during hospital stay: various broad spectrum antibiotics, Furosemide, manually assisted cough, low-dose oxygen therapy Lopinavir/Ritonavir, hydroxychloroquine N/A - fever - arterial blood gas - nasopharyngeal swabs for the detection of SARS-CoV-2 N/A N/A N/A N/A N/A N/A
  • Case report of a 56-year-old tetraplegic male developing COVID-19.
  • The patient never exhibited coughing, and did not develop severe symptomatology, in spite of its disability
27 June Simonelli C 10.4081/monaldi.2020.1085 2020 Italy March 14th - April 14th 2020 To describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) Service during the COVID-19 emergency in an Italian rehabilitation hospital, with focus on the Respiratory Physiotherapist Therapists’ (RPTs) role Descriptive Study - Retrospective uncontrolled cohort Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients 170 Moderate/severe impairment of motor functional capacity with a SPPB 3 (0-7) points out of 12 Organizational plan: general new hospital organization, role of RPTs, the number of all tasks performed by the RPTs during a typical working day, as well as the percentage of patients who needed a specific performance N/A N/A N/A N/A N/A N/A N/A N/A
  • COVID-19 care team developed based on a multidisciplinary panel of physicians, nurses, and RPTs to manage 90 beds for post acute patients with COVID-19
  • >RPTs tasks are: oxygen therapy daily monitoring, non invasive ventilation and CPAP delivery, pronation and postural changes, reconditioning exercises, functional assessments.
  • Three “what-to-do” algorithms guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity.
  • 170 patients treated in 1 month, with RPTs managing oxygen therapy (in a third of cases), reconditioning (60% of the cases), and initial and final functional motor capacity assessment in all subjects.
28 June Su XW 10.1002/mus.26988 2020 USA N/R To describe a patient who developed quadriplegic GBS with dysautonomia preceded by mild COVID-19–induced diarrhea. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 - 7 days before admission: mild diarrhea, anorexia, and chills, without fever or respiratory symptoms - at admission: Quadriplegic Guillain-Barré syndrome with dysautonomia and syndrome of inappropriate antidiuretic hormone secretion - mechanical ventilation - sulfamethoxazole-trimethoprim N/A - strength and extremities strength - nerve conduction studies - blood electrolytes N/A N/A N/A N/A N/A N/A
  • The patient was a 72-year-old male that suffered from mild COVID-19-induced diarrhea.
  • He rapidly evolved in quadriplegic Guillain-Barré syndrome with dysautonomia and syndrome of inappropriate antidiuretic hormone secretion.
  • Patient with Guillain-Barré syndrome should be tested for COVID-19
29 June Tatu L 10.1007/s00415-020-10005-3 2020 France - Switzerland From March to April 2020 To report an unusually high number of cases with diagnosis of Guillain–Barré syndrome during COVID-19 pandemic Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) N/A Patients with diagnosis of Guillain–Barré syndrome with negative findings on SARS-CoV-2 nasopharyngeal swab and SARSCoV-2 serology 6 All 6 patients reported paresthesia. 4 patients reported paraparesis. 2 patients reported tetraparesis. 4 patients reported ataxia. 1 reported facial paralisis. Reporting clinical manifestations of 6 patients with diagnosis of Guillain–Barré syndrome during COVID-19 pandemic in a Neurologic Unit N/A N/A N/A N/A N/A N/A N/A N/A Patient 3 had an acute motor-sensory axonal neuropathy; acute inflammatory demyelinating polyneuropathy (AIDP) was found in the other 5 patients. The neurological progression was favorable in 5 cases. Two patients (patients 1 and 2) relapsed, one of whom died from a severe acute respiratory syndrome.
30 June Tunç A 10.1016/j.jocn.2020.05.018 2020 Turkey Up to April 14th, 2020 To describe a series of simultanously diagnosed COVID-19 and acute ischemic stroke Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients 4 Case 1 presented left facial paresis, dysarthria, left hemiparesis (NIHSS: 16), high fever, and cough. Case 2 suffered from dysarthria and right hemiparesis (NIHSS: 5), intermittent fever, and upper respiratory tract symptoms. Case 3 reported loss of consciousness, dysarthria, right hemiparesis ( NIHSS: 10), and mild cough. Case 4 left hemi-hypoesthesia with mild ataxia ( NIHSS: 2), fever, cough and shortness of breath. N/A N/A N/A N/A N/A N/A N/A N/A N/A Ischemic stroke may simultaneously develop in the course of Covid-19 independently of the critical disease process. In this study the average of time from Covid-19 onset to the diagnosis of ischemic stroke was 2 days (no cardioembolic type)
31 June Vitale JA 10.1080/07420528.2020.1775241 2020 Italy April 27th - May 12th, 2020 To describe the quality of sleep of four COVID-19 recovered patients during the sub-acute stage of the disease Descriptive: Case Series Rehabilitation in acute care Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 patients 4 Patient 1: able to walk autonomously without aid; Patient 2: able to walk autonomously without aid; Patient 3: able to walk autonomously using a single crutch; Patient 4: not able to stand up or walk autonomously. Wearing an actigraph around the clock and completing a daily sleep diary to record bedtime, get-up time, and the spans of the day and night when the actigraph was not worn. Furthermore, the 4 patients underwent functional evaluation tests N/A Sleep parameters (time in bed, total sleep time, sleep efficiency, sleep latency, wake after sleep onset, immobility time, fragmentation index), assessed through an actigraph on the wrist of the non-dominant hand; the Pittsburgh Sleep Quality Index (PSQI); 30 s Sit-To-Stand Test (STST) and Timed Up and Go Test (TUG) N/A N/A N/A N/A N/A N/A The mean sleep duration was 6.3 hours, indicating an insufficient sleep duration that could be partially attributed to the forced early awakening. Three out of four subjects were able to perform functional tests. These preliminary data suggest that functional recovery could not be considered as directly linked to sleep quality
32 June Wang X 10.1093/qjmed/hcaa178 2020 China February 3rd - 21st, 2020 To track the course of clinical outcomes of COVID-19 patients after discharge, and the transmission risk during the observation period, therefore to make improvement on post-discharge management if necessary. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 131 On discharge, 78 of the 131 (59.54%) patients had no symptoms. However, 38 (29.01%) patients had cough, 10 (7.63%) had fatigue, 8 (6.11%) had expectoration, 8 (6.11%) had chest tightness, 5 (3.82%) had dyspnea, 4 (3.05%) had chest pain, 2 (1.53%) had dizziness and 2 (1.53%) had palpitation. Other rare symptoms, including pharyngeal pain, nausea, inappetence and vomiting were presented in 1 (0.76%) patient, respectively Exposure to COVID-19 N/A Information regarding symptoms and treatment post hospitalization (detailed treatment of oxygen therapy and medicines), reexamined outcomes, distribution of quarantine locations and close contact history after discharge N/A N/A N/A N/A N/A N/A
  • Out of 131 patients, 40.05% cases still had symptomatology at discharge, with the most represented symptom being cough (29.01%), followed by fatigue (7.63%), expectoration (6.11%), chest tightness (6.11%), dyspnea (3.82%), chest pain (3.05%), and palpitation (1.53%).
  • In the third and fourth weeks only 18 patients had one or more symptoms.
  • 8 patients still tested positive for SARS-CoV-2 after discharge.
  • Considerate self-quarantine and close follow-up of patients are required after discharge.
33 June You J 10.1016/j.jinf.2020.06.003 2020 China March 26th - May 1st, 2020 To report the pulmonary function and chest CT changes in COVID-19 patients after discharge Descriptive Study - Retrospective uncontrolled cohort N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 18 N/A Spirometry Lung CT at 40 +/- 11 days of hospital discharge N/A All spirometry parameters of ventilation function Lung CT features N/A N/A N/A N/A N/A N/A COVID-19 survivors after discharge may report persistent restrictive ventilatory defect and small airway function impairment, regardless of their disease severity. So a long-term follow-up of lung function after discharge should be performed in clinical practice to provide a guideline for pulmonary rehabilitation.
34 June Zanin L 10.1007/s00701-020-04374-x 2020 Italy N/R To describe the case of a COVID-19 patient presenting with neurological symptoms associated with demyelinating brain lesions. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 - at admission: GCS of 12 (E3 M6 V3), anosmia and ageusia, interstitial pneumonia - during hospital stay: seizures - Antiretroviral, hydroxychloroquine - lacosamide, levetiracetam, phenytoin - mechanical ventilation - High-dose steroid treatment N/A - pulmonary impairment - sensorimotor deficits N/A N/A N/A N/A N/A N/A
  • The authors describe the case of a 54-year-old female, who complained of anosmia and ageusia for several days before severe COVID-19 onset.
  • She needed mechanical ventilation and during intubation presented two episodes of seizures.
  • While head CT scan was negative, MRI showed demyelinating lesions of the periventricular white matter, at the bulbo-medullary junction and at the cervical and dorsal spinal cord.
  • The authors conclude that neurological impairment during COVID-19 acute phase and seizures could be attributed to demyelinating lesions.
35 June Zheng Z 10.1002/jmv.26040 2020 China February 2020 To introduce the authors' experience in treating two COVID-19 cases by ozone therapy Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 patients 4 Fever, dyspnea, headache, runny nose, fatigue, loss of appetite, cough, sore throat, altered laboratory and imaging findings Ozone therapy - Major Autohemotherapy (MAH) for seven consecutive days N/A Symptoms, laboratory indicators, chest imaging N/A N/A N/A N/A N/A N/A Two COVID-19 patients who underwent ozone therapy MAH for seven days showed fast recovery of symptoms and normal range of laboratory indicators.
36 June Zheng QN 10.1017/dmp.2020.214 2020 China January -February 2020 To develop a model able to predict the length of rehabilitation from the analysis of clinical risk factors Descriptive Study - Retrospective uncontrolled cohort Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients 90 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A The authors developed, through multivariate stepwise linear regression, a model to predict lenght of stay of post-acute mild COVID-19 patients in an inpatient rehabilitation setting. The five parameters included in the model were white blood count, partial pressure of carbon dioxide, serum potassium, total bilirubin and aspartate aminotransaminase.
37 July Burns SP 10.1038/s41393-020-0529-0 2020 USA March 9th - June 30th, 2020 To describe case fatality of COVID-19 infection in Veterans with SCI/D Analytical: Cohort study Specialized postacute rehabilitation Epidemiology - Prevalence N/A Acute, post-acute, late-onset, or permanent on a pre-existing health condition Veterans with SCI/D with diagnosis of COVID-19 140 N/R N/A Veterans with SCI/D without diagnosis fo COVID-19 Case fatality rate N/A N/A N/A N/A N/A N/A The SCI/D Veteran case fatality rate with COVID-19 was 19%; it was 2.4 times the rate observed in the non-SCI/D Veteran population with an absolute rate that is 11% greater (95% CI: 5–19%; Z score = 4.8; p < 0.0002).
38 July Curci C 10.23736/S1973-9087.20.06339-X 2020 Italy March 10th - April 15th, 2020 To characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to a Rehabilitation Unit. Analytical: Cross-sectional study Specialized postacute rehabilitation Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 32 Most patients needed respiratory supports (mainly nasal cannula and Venturi Mask) with a sustained FiO2 to maintain a good peripheral oxygen saturation. Moreover, the majority was bedridden and suffered from dyspnoea and shortness of breath even for minimal activities N/A N/A N/A N/A N/A N/A N/A N/A N/A
  • Pulmonary function: 13 of them had FiO2 ≥ 40% <60% (mean 51.7 ± 14.0 %), 19 FiO2 ≥ 21% <40% (mean 26.7±4.5 %). Patients with lower FiO2 showed lower PaO2 values and a lower PaO2/FIO2 ratio.
  • Disability status: BI was 45.2±27.6, the patients with higher FIO2 showed lower values: 39.6 ± 25.7 vs 53.3 ± 29.3. All patients had grade 4 or 5 on the mMRC Dyspnoea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
  • Post-acute COVID-19 patients suffered from dyspnoea and shortness of breath even for minimal activities, with a resulting severe disability.
  • An early rehabilitation protocol was adapted to the two subgroups according to the baseline conditions of the patients.
39 July Di Stefano V 10.1007/s00415-020-10064-6 2020 Italy April 20th - May 4th, 2020 To quantify the reduction of PA in patients with NMD due to lockdown, and its impact on quality of life Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Patients with pre-existing NMD and healthy age-matched controls NMD group= 149; healthy controls= 119 N/A N/A N/A Levels of PA measured by IPAQ-SF as energy expenditure (MET–minutes/week), both before and in the last 7 days of the quarantine. The distribution of MET was calculated for different levels of PA intensity (vigorous-intensity PA; moderate-intensity PA; moderate-to-vigorous PA; walking activity) in all subjects. SF-12 was also administered by telephone to NMD group . N/A N/A N/A N/A N/A N/A In healthy controls, a significant reduction of PA was reported during quarantine compared to before quarantine for vigorous-intensity, moderate-intensity and moderate-to-vigorous intensity and total PA levels, and for walking activity. In NMD, a significant reduction of PA was reported for walking activity, moderate-to-vigorous and total PA levels, while no difference was found for vigorous-intensity and moderate-intensity PA. Furthermore, NMD showed reduced scores for SF12.
40 July Diaz-Segarra N 10.1097/PHM.0000000000001532 2020 USA N/R To report clinical findings of four COVID-19 patients that developed acute ischemic stroke Descriptive: Case Series Rehabilitation in acute care Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients 4 Patient 1: Dysarthria; left hemiparesis, and reduced LOC + cough, fever, chills; deceased on day 3; Patient 2: Aphasia, facial droop; right hemiparesis, sensory deficit, complete hemianopsia + None symptoms of COVID-19; discharged home on day 9; Patient 3: Reduced LOC + Shortness of breath, fevers; ARDS; sepsis, MOF, deceased on day 42; Patient 4: Reduced LOC + Cough, SOB, diarrhea; ARDS, sepsis, MOF, discharged to rehabilitation on day 29. Patient 1: Mechanical thrombectomy, aspirin; Patient 2: IV t-PA, mechanical thrombectomy, aspirin; Patient 3: Aspirin; Patient 4: Aspirin N/A N/A N/A N/A N/A N/A N/A N/A This case series highlights that COVID-19 ischemic strokes had a heterogeneuos clinical presentation with an unknown duration of the COVID-19 related prothrombotic state. Therefore, the authors concluded that the physiatric awareness of this prothrombotic state is mandatory, taking into account the increased incidence of ischemic strokes in COVID-19 patients referred to rehabilitation units.
41 July Gualtieri P 10.3390/ijms21134670 2020 Italy March 19th - April 27th, 2020 To evaluate the differences in body composition during a ICU hospitalization in overall, lean, and obese COVID-19 patients. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute COVID19 patients 30 (13 lean and 17 obese patients) N/R Chest CT within 24 hours and about 20 days later N/A Differences in body composition and liver composition during ICU hospitalization (assessed by chest CT) N/A N/A N/A N/A N/A N/A Subscapular thickness, suprailiac thickness, sum thickness, body density, FM%, and waist circumference were statically increased in the obese group compared to the lean group. Liver attenuation and liver/spleen ratio were statistically reduced in the obese group compared to the lean group. These findings could be co-caused by COVID-19, prolonged bed rest, and a low-grade inflammation typical of obesity.
42 July Halpin SJ 10.1002/jmv.26368 2020 UK May-June 2020 To describe the symptoms and rehabilitation needs of COVID-19 patients after discharge Analytical: Cross-sectional study Rehabilitation services at home Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 4 weeks after hospital discharge 100 N/A Telephonic survey N/A Prevalence of post-discharge symptoms N/A N/A N/A N/A N/A N/A The most common symptom reported was fatigue (72% of post ICU patients; 60.3 % of hospitalized patients), followed by breathlessness (65.6% in ICU group; 42.6% in hospitalized group) and psychological distress (46.9% in ICU group; 23.5% in hospitalized group). There was a clinically significant drop in EQ5D in 68.8% participants in the ICU group and in 45.6% of participants in the ward group. The authors recommend planning rehabilitation services to manage these symptoms appropriately and maximise the functional return of COVID-19 survivors.
43 July Huang Y 10.1186/s12931-020-01429-6 2020 China N/R To investigate the influence of COVID-19 on lung function in early convalescence phase (at 30 days after discharged) Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 57 N/A N/A N/A Lung volumes (TLC), spirometry (FVC, FEV1), DLCO, ,respiratory muscle strength, 6-MWT and high resolution CT N/A N/A N/A N/A N/A N/A Out of 57 COVID-19 patients, 40 were non-severe and 17 were severe ones. Impaired diffusing-capacity, respiratory muscle strength decrease, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in the early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment (75.6% vs 42.5%) and encountered more TLC decrease and 6MWT decline. Tha authors showed that most of the COVID-19 patients had a pulmonary function impairment in early convalescence phase, concluding that there is a need of longer follow-up studies in COVID-19 patients to better investigate clinical outcomes (i.e. tendency of lung function and exercise tolerance) in recovered COVID-19 patients.
44 July Khalifa M 10.1093/jpids/piaa086 2020 Saudi Arabia From 10th of April, 2020 To report one of the first descriptions of GBS and COVID-19 association in a child Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 child developing GBS 1 After three weeks with mild febrile illness with mild respiratory manifestations and a persistent cough, a eleven-year-old boy presented with typical features of GBS and after five days a morbilliform skin rash over the palms of both hands. -intravenous immunoglobulin (IVIG) infusions at a dose of 1 gram/kg/day for two days. -paracetamol when needed (10mg/kg/dose) - hydroxychloroquine twice daily (6.5 MG/KG) for one day, and then (3.25 MG/KG) twice daily for seven days. -as thromboprophylaxis low molecular weight heparin (R/ Enoxaparin) was given s.c.20 IU once daily. N/A Neurological assessment N/A N/A N/A N/A N/A N/A This report describes an eleven-year-old boy, who presented with acute GBS, three weeks after a mild symptomatic respiratory illness (positive infection via nasopharyngeal RT-PCR). -Awareness of neuromuscular presentations also in children may have a guiding significance for the early detection of the combined or preceding infection with SARS-CoV-2
45 July Kirshblum SC 10.1002/pmrj.12454 2020 USA April 4th - 27th, 2020 To determine the prevalence of COVID-19 in asymptomatic individuals referred for admission to an inpatient rehabilitation facility in a high prevalence community setting Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Clinical presentation N/A Post-acute Patients admitted to an inpatient rehabilitation facility and presumed to be COVID-19 free 103 N/A N/A N/A Positivity at the reverse transcriptase-polymerase chain reaction SARS-COV-2 testing withing the first two weeks of admission N/A N/A N/A N/A N/A N/A Seven patients resulted positive at SARS-COV-2 testing at admission (6.8%). Two positive patients stayed asymptomatic while five developed symptoms in the next 5.2 days. Nine patients who tested negative were subsequently re-tested for developing symptoms compatible with COVID-19 infection, and five of them resulted positive. Overall, 12 patients (13.6%) resulted positive in the first 14 days of hospitalization. Screening for SARS-CoV-2 at the time of admission to an inpatient rehabilitation facility can identify pre-symptomatic or asymptomatic individuals, to determine their appropriate placement within a facility and using appropriate infection control practices. However, negative results do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.
46 July Krett JD 10.1016/j.jneuroim.2020.577326 2020 Canada N/R To report a critically ill man with a COVID-19-associated hemorrhagic encephalopathy Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 Cough and fatigue and after 2 days increasing confusion. -At Hospital admission, the patient was disoriented, agitated, without lateralizing neurological deficits. -13 days later, the patient was unresponsive and diffusely paretic. -2 months following admission, the patient gradually recovered. Mechanical ventilation, minimal vasopressor support, oral hydroxychloroquine, and neurorehabilitation N/A Neurological assessment, CSF analyses, brain MRI N/A N/A N/A N/A N/A N/A This case reports encephalopathy with multifocal cerebral hemorrhages in a COVID-19 patient with severe, otherwise unexplained cortical dysfunction.
SARS-CoV-2 RNA was not detected in cerebrospinal fluid (CSF) or blood. CSF analyses suggested a cytokine release syndrome. Two months following hospital admission, the patient gradually recovered. He was transferred to a neurorehabilitation unit with mild residual physical and cognitive impairments.
Awareness of this clinical entity may facilitate the identification of patients with a potentially remediable cause of encephalopathy in COVID-19.
47 July Kushlaf H 10.1002/mus.27020 2020 USA N/R To report the clinical course of a patient with myasthenia gravis who developed COVID-19 Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patient with myasthenia gravis developing COVID-19 1 The patient presented with fever and SOB Hydroxychloroquine for 5 days, tocilizumab, and IVIG 1 g/kg daily for two consecutive days. N/A N/A N/A N/A N/A N/A N/A N/A A 66-year-old woman, who was diagnosed with myastenia gravis at age 44, was intubated for hypoxemic respiratory failure and she also presented with hypotension and acute renal failure for which she was placed on continuous renal replacement therapy followed by intermittent emodialysis. After the COVID-19 treatament, she slowly improved and was extubated after 17 days then discharged to inpatient rehabilitation.
48 July Li Z 10.23736/S1973-9087.20.06298-X 2020 China February 29th - March 2nd, 2020 To collect the basic information, dysfunctions, and rehabilitation needs of hospitalized COVID-19 patients. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute Post-acute hospitalized COVID-19 patients 280 N/A A questionnaire that included demographic and clinical history of the patients, the awareness about rehabilitation and the willingness to do it, current dysfunctions they suffer from, and the specific needs for rehabilitation, was administered to all the patients included. N/A Awareness and willingness of rehabilitation; common dysfunctions; current rehabilitation needs N/A N/A N/A N/A The average Content Validity Index of the questionnaire was 0.958. Cronbach’s alpha was used to assess the internal consistency reliability, which was found to be 0.944 . N/A Patients were 51.8% male and 48.2% females. 64.2% of the patients were over 51 years of age, and only 9.3 % below 30 years of age. The most common physical dysfunctions reported by the patients were sleep disorders (63.6%), decreased activity endurance (61.4%), respiratory dysfunction (57.9%), loss of appetite (55.4%), and pain disorder (47.5%). Meanwhile, the most reported psychological dysfunctions were anxiety (62.1%), fear (50.0%), apathy (41.8%), depression (40.7%), and despair (32.5%). The patients felt a high demand for rehabilitation: the sum of the high need and need response with regard to exercise guidance, dietary instruction, and traditional Chinese medicine therapy, were 45.0%, 40.4%, and 39.6%, respectively
49 July Manganotti P 10.1002/jmv.26289 2020 Italy March-April 2020 To report a case series of 5 COVID-19 patients who developed GBS Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients developing GBS 5 Fever and cough, and a significant impairment of taste and smell in 4/5 patients. The patients developed progressive weakness of the upper and lower limbs, in a disto-proximal fashion with a latency ranging from 14 to 30 days. IVIG therapy was initiated in 4/5 patients at a dose of 0.4 gr/kg for 5 days. N/A N/A N/A N/A N/A N/A N/A N/A Four out 5 COVID-19 patients with GBS presented with a mild facial nerve involvement limited to the muscles of the lower face; in one patient, taste assessment showed right-sided ageusia of the tongue, ipsilateral to the mild facial palsy. The Authors report that peripheral nervous system involvement after COVID-19 might be successfully treated with IVIG, as showed in 4/5 patients, whose neurological symptoms partially resolved without any side effect.
50 July Ng JA 10.1093/ptj/pzaa124 2020 USA April - May, 2020 To describe the establishment, operation and evolution of a rehabilitation therapist staffed prone team. Descriptive: Historical cohort Rehabilitation in acute care Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 patients in need of prone positioning 934 N/A Position change by a prone team. N/A Number of position changes in a 7 weeks period, time spent for each position change, number of members of the team needed for each position change.  N/A N/A N/A N/A N/A N/A With the surge of ARDS cases due to COVID-19, the request for proning position increased exponentially. Given the possible side effect of prone positioning, and the complexity of the procedure, a team of rehabilitation therapists expert of mobilisation is needed to improve the outcome of patients. The team achieved during the pandemic the following numbers and goals. Total volume of requests to the prone team for position changes was 934. 70% of position changes involved 3 prone team members, 26% involved 2, 13% involved only 1 and 11% involved 4. The mean (SD) number of minutes for each position change was 20 (9.15) with a range of 5 to 80 minutes.
51 July Pfefferkorn T 10.1007/s00415-020-09897-y 2020 Germany April 2020 To report the case of a COVID-19 patient presenting with acute polyradiculoneuritis. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 Fever, cough, tetraparesis and acral paresthesias. Mechanical ventilation, tracheostomy, intravenous immunoglobulins, plasma exchange therapy. N/A N/A N/A N/A N/A N/A N/A N/A The authors report the case of a 52 years old man who presented with tetraparesis after 14 days of fever and respiratory symptoms and was found positive on COVID-19 testing. The patient underwent mechanical ventilation and tracheostomy, and IVIG and plasma exchange therapy were administred. Thirty-one days after admission the patient showed signs of motor improvement with regressive facial and hypoglossal paresis but still needed mechanical ventilation, and was referred to a specialized rehabilitation clinic.
52 July Piscitelli D 10.1007/s10072-020-04593-1 2020 Italy March 5th - May 13th,2020 To report the case of a 39-year-old woman, in- home nurse, of normal social well-being with no history of somatoform or other psychiatric disorder or traumas, who developed, with SARS-CoV-2 infection, functional tremors. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 After 7 days with mild COVID-19 symptoms the patient developed a lower limb tremor with variable frequency and amplitude. She presented abnormal movements while sitting (e.g., lower limb twisted movements), walking (e.g., ataxic gait), or at rest (e.g., jerky movements in supine position) N/A N/A N/A N/A N/A N/A N/A N/A Case report of a patient without any history of psychiatric/neurologic events.
  • After 7 days with COVID-19 symptoms requiring quarantine, she developed a lower limb tremor and abnormal movements.
  • In the Emergency Department, she was treated with benzodiazepines without significant improvement. She was admitted to the Neurological Department, where she was found free from any neurological impairment and discharged after 10 days.
  • One week later, abnormal movements increased, she underwent instrumental examinations that found no abnormalities.
  • Two months after the onset, she tested negative twice for SARS-CoV-2 and tremor decreased.
  • This case represents the development of psychiatric comorbidity (a functional movement disorder) subsequent to an event threatening body integrity and autonomy of the subject, by means of the COVID-19 condition itself or of the isolation due to lockdown.
53 July Rosen K 10.1007/s11420-020-09774-4 2020 USA April 8th - May 12th, 2020 To investigate if an inpatient telerehabilitation program was viable for COVID-19 patients. Descriptive: Historical cohort Rehabilitation in acute care Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 33 (12 of whom received only telerehabilitation PT services) N/A Telerehabilitation In person PT or Telerehabilitation PT + in person PT Percentage of patient that met their PT goals and were discharged. N/A N/A N/A N/A N/A N/A The Hospital for Special Surgery in New York city, due to COVID-19 outbreak, introduced a telerehabilitation service for COVID-19 patients, based on a COVID-19 rehabilitation response algorithm. This latter could identify 3 groups:
  1. patients who required in-person PT only;
  2. patients who required telerehabilitation PT only;
  3. patients who required a combination of in-person and telerehabilitation PT.
All the 12 patients treated with telerehabilitation PT only met their PT goals and were discharged home safely. Therefore, inpatient telerehabilitation might be considered as a viable option for selected COVID-19 inpatients in order to reduce their LOS.
54 July Saggese CE 10.1159/000509453 2020 Italy March - April, 2020 To present the case of a COVID-19 patient presenting with stroke and thromboses in different locations Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient presenting with stroke 1 Expressive aphasia, right hemiplegia, right neglect occurring after ten days of fever and cough. rTPA therapy, oxygen, clopidogrel, atorvastatin, hydroxychloroquine, azithromycin, enoxaparin, amlodipine and ramipril. N/A N/A N/A N/A N/A N/A N/A N/A The paper describe the case of an acute ischemic stroke patient who was suffering from fever and cough since ten days and was found positive for COVID-19 on admission. Afterwards he developed right dorsalis pedis and distal lateral plantar artery occlusion that were recanalized with balloon catheter, and left forearm superficial thrombophlebitis. The authors underline that although this was not a severe case of COVID-19, the ischemic vascular complications may have been linked to the COVID-19 infection.
55 July Shalash A 10.1002/mds.28134 2020 Egypt N/R To investigate the impact of the COVID-19 pandemic on the mental health, physical activities, and QoL of PD patients. Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A PD patients 58 (38 PD, 20 no PD) N/A telephone interview Age- and sex-matched controls without PD perception of impact of COVID-19, DASS-21, IPAQ, PDQ39 N/A N/A N/A N/A N/A N/A Compared with controls, PD patients showed significantly worse stress, depression, anxiety, total DASS, moderate physical activity, walking, total IPAQ, total and most of the PDQ39 dimensions, which were correlated with current mental health and pre- lockdown characteristics (i.e. motor severity).
  • Most PD patients reported a negative impact on their mental health, physical activity, and health care, and interest in virtual visits.
  • PD patients showed a significant decline in physical activity compared with their pre-lockdown state.
  • The current findings highlight the importance of managing these issues and continuing care of PD patients, particularly by adopting telemedicine
56 July Tankisi H 10.1016/j.clinph.2020.06.003 2020 Denmark March - April, 2020 To describe the case of a COVID-19 patient who developed critical illness myopathy Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 Severe symmetrical proximal and distal weakness, diffuse muscle wasting, and absent deep tendon reflexes occurring 10 days after COVID-19 infection onset with fever, cough, dyspnea Piperacillin/tazobactam, oxygen, mechanical ventilation N/A N/A N/A N/A N/A N/A N/A N/A The authors describe the case of a severe COVID-19 patient that needed mechanical ventilation and ICU stay. After 65 days of hospitalization the patient presented severe muscle weakness. Electromyography analysis revealed critical illness myopathy. This is the first case of CIM in a patient surviving from severe COVID-19. While clinical and electrophysiological findings resembled CIM of other causes, this case deserves special attention in the context of a growing awareness of long-term complications of COVID-19.
57 July Tay SS N/A 2020 Singapore March - April, 2020 To describe the case of a COVID-19 patients who benefitted from the use of a robotic patient-guided suspension system for mobilisation. Descriptive: Case Report Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Any Activity limitation and participation restriction (d) Post-acute COVID-19 patient 1 The patient presented, cough, dyspnea and respiratory failure on admission to acute care Conventional physiotherapy and occupational therapy, gait training with the Andago V2.0 robot (Hocoma) which is a dynamic patient-guided suspension system for overground walking. N/A HADS-A, HADS-D, 6MWT N/A N/A N/A N/A N/A N/A A severe COVID-19 patient after ICU discharge presented depression and anxiety and severe impairment in gait autonomy and endurance. After conventional physical therapy and training with robotic patient-guided suspension system the patient was able to walk significantly longer in the 6MWT and had lower score in HADS-A and D. The robotic system seemed safe and efficient for recovering gait autonomy in the patient presented.
58 July Tiet MY 10.1136/bcr-2020-236536 2020 UK N/R To report a case of GBS associated with COVID-19 Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 patient developing GBS 1 He reported a 3-week history of shortness of breath, headache and cough. -Then, he showed worsening cough and distal lower limb paraesthesia, resulting in difficulty mobilising. -3 days after being discharged home there was worsening lower limb paraesthesia and ascending lower limb weakness. -4 days later, he developed facial diplegia, limbs weakness (MRC: 1/5 in lower limbs, 3/5 proximal upper limbs and 2/5 distal upper limbs), distal reduced sensation to pinprick and vibration sense, dysaesthesia in lower limbs, and he was areflexic. Monitoring in intensive care -nasogastric tube for feeding due to swallowing difficulties -intravenous immunoglobulin 0.4 g/kg daily for 5 days -neurorehabilitation N/A Neurological assessment, SARS-CoV-2 PCR in cerebrospinal fluid and from oropharyngeal swabs N/A N/A N/A N/A N/A N/A The patient developed GBS as a likely postinfectious complication 3 weeks after the onset of mild COVID-19 related symptoms.
  • He was highly responsive to immunoglobulin therapy, emphasising the importance of early recognition and treatment.
  • Despite neurological sequelae, RNA was not detected in CSF, but SARS-CoV-2 PCR from oropharyngeal swabs remained positive for 7 weeks after initial COVID-19 symptoms.
  • Eleven weeks later, after receiving neurorehabilitation and optimisation of neuropathic medications, the patient was able to mobilise unassisted.
59 July Zhao Y-M 10.1016/j.eclinm.2020.100463 2020 China January 20th - February 24th, 2020 To study the pulmonary function, HRCT scan of the thorax and SARS-CoV-2 IgG in serum in COVID-19 patients 3 months after their hospital discharged and to investigate the relationship between the clinical characteristics and the pulmonary function or CT scores. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Chronic COVID-19 survivors 55 Of 55 patients, including 4 mild (7.27%), 47 moderate (85.45%) and 4 severe (7.27%) cases, 35 presented COVID-19 related symptoms including gastrointestinal symptoms (30.91%), headache (18.18%), fatigue (16.36%), exertional dyspnea (14.55%), as well as cough and sputum (1.81%). Of the 55 patients, 6 experienced olfactory and gustatory dysfunctions during infection period and 2 female still experienced a decrease sense of taste during follow-up period. pulmonary function test Clinical assessment, HRCT of the thorax, lung function and serum levels of SARS-CoV-2 IgG antibody tests 3 months after discharge N/A N/A N/A N/A N/A N/A 3 months after discharge COVID-19 symptoms were detected in 35/55 patients and different degrees of radiological abnormalities were detected in 39 patients.
  • Urea nitrogen concentration at admission was associated with the presence of CT abnormalities.
  • Lung function abnormalities were detected in 14 patients
  • The level of D-dimer was an important prognostic factor for abnormal DLCO.
  • 47 of 55 patients showed SARS-CoV-2 IgG in serum, among which the generation of IgG antibody in female patients was stronger than male patients in the infection rehabilitation phase.
  • It is necessary to follow up the COVID-19 patients to appropriately manage any persistent or emerging long-term sequelae. Thus, for patients who have markable raised D-dimer, pulmonary rehabilitation would be needed subsequently even in the absence of other severe respiratory symptoms.
60 August Abdulsalam MA 10.1111/ane.13321 2020 Kuwait N/A To report a case of generalized status epilepticus as a possible initial manifestation of COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 1 Continuous tonic-clonic seizures Intubated and mechanically ventilated,Intravenous diazepam but was ineffective, Intravenous midazolam N/A N/A N/A N/A N/A N/A N/A N/A This is a case of a 32-year-old male who presented generalized status epilepticus without a prior history of seizure or epilepsy as a possible initial manifestation of COVID-19 infection. He had no other symptoms of COVID-19.
  • After midazolam the convulsions were aborted and he extubated after 36 hours.
  • CT scan of the brain showed no lesion, Cerebrospinal fluid revealed an elevated protein level with normal glucose.
  • About fourteen days later, he was discharged in stable condition, remaining afebrile and asymptomatic.
  • The pathogenesis of this manifestation may be multifactorial, as the result of both the neurotropism of SARS-CoV-2 in addition to blood-brain barrier breakdown precipitated by proinflammatory cytokine reactions.
61 August Akram A 10.7759/cureus.9320 2020 Pakistan N/A To describe the case of an elderly patient with preexisting IPF and laboratory-confirmed SARS-CoV- 2, who presented acutely with rapid progression to septic shock Descriptive: Case Report N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Idiopathic Pulmonary Fibrosis developing COVID-19 1 high fever, hypotension, confusion, lethargy, tachypnea, bilateral crackles hydroxychloroquine 400 mg × BD, IV azithromycin 400 mg × OD, IV solu cortef 100 mg × TDS, heparin, IV fluids and a norepinephrine infusion. N/A N/A N/A N/A N/A N/A N/A N/A This case reports an acute COVID-19 infection in a elderly patient with IPF.
  • At admission, the patient was confused, lethargic, dyspneic with high fever and low blood pressure and a room air SpO2 of 90%
  • Laboratory exams showed leukopenia, lymphocytopenia, altered coagulation and liver function studies
  • On the night following admission his status deteriorated and the patient died by septic shock
The author concluded that IPF patients are at high risk of SARS-CoV-2 pneumonia with more severe manifestations. These patients should take extra precautions to avoid exposure to SARS-CoV-2.
62 August Avci A 10.1007/s13365-020-00888-3 2020 Turkey N/A To report a case of subarachnoid hemorrhage developing in patient with Covid-19-related pneumonia Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 1 Subarachnoid hemorrhage with impaired consciousness N/A N/A N/A N/A N/A N/A N/A N/A N/A A 50-year-old male with no concomitant disease was admitted to the emergency department due to impaired consciousness: lung imaging suggested COVID-19-associated pneumonia and cerebral tomography revealed subarachnoidal hemorrhage. The patient was hospitalized in ICU and died on the 83rd day due to COVID-19-associated pneumonia. In the presence of an anamnesis suggesting respiratory system infection such as cough and weakness in patients who come with sudden loss of consciousness, performing lung imaging as well as the performing brain computerized tomography can allow detection of an underlying Covid-19 infection.
63 August Bagnato S 10.1016/j.ijid.2020.07.072 2020 Italy From March to June, 2020 To describe neurophysiological findings from a patient who developed critical illness myopathy after a long stay in ICU for COVID-19 Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 Diffuse and symmetrical muscle weakness (ranging from 3/5 to 4/5 on MRC) 68 days post COVID-19 onset. Deep tendon reflexes reduced in lower limb. The patient walked a few steps with assistance. Rehabilitation program 3 h/day for 6 days/week for 2 months N/A N/A N/A N/A N/A N/A N/A N/A The patient had a critical illness myopathy confirmed by NCS/EMG/DMS. She underwent a rehabilitation treatment for 2 months with almost complete motor recovery. Given a large number of patients with COVID-19 who require long ICU stays, many are very likely to develop this condition in the coming months. Since rehabilitation programs can be effective, health systems must plan to provide adequate access to rehabilitative facilities for both pulmonary and motor rehabilitative treatment after COVID-19.
64 August Basi S 10.1136/bcr-2020-235920 2020 UK April 2020 To describe a case report of a 66-year- old man with an acute ischaemic stroke in the setting of a COVID-19 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 At the admission the patient showed a left-sided weakness, an incresed musle tone in his left upper limb, a mild left facial droop, and a deterioration in his speech pattern. Moreover, he required 2 L of nasal cannula oxygen to maintain his oxygen saturations between 88% and 92%. Then, his respiratory condition worsened and his levels of consciousness reduced. The patient was pronounced dead by doctors at four days after the admission. Nasal cannula oxygen at 2 L and then Venturi mask at 8 L of oxygen; intravenous and ciprofloxacin; 300 mg of aspirin N/A N/A N/A N/A N/A N/A N/A N/A A 66 yrs old patient admitted with diagnosis of right frontal cerebral infarct had a concomitant COVID-19 pneumonia. In his clinical history he had atrial fibrillation and had one previous ischaemic stroke, with a consequent left-sided haemiparesis, that had completely resolved. His worsening respiratory condition and reduced levels of consciousness, present during the LOS, made it impossible to assess progression of the neurological deficit after stroke. His comatose condition persisted throughout the admission. The patient was pronounced dead by doctors at four days after the admission.
65 August Belli S 10.1183/13993003.02096-2020 2020 Italy N/A To assess the proportion of COVID-19 patients with low physical functioning and/or impaired performance of ADLs at the time of discharge. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 115 N/A N/A N/A - 1-minute sit-to-stand test - Short Physical performance Battery - Barthel Index N/A N/A N/A N/A N/A N/A 103 of 115 patients hospitalized for COVID-19 survived and were discharged at home
  • During the stay 9 patients received non-invasive ventilation and 12 mechanical ventilation and NIV
  • At discharge:
    • The patients were discharged home after a mean stay of 16.1 (7.4) days, with a length of stay shorter for the mechanically ventilated group: 11.1 (3.4) versus 16.8 (7.6) days
    • 33.3% of patients had a number of 1 minute sit-to-stand repetitions below percentile 2.5
    • 53.3% had low and 17.5% moderaty SPPB summary scores
    • 47.5% had a poor score on the Barthel index (<= 60)17.5% were still bedridden 21% needed O2-supplementation- COVID-19 patients discharged home after hospitalisation in an acute and subsequent post-acute ward, have a clear need for rehabilitative interventions
66 August Benger M 10.1016/j.bbi.2020.06.005 2020 UK From 1st February 2020 to 14th May 2020 To provide a description of clinical, radiological and laboratory characteristics of consecutive patients presenting to King’s College Hospital (KCH) with ICH in association with COVID-19 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 5 Case 1:
  • 41 years old male with well controlled hypertension and type 2 diabetes with 8 days history of cough, fever and fatigue who needed intubation 24 hours post-admission
  • one day after extubation: drowsiness and right-sided hemiplegia
Case 2:
  • 54 years old female well controlled hypertension and type 2 diabetes presenting with a 2-weeks history of cough, and 12-hours history of sudden onset dysarthria and left-sided hemiparesis
Case 3:
  • 55 years old male with well controlled hypertension presenting with a 3-weeks history of cough, pleuritic chest pain and shortness of breath and severe hypoxia
Case 4:
  • 64 years old female with a six-day history of cough, shortness of breath and fever requiring immediate intubation and ventilation for multiple organ failure (respiratory, cardiac and renal), the patient
  • Four weeks post-admission, low GCS post-sedation wean
Case 5:
  • A 52 years old male with a history of ischaemic heart disease, quiescent untreated multiple sclerosis, asthma, hypertension and hyperlipidaemia, presented with a two-week history of shortness of breath, cough, fevers and pleuritic chest pain
  • Three days post-admission: deterioration of respiratory function
  • Three weeks later: ongoing low GCS after sedation wean
Case 1:
  • mechanical ventilation
  • prophylactic dose of low molecular weight heparin
Case 2:
  • prothrombin complex concentrate and vitamin K
Case 3:
  • immediate intubation and ventilation
  • treatment for multiple organ failure (lung, cardiac, renal and liver)
  • prophylactic dose of LMWH
Case 4:
  • immediate intubation and ventilation
  • treatment for multiple organ failure (respiratory, cardiac and renal)
  • prophylactic dose of LMWH
Case 5:
  • intubation and ventilation
  • cardiac, respiratory, and renal support
  • intravenous heparin later switched to a prophylactic dose of LMWH
N/A N/A N/A N/A N/A N/A N/A N/A 5 relatively young patients with COVID-19 suffered from ICH with a mean age lower than expected for ICH
  • 4 patients had lobar ICHs and all of them had a pre-existing hypertension
  • The delay between the onset of COVID-19 symptoms and time of ICH diagnosis had a median of 32 days and during that period all patients had evidence of a prolonged inflammation with multiple organ failure in four out of five patients
  • patients 1 and 2 were discharged to rehabilitation centres while the other patients remained in ICU requiring multiple organ support
Albeit a causal relationship between ICH and COVID-19 remains to be confirmed, this study provides the first evidence for a younger patient demographic, a lobar predominance, and a long systemic inflammatory prodrome. It also highlights two challenges:
  • treating the thrombotic consequences of COVID-19
  • diagnosing ICH in heavily-sedated ICU patients
67 August Bolaji P 10.1136/bcr-2020-236820 2020 UK N/A To report a COVID-19 case with extensive cerebral venous sinus thrombosis with bilateral venous cortical infarcts and acute cortical haemorrhage Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 with CVST 1 Left-sided weakness, left-sided sensory inattention, and subsequent focal seizures, then status epilepticus and coma Anticoagulation and antiepileptic, intubation, then inpatient rehabilitation N/A N/A N/A N/A N/A N/A N/A N/A This case reports of a 63 yrs old man a potential association between CVST and COVID-19 infection.
  • COVID-19 may cause venous thromboembolism either through increased cytokine and clotting factors production or direct endothelial injury through binding to the ACE2 receptor.
  • CVST is associated with a good functional outcome despite the severity of neurological deficit if it is diagnosed and treated early with anticoagulation and complications like status epilepticus are addressed.
68 August Chakraborty U 10.1136/bcr-2020-238668 2020 India N/R To report a case of acute transverse myelitis associated with COVID-19 infection in a 59-year-old female Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Acute-onset progressive ascending flaccid paraplegia, retention of urine, constipation, and fever. No lower limbs deep tendon reflexes, a sensory level at T10 segment. After injectable steroids she did show some signs of recovery. A day later, she developed an acute- onset respiratory failure, a sudden cardiac arrest and she died despite resuscitation maneuvers. Corticosteroids N/A N/A N/A N/A N/A N/A N/A N/A Considering the onset of ATM symptoms in the background of a confirmed COVID-19 test and initial improvement with steroids, ATM may be considered as an immune-mediated response to the virus. It is rare but it has severe consequences and early identification is very important to initiate appropriate treatment.
69 August Cunha P 10.1111/ene.14474 2020 France N/A To describe a new type of delayed onset movement disorders in five patients who were admitted to ICUs for severe SARS-CoV-2 infection Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Sensory functions and pain b2) Post-acute COVID-19 5 Upper limbs postural and action-tremor was observed in 4 patients,
  • Patient 2 had also irregular orthostatic tremor
  • Patient 4 had bilateral upper limbs jerky/myoclonic abnormal movements at rest and during posture and action
  • Associated signs included a moderate proximal motor deficit in 4 patients and a mild hemiparesis in one patient.
- in ICU: intubation and ventilation N/A N/A N/A N/A N/A N/A N/A N/A
  • 5 COVID-19 patients developed abnormal movements 23 ± 7 days (mean + SD) after ICU discharge
  • MRI performed in all patients showed microbleeds in 4 patients and a bilateral frontotemporal hypoperfusion in one patient
70 August D'Andrea S 10.1038/s41394-020-0319-0 2020 Italy April 2020 To evaluate differences in clinical features and evolution of COVID-19 between people with SCI and able-bodied individuals Descriptive: Historical cohort Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition SCI patients developing COVID-19 15 Out of 15 SCI-patients affected by COVID-19, 10 (66.7%) were symptomatic, 10 (66.7%) with fever, 9 (60.0%) with dry cough, 3 (20.0%) had dyspnea, 2 (13.4%) with diarrhea, 1 (6.7%) had anosmia, and 2 (13.4%) had fatigue. All individuals who tested positive for SARS-CoV-2 among SCI patients (cases) and able-bodied healthcare workers (controls) were enrolled in a historic cohort study COVID-19 able-bodied controls (n=17) COVID-19 clinical features; COVID-19 radiological findings; COVID-19 treatment; COVID-19 evolution N/A N/A N/A N/A N/A N/A Fever and dry cough were the most common symptoms of COVID-19 without significant differences between SCI patients and able-bodied controls. In conclusion, the authors showed that in their sample SCI patients had a favorable prognosis, not differing from controls. Therefore, the authors hypothesized that it is due to the early COVID-19 diagnosis, with a consequent prompt management; however, future larger studies are necessary to confirm these findings.
71 August Figueiredo R 10.1136/bcr-2020-237146 2020 Portugal N/A To present a case of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute pregnant woman with COVID-19 1 A 35-year-old woman, primigravida, 39-week gestation, presenting with involuntary drooling with acute peripheral facial palsy
  • 10-day tapering prednisolone course, starting at 60 mg/day
  • Eye hydration measures
  • Facial physiotherapy exercises
N/A Facial palsy severity N/A N/A N/A N/A N/A N/A
  • This is the case report of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy
  • Labor ensued normally, with vaginal delivery
  • Tha patient received facial physiotherapy and 15 days after birth neurologic deficits slightly improved
  • Neurological symptoms could be the first and only manifestation of the COVID-19.
72 August Franco C 10.1183/13993003.02130-2020. 2020 Italy From March 1st to May 10th,2020 To analyze the safety of the hospital staff, the feasibility, and outcomes of noninvasive respiratory support applied to patients outside the ICU. Descriptive: Historical cohort General postacute rehabilitation Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 670 N/A 163 HFNC, 330 CPAP, 177 NIV N/A Length of stay in hospital, endotracheal intubation and deaths N/A N/A N/A N/A N/A N/A The majority of patients (49.3%) were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9% with 16%, 30%, and 30%, while the total endotracheal intubation rate was 27% with 29%, 25% and 28%, for HFNC, CPAP, and NIV, respectively, and the relative probability to die was not related to the NRS.
  • Endotracheal intubation and length of stay were not different among the groups. The mortality rate increased with age and comorbidity class progression.
  • 42 of 353 (11.4%) health-care workers who had been taking care of patients receiving NRS tested positive for infection, but only 3 required hospitalization.
  • The application of NRS outside the ICU is feasible and associated with favorable outcomes. Nonetheless, it was associated with a risk of staff contamination.
73 August Hajdu SD 10.1161/STROKEAHA.120.030794 2020 International November 2019 - April 2020 To determine the effect on endovascular therapy for patients with acute ischemic stroke during the COVID-19 confinement Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A Stroke Patients (treated with endovascular therapy in the COVID-19 period ) 1600 N/A To compare outcome measures according to the COVID-19 confinement (dates identified for each country varying from March 9, 2020 to March 23, 2020) Patients treated by endovascular therapy for acute ischemic stroke before COVID-19 confinement Mean number of endovascular therapies performed and mean stroke onset-to-groin puncture time interval (minutes) per hospital and per 2-week interval N/A N/A N/A N/A N/A N/A There was a significant decrease in mean number of endovascular therapies performed per hospital per 2-week interval between before and after COVID-19 confinement (9.0 vs 6.1; p<0.001). Moreover, the authors observed a significant increase in mean stroke onset-togroin puncture time between before and after COVID-19 confinement (300.3 vs 354.5 minutes; p<0.001). Less interventions might lead to a higher disability.
74 August Han X 10.1097/PHM.0000000000001535 2020 China From December 30, 2019 to February 17, 2020 To analyze the infection features of inpatients with brain damage in one rehabilitation ward of a large general hospital with natural exposure to COVID-19 at the beginning of the outbreak Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Brain injury rehabilitation inpatients developing COVID-19 25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 4 of 25 patients (16%) with brain damage admitted to this rehabilitation ward were diagnosed with COVID-19 pneumonia. COVID-19 patients were older (60.5 vs 50), with a higher prevalence rate of tracheotomy (75% vs 9.5%) and underlying pulmonary infection (100% vs 38.1%). Their modified Barthel Index scores were significantly lower than those of noninfected subjects (7.5 ± 9.6 vs 29.5 ± 26.4). Brain damage inpatients with impaired airways and low activity levels are more susceptible to COVID-19 and can easily become severely ill or even die.
75 August Hemphill NM 10.1016/j.cjca.2020.04.038 2020 USA From the beginning of 2020 to April 5th To quantify the change in physical activity observed during the early phase of the COVID-19 pandemic in children with CHD Analytical: Cohort study N/A Epidemiology - Prevalence N/A N/A Children with CHD 109 N/A Physical activity in the first 14 weeks of 2020 Physical activity in the corresponding weeks in 2019 Weekly average step counts N/A N/A N/A N/A N/A N/A This paper compares the physical activity, measured as weekly average step counts, of children with CHD in the first 14 weeks of 2020 and compare it with the same period in 2019: from January through early March (week 1 to 12), 2019 and 2020 step-counts are similar and increasing, while later in March, 2020 step-counts are significantly lower than 2019 (week 13 and 14). Reduced physical activity due to COVID-19 pandemic may have negative impacts on physical, cardiovascular and mental health in children with CHD: long term impact need to be considered.
76 August Hermann M 10.1097/PHM.0000000000001549 2020 Switzerland From March to May, 2020 To characterize COVID-19 patients referred to in- patient rehabilitation and describe performance and outcome during cardiopulmonary rehabilitation. Analytical: Cohort study Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 28 N/A Multimodal 2-4 weeks inpatient CR: 25-30 therapy sessions, 5-6 days per week. CRQ, HADS, CIRS, FIM, 6-MWT, FT N/A N/A N/A N/A N/A N/A The cohort presents patients referred for CR who was divided into mechanically ventilated patients (n=12) or not ventilated patients (n=16) in the acute hospital setting in order to analyze the impact of very severe COVID-19.
  • 50% were female, mean age was 66 years and patients stayed in the acute hospital for 19.3±10.7 days before referral for CR. 17 patients (61%) needed previous ICU treatment.
  • Risk factors, assessments, and questionnaires on admission were comparable in both groups.
  • Significant enhancements were observed in 6-MWT and FT which were independent of previous ventilation status.
  • Comprehensive CR following COVID-19 is safe, feasible, and effective.
77 August Hsueh S-J 10.1016/j.jfma.2020.07.042 2020 Taiwan March to May To report a possible neuromuscular manifestation of SARS-CoV-2 infection Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with quadriplegia 1 - 51-year-old Taiwanese woman with a history of hypertension and obesity - On admission: dyspnea - Post-extubation: quadriplegia with intact pinprick sensation intact, and mildly decreased vibratory sensation in the ankles - intubation - rosuvastatin, cisatracurium, zithromycin, meropenem, lopinavir/ ritonavir, hydroxychloroquine, baricitinib and sedative agents N/A N/A N/A N/A N/A N/A N/A N/A This is the case report of a middle-aged woman found positive to SARS-CoV-2 after a travel to Europe. Due to progressive dyspnea, she was intubated and on March 15th and extubated on April 9th. The PCR for SARS-CoV-2 became negative since April 6th. The following days she remained quadriplegic with gradual recovery which led her to be able to walk again on May 1st. Laboratory and instrumental exams were compatible with myopathy. Follow-up in late May 2020 revealed full muscle power. Authors suggest that inflammatory myopathy should be considered as a cause for persistent respiratory failure and weakness in patients with COVID-19
78 August Khare J 10.1016/j.dsx.2020.08.012 2020 India N/A To study the effect of lock down on glycemic control in diabetic patients and possible factor responsible for this Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors N/A N/A Adult patients with type 2 diabetes 143 N/A N/A Same population - pre-lock down Fasting Blood Glucose Post Prandial Blood Glucose N/A N/A N/A N/A N/A N/A This study compared assessed the effects of lock-down on blood glucose levels in adults with type 2 diabetes. Both fasting and postprandial blood glucose in lock down period were higher than prior to lock down, statistically significant difference was seen with postprandial blood glucose only. The most common factor worsening of hyperglycemia were:
  1. psychological stress
  2. change in exercise
  3. dietary changes
  4. difficulty in getting medication and medical advice
79 August Lascano AM 10.1111/ene.14368 2020 Switzerland From March to April 2020 To report a series of three cases of typical GBS, preceded by classic signs and symptoms of biologically confirmed COVID-19 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 3 Distal paresthesias and rapidly progressive limb weakness, evolving to either moderate tetraparesis (2/3) or tetraplegia (1/3) and areflexia (3/3) within the first 5 days. Two patients presented with pain and only one with bulbar signs and facial biplegia. Neurological symptoms appeared within the first 22 days (7, 15 and 22 days) after the appearance of typical COVID-19-related symptoms. Intravenous immunoglobulin N/A N/A N/A N/A N/A N/A N/A N/A Three patients presented a classic demyelinating pattern, occurring 15 (7-22) days after classic signs and symptoms of biologically confirmed COVID-19. All three patients were treated with intravenous immunoglobulin and had a favourable clinical course: one fully recovered and was discharged, another one was able to walk with assistance and the last one remained bedridden but was able to rise to standing up.
80 August Le Guennec L 10.1111/epi.16612 2020 France N/A To report a case of status epilepticus as the first manifestation of COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 At admission: 5-day history of cough, fever, and anosmia One week after admission: verbal perseverations and imitation behavior, drowsiness - mechanical ventilation - intravenous levetiracetam - IV-Immunoglobulins at 2g/kg N/A N/A N/A N/A N/A N/A N/A N/A This is a case report of a 69-year-old patient admitted to ICU for status epilepticus who required endotracheal intubation. He had a medical history of diabetes mellitus, hypertension and a single seizure. The patient was treated with IV-Immunoglobulins. He improved after one week, allowing for weaning from mechanical ventilation, but he presented signs of frontal lobe syndrome. MRI at day 15 showed the persistence of a marked hyperintensity of the right caudate nucleus and a significant decrease of the hyperintensity of the prefrontal cortex, MRI at day 30 was normal. Authors hypothesized that this particular form of orbitofrontal status epilepticus might have been triggered by the passage of SARS-CoV2 through the olfactory pathway
81 August Lee AJY 10.1016/j.physio.2020.06.002 2020 Singapore N/A To describe clinical course and physiotherapy intervention in a sample of COVID-19 patients Descriptive: Case Series Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 9 Out of 9 patients (median age: 66 years), one case (Case 7) with pre-existing asthma/chronic obstructive pulmonary disease overlap syndrome, showing with a dry and unproductive cough, was referred for respiratory care. All the other patients were referred for rehabilitation; of these, exertional and positional-related oxygen desaturation was a common feature in five patients (Case 1, 2, 5, 6, 8). One individual (Case 1) demonstrated severe and persistent postural hypoxaemia (oxygen saturation decreased to <90% when seated upright from a supine position and lasted beyond 4 weeks following ICU discharge). Rehabilitative therapy sessions were organised into small interval sessions with multiple rest breaks in between exercise sets. Interval training was prescribed in the initial stages of the rehabilitation before gradually progressing to continuous training, as the patients were unable to tolerate continuous aerobic exercises. N/A Clinical course N/A N/A N/A N/A N/A N/A Early detection of COVID-19 infection and management and recognition of this phenomenon is mandatory. A tailored rehabilitation approach should be performed in accordance with patient tolerance. A prolonged duration of rehabilitation course may be expected especially for severly ill patients
82 August Longobardi Y 10.1177/0194599820948043 2020 Italy From April 7 to May 11, 2020 To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. Analytical: Cohort study Specialized postacute rehabilitation Meso Level N/A N/A Adult laryngectomy patients who use a voice prosthesis 73 N/A - semi structured interviews to inquire about the nature of the need
- on the basis of the answers, telematic contact with the relevant professional figure
- if needed, subsequent outpatient visit
N/A N/A N/A N/A N/A N/A N/A N/A
  • Out of 73 patients, 37 requested a video call to receive consultation either medical/speech therapy, related to voice prosthesis issue or psychological. Patients that did not request consultation were those who had had a more recent visit.
  • In 62% of the cases the call was sufficient to solve the issue, in the remaining cases an outpatient visit was not postponable
  • Hospital Anxiety and Depression Scale scores decreased significantly comparing pre to post-telematic support
  • All the patients reported a high score at the VAS for satisfaction with service
83 August Maideniuc C 10.1007/s00415-020-10145-6 2020 USA N/A To describe a case of COVID 19 patient with ANM and AMAN, a rare variant of GBS, without systemic signs of infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with ANM 1 At the admission, the 61-year-old woman showed increased tone in the lower extremities and weakness of upper and lower extremities (worse in the lower ones); reflexes were normal in the upper extremities but brisk in the lower extremities with upgoing toes bilaterally. The patient continued to progress and became quadriparetic. At 3 weeks after her initial onset of symptoms, she was areflexic in all extremities. EMG showed evidence of acute motor axonal neuropathy with normal sensory conductions Methylprednisolone 1 g IV for 5 days without improvements. Then, at 3 weeks she received five rounds of plasma exchange and was discharged to an inpatient rehabilitation setting. N/A N/A N/A N/A N/A N/A N/A N/A The authors reported the first case of COVID 19 patient who presented with GBS and ANM at the same time without any systemic manifestation. Immunotherapy seemed to have a role in immune-mediated neurological conditions associated with COVID-19. The patient started to stand up with the assistance and was able to take few steps with the walker at the rehabilitation facility after the discharge from the Neurology Unit. It is mandatory an early diagnosis and a consequent early management of immuno-mediated neurological conditions associated with COViD-19
84 August Mella-Abarca W 10.3332/ecancer.2020.1085 2020 Chile From April to June 22nd, 2020 To describe a model of physical therapy using telerehabilitation for people with breast cancer during the COVID-19 pandemic in Chile Descriptive: Historical cohort Specialized postacute rehabilitation Meso Level N/A N/A People with breast cancer 118 N/A Telerehabilitation N/A Side effects of breast cancer surgery, including lymphedema, axillary web syndrome, limited movement in the upper limbs and reduced muscle strength N/A N/A N/A N/A N/A N/A This paper describe a model of physical therapy using telerehabilitation for people with breast cancer and report data on its implementation: during the pandemic, 226 care events have been recorded, 142 (63%) of which correspond to tele-rehabilitation in 118 patients. Both patients and physiotherapists reported a high level of acceptance and satisfaction. The model can be implemented in the case of telerehabilitation when face-to-face appointments can not be performed and can be facilitated by:
  1. Having an electronic medical record system which allows legal record-keeping and to establish concrete rehabilitation objectives;
  2. Having a multidisciplinary team which maintains good communication;
  3. The growth in use of technology in the country (wide internet access and smartphones);
  4. Obligatory quarantine, which may enable the company of a family member to assist the patient to manage the technology;
  5. The creation of a webpage with facilitates asynchronous contact with the person;
  6. High levels of commitment and motivation of therapists/patients to participate in this new model.
85 August Mooney B 10.1007/s11420-020-09778-0 2020 USA From April 4, 2020, to May 30, 2020 To determine the outcomes of a collaboration between PT and SLP in the treatment of COVID-19 patients who underwent tracheostomy placement Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 3 Patient 1: A 33-year-old woman. Post-weaning, she exhibited delirium, right upper extremity myopathy/neuropathy, anxiety.
Patient 2: An 81-year-old man. Post-weaning, he produced thick, purulent secretions, a pressure ulcer, constipation, delirium, and respiratory stridor.
Patient 3: An 84-year-old man. Post-weaning, he was diagnosed with toxic metabolic encephalopathy and MRI signs of a subacute stroke. Moreover, he was found to have a pulmonary embolism.
PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. N/A Achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. N/A N/A N/A N/A N/A N/A Three patients with COVID-19 received coordinated PT and SLP following prolonged intubation and tracheostomy.
  • Time to tracheostomy from intubation was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from the ventilator was 9 days in a case and 5 days for the others.
  • All three patients achieved respective PT and SLP functional milestones, including mobility, communication, and swallowing. The timing of PT intervention in preparation for SLP intervention maximized the improvement of the function of both physical and speech milestones.
  • The results suggest a positive impact of collaborative treatment.
86 August Muhammad S 10.1016/j.bbi.2020.05.015 2020 Germany N/A To report the first case of COVID-19 positive patient presenting with a concomitant subarachnoid haemorrhage from an intracranial aneurysm Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 60-year-old COVID-19 positive patient presenting with a concomitant subarachnoid haemorrhage from an intracranial aneurysm - intubation
- microsurgical clipping of intracranial aneurysm
N/A N/A N/A N/A N/A N/A N/A N/A
  • This is the first case of COVID19 infection and concomitant aneurysmal subarachnoid haemorrhage from a ruptured pericallosal artery
  • The aneurysm was clipped microsurgically immediately after admission
  • Due to positive SARS-CoV-2 PCR the patient was transferred to a specialized ward where she received treatment for pneumonia
  • Once cured from COVID-19, the patient was transferred for rehabilitation due to poor grade subarachnoid haemorrhage
87 August Negrini S 10.1016/j.apmr.2020.08.001 2020 Italy From January to March, 2020 To investigate the feasibility and acceptability of telemedicine as a substitute for outpatient services in emergency situations such as COVID-19 Descriptive: Historical cohort Specialized outpatient rehabilitation Meso Level N/A N/A Patients with spinal disorders 1207 N/A Usual consultations and physiotherapy during the control and COVID phases, only telemedicine services (telephysiotherapy and teleconsultations) during the telemed phase Control phase of 30 working days including the usual services before the spread of COVID-19 (January 7-February 23); a COVID phase of 13 working days during which there was a surge of usual services before starting telemedicine (February 24-March 14) number of services provided in 3 phases; continuous quality improvement questionnaires N/A N/A N/A N/A N/A N/A During telemed phase, 325 teleconsulations and 882 telephysiotherapy sessions V30were provided in 15 days.
  • There was a rapid decrease ( -39%) of outpatient services from the control to the COVID-19 phase, which partially recovered in the telemed phase for telephysiotherapy (from -37% to -21%) and stabilized for teleconsultation (from -55% to -60%) interventions. Usual face-to-face interventions were required for 0.5% of patients.
  • Patients’ satisfaction with telemedicine was very high (2.8 out of 3).
  • Telemedicine is feasible and allows medical professionals to continue providing outpatient services with a high level of patient satisfaction.
88 August Ntaios G 10.1161/STROKEAHA.120.031208 2020 International January 2020 - May 2020 To assess whether stroke severity and outcomes in patients with acute ischemic stroke are different between COVID-19 and non-COVID-19 patients Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 inpatients with acute ischemic stroke 174 The most prevalent COVID symptoms were fever (55.2%,), cough (53.5%), and dyspnoea (43.7%). The main stroke symptoms were motor (67.8%), dysarthria (46%), and sensory (42%). The median NIHSS was 10. Assessment of stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke Non-COVID-19 patients hospitalized with acute ischemic stroke registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. mRS N/A N/A N/A N/A N/A N/A Forty-eight COVID-19 patients (27.6%) died, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors, 49 (51%) had severe disability at discharge. Patients with COVID-19 resulted to have higher risk for severe disability (median mRS 4 vs 2; p<0.001) and death (OR: 4.3) compared with patients without COVID-19.
89 August Peng M 10.12998/WJCC.V8.I15.3305 2020 China January-February 2020 To present two cases of COVID-19 who received MV and were managed successfully with a sequential weaning protocol Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 2 Fever, cough and fatigue at admission; failed improvement after 2 hours of non-invasive ventilation, requiring MV MV sequential weaning protocol, attentive to the timing of intubation and extubation, early prone positioning (12 hours/day during the first 5 days of MV), infection control, and sequential advancement and withdrawal of invasive ventilation N/A MV weaning N/A N/A N/A N/A N/A N/A Two critical COVID-19 patients with respiratory failure firstly received NIV and, due to the missing improvement after two hours, were following advanced to MV. Using a sequential weaning protocol, the patients were successfully extubated and placed on NIV and, later, on high-flow nasal cannula oxygen therapy. The patients were then transferred from the ICU to the common ward. Based on the good outcomes of the patients, the proposed weaning protocol could be considered for patients with critical COVID-19.
90 August Perrin P 10.1111/ene.14491 2020 France From March 9 to April 9, 2020 To describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights especially with respect to the CRS Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 5 Neurological presentation included confusion (n = 5), tremor (n = 5), cerebellar ataxia (n = 5), behavioral alterations (n = 5), aphasia (n = 4), pyramidal syndrome (n = 4), coma (n = 2), cranial nerve palsy (n = 1), and central hypothyroidism (n = 3). corticosteroids and intravenous immunoglobulins N/A N/A N/A N/A N/A N/A N/A N/A Neurological disturbances occurred in the second week after COVID-19 onset in 3 cases (in the others, the exact onset was not assessable because of the critical conditions). Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema mimicking ischemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted with recovery from neurological disturbances in two cases. These data indicate that corticosteroids aimed at tackling CRS and IVIg may be effective to control severe neurological disturbances in patients with COVID-19.
91 August Pisano TJ 10.1097/PHM.0000000000001578 2020 USA N/A To report the case of acute SCI with COVID-19 that developed bilateral DVT despite chemoprophylaxis Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Acute non traumatic SCI developing COVID 19 1 At the admission, 48 year old male showed urinary retention, constipation, lower extremity weakness and sensory impairment. MRI revealed multilevel degenerative disk disease with a T11-12 compressive mass of unclear etiology. He was transferred to a tertiary facility for higher level of neurosurgical care with no lower extremity motor or sensory function. Here, after surgical intervention he had T11 AIS A paraplegia. Then, patient had a diagnosis of DVT with a consequent change in his anticoagulation therapy from chemoprophylaxis dosing to therapeutic dosing using a heparin algorithm infusion (1650 units/hour) with a PTT target range of 50-70 seconds. Anticoagulation was transitioned to oral 15 mg rivaroxaban at a dose of 15 mg two times per day on hospital discharge (day 16) The patient underwent a T10-L1 decompressive laminectomy removing of a large extruded T11-12 herniated disc and was started on VTE chemoprophylaxis with heparin 5000 units administered subcutaneously three times N/A N/A N/A N/A N/A N/A N/A N/A The patient presented acute nontraumatic SCI that has an inherent increased risk for VTE, and COVID-19 without significant respiratory symptoms. During hospitalization, the patient developed first extensive bilateral lower extremity deep vein thrombosis despite chemoprophylaxis, and then bilateral pulmonary embolism, despite therapeutic anticoagulation. This case highlights the need for clinicians to have elevated vigilance in regards to screening and treatment for VTE in high-risk patients, such as SCI with a concurrent diagnosis of COVID-19, because might require more aggressive management or interventions.
92 August Quinn L 10.1093/ptj/pzaa128 2020 USA N/A to describe a physical activity coaching program for individuals newly diagnosed with Parkinson Disease and to highlight rapid modifications made to this program in response to the COVID-19 pandemic Analytical: Cohort study Specialized outpatient rehabilitation Meso Level N/A N/A people with early-mid stage Parkinson Disease 27 N/A adaptation to telehealth delivery of a physical activity coaching program which included 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake N/A N/A N/A N/A N/A N/A N/A N/A
  • The Engage-PD, a coaching program for people with newly diagnosed Parkinson Disease, rapidly transitioned to a telehealth platform.
  • The structure of assessments was modified, excluding some tests and adapting all other assessments to video interview.
  • The recruitment rate was larger than expected, reflecting the unique opportunity provided by stay-at-home guidelines
  • All participants who enrolled in the program had access to technology and were able to connect within the first session
93 August Ros-Castelló V 10.1002/mdc3.13025 2020 Spain N/A to report a case of a patient who developed myoclonus after a COVID-19 infection recovery Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 At admission: - 5-day history of fever and shortness of breath
- tachypnea
One month after admission:
- progressively disabling myoclonus in upper limbs and negative myoclonus in lower limbs leading to falls
In ICU:
- high flow oxygen therapy and prone position
- intubation
- lopinavir/ritonavir
- hydroxychloroquine
- ceftriaxone, azithromycin, meropenem
- corticosteroids
- prophylactic doses of low-molecular-weight heparin
After myoclonus onset:
- low doses of clonazepam
N/A N/A N/A N/A N/A N/A N/A N/A This is the case report of a 72 years old woman who developed myoclonus after a COVID-19 infection. Two days after admission, the patient was intubated due to hypoxemia and treated with antivirals, hydroxychloroquine, antibiotics and corticosteroids an prophylactic LMWH., One month from admission and two weeks from the withdrawal of antibiotics, antivirals and corticosteroids, she developed progressively disabling myoclonus in upper limbs and negative myoclonus in lower limbs. The myoclonus almost disappeared after two days of low doses of clonazepam. Hypoxia was held responsible for myoclonus in light of normal laboratory tests and absence of concomitant medical therapy.
94 August Saeki T 10.1097/PHM.0000000000001545 2020 Japan February 2020 To describe the rehabilitation therapy of a COVID-19 patient who received MV Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Fever and worsening of respiratory conditions, until his percutaneous oxygen saturation was < 80% while receiving 10 L/min oxygen via a non-rebreather mask Rehabilitation therapy N/A N/A N/A N/A N/A N/A N/A N/A A 65-year-old man was admitted to ICU and MV started due to worsening of his respiratory condition. Six days after admission, rehabilitation therapy started but limited to positioning, postural drainage and passive mobilisation, while increased to active exercises, standing and stepping, gait and endurance training as the patient’s conditions got better. On day 19, he was extubated and, on day 34, discharged and instructed to continue home exercise. One month after discharge, muscle strength and activity of daily living returned to normal. This report highlights the importance of early rehabilitation in severe COVID-19 patients.
95 August Sakai T 10.2340/16501977-2731 2020 Japan From April 24 to May 24, 2020 To describe the effectiveness and risk management of remote rehabilitation for COVID-19 patients Descriptive: Case Series General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 43 N/A Remote rehabilitation Direct rehabilitation Destination after discharge, PCR results, mobility scores on level surfaces, and Barthel Index total scores Need for intubation and rehabilitation-related complications N/A N/A N/A N/A N/A Eighteen COVID-19 patients underwent remote rehabilitation using a mobile terminal to minimize contact: all of them were discharged home or to a hotel and no serious adverse events were observed. Remote rehabilitation was an effective and safe modality against the transmission of infection and could facilitate rehabilitation of patients in COVID-19 wards. It should be noted that patients in the remote rehabilitation group were significantly younger than those in the direct rehabilitation group and that the most severe cases belonged to the direct rehabilitation group.
96 August Sassone B 10.1097/HCR.0000000000000539 2020 Italy From January 7 to April 6, 2020 To investigate and quantify the reduction of PA in patients with automatic implantable cardioverter-defibrillators for primary prevention of sudden death Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Patients with automatic ICDs 24 N/A N/A PA 40 days before the national lockdown began Daily PA (hours/day) was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems. N/A N/A N/A N/A N/A N/A
  • During the forced 40-day in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-day confinement-free period
  • To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs.
97 August Schirinzi T 10.1002/mdc3.13026 2020 Italy From 20th of April to 2nd of May 2020 to remotely investigate the impact of COVID-19 emergency on daily-life of a cohort of Italian PD patients, specifically focussing on the relationship between physical activity changes and the self-perceived health. Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A people with Parkinson Disease 74 N/A N/A N/A motor activity habits before COVID-19 emergency:
- physiotherapy/rehabilitation practice,
- sports practice (type and weekly frequency)
motor activity habits during lockdown:
- physiotherapy/rehabilitation practice
- physical exercise practice (indoor/outdoor, type of activity)
- a self-reported questionnaire to quantify the intensity of physical activity as Metabolic Equivalent (MET) min/week
- use of technology-based tools: previous experience, frequency of current use, opinion on the usefulness
- use of wearable devices
- perception of own health during COVID-19 emergency
- Three self-administered scales: the International Physical Activity Questionnaires – Short Form, the Parkinson’s Well-Being Map (PWBM), the Beck Depression Index
N/A N/A N/A N/A N/A N/A
  • Because of COVID-19 emergency, the number of patients under physiotherapy/rehabilitation decreased significantly, from 32% to 7%
  • The total number of patients playing sports remained stable
  • 59.5% of patients referred a perception of worsening in their global health during COVID-19 emergency, hese patient had
    • higher scores of both PWBM and BDI
    • lower total MET
  • Binomial logistic regression model indicated that total MET was inversely associated with “worsening” independently from age, age at onset, disease duration, BDI and PWBM total scores
  • TBTs were used by 50% of the whole study population
  • Commercially available wearable devices (as pedometer) were used by 25% of patients
  • Results showed that COVID-19 outbreak, and the subsequent restrictions, had a significant impact on PD patients’ daily-life
98 August Schlachetzki F 10.1177/1357633X20943327 2020 Germany From January to April 2020 To evaluate the effect of the COVID-19 pandemic lockdown on stroke consultations and treatment recommendations using the acute consultant database of the telestroke network TEMPiS Descriptive: Historical cohort N/A Epidemiology - Prevalence N/A N/A Telemedicine consultations in the telestroke network TEMPiS N/A N/A Data collected during the first four months of 2020 Data collected during the same months in the years 2017–2019 Data for presumed and definite ischemic stroke, recommendations for rtPA and EVT N/A N/A N/A N/A N/A N/A
  • The study considered 7608 consultations at 12 clinics without neurology departments in the telestroke network TEMPiS;
  • Compared to the same period in 2017-2019, lower incidences of ischemic stroke and other acute neurological disorders requiring consultation were observed. Moreover, a significant reduction in recommendations for rtPA and a similar level in recommendations for EVT (while it should be noted that they were significantly higher before lockdown in 2020) were observed in the lockdown period (March 16 - April 30), suggesting fewer incidences of ischemic stroke severities;
  • A rebound effect following the lockdown period, with an increased incidence of stroke, as patients’ frailty may have increased during the lockdown due to decreased mobility, can be expected.
99 August Shan MX 10.1136/bcr-2020-237406 2020 USA N/A To report the case of a patient receiving pulmonary rehabilitation following COVID-19 infection Descriptive: Case Report Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1 At admission:
- 8 days of fever, chills, cough and lethargy and positive outpatient COVID-19 test
In acute ward:
- intubation
- including hydroxychloroquine, azithromycin, ceftriaxone, vancomycin, cefepime, doxycycline and tocilizumab
During patient’s rehabilitation course
- therapy focused on improving activity tolerance and endurance
N/A functional outcome measured with multiple assessments:
- the Chair Stand Test
- the Timed Up & Go
- the 6MWT
N/A N/A N/A N/A N/A N/A This is the case report of an elderly woman who survived COVID-19 and was referred to the Acute Rehabilitation Unit for pulmonary rehabilitation. Patient's functional outcomes, as measured by Chair Stand Test, TImed Up & Go and 6MWT, improved in the 11 days she spend in the rehabilitation unit.
Her gait speed, heart rate, oxygen saturation after ambulation and incentive spirometer volume showed similar improvements.
She was discharged home with a prescription for a rollator as well as home and outpatient cardiopulmonary therapy for continued rehabilitation.
100 August Shariyate MJ 10.22038/abjs.2020.47626.2333 2020 Iran March 2020 To report three cases of COVID-19 patients with fragility hip fractures Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patients with fragility hip fractures developing COVID-19 3 Patient 1: 73 year old male admitted with intertrochanteric femoral fracture, complaining weakness. He was transferred to PACU and was discharged from the hospital after 2 days; he returned to the hospital 3 days after discharge with new onset fever, weakness, dyspnea, and anorexia.
Patient 2: 69 year old male admitted with intertrochanteric femoral fracture, complaining weakness.
Partient 3: 93 year old female admitted with femoral neck fracture; he showed a low grade fever along with cough and feeling of fatigue.
Patient 1 underwent surgical fixation under spinal anesthesia and intravenous sedation.
Patient 2 was treated in a same manner as was done for Patient 1.
Patient 3: the authors urged to postpone surgery due to severe pulmonary involvement in the patient.
All three patients received oseltamivir and hydroxychloroquine. One patient also received corticosteroid.
N/A N/A N/A N/A N/A N/A N/A N/A Elderly patients with fragile lower extremity fractures are at high risk of COVID-19. The authors recommended careful assessment using chest CT scan and other lab tests.
101 August Tan GP 10.1016/j.resp.2020.103515 2020 Singapore From January 29 to May 29, 2020 To describe the clinical characteristics and outcome of individuals affected by COVID-19 and Platypnea orthodeoxia syndrome-POS Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 5 Oxygen desaturation, dyspnea and tachypnea during physiotherapy when sat up from a recumbent position A modified physiotherapy approach including bed exercises, pre-emptive increases in supplemental oxygen in anticipation of movement and/or exercise, and interval training with multiple breaks N/A N/A N/A N/A N/A N/A N/A N/A During physiotherapy when sat up from recumbent position, five out of 20 ICU survivors presented POS, a clinical syndrome characterized by orthostatic oxygen desaturation and positional dyspnea from supine to an upright position. A modified physiotherapy approach was instituted: bed exercises, pre-emptive increases in supplemental oxygen in anticipation of movement and/or exercise, and interval training with multiple breaks. POS resolved over a median (range) of 17 (6–39) days. Compared to ICU survivors without POS, patients with POS were older and had lower body mass index. POS is an under-recognized clinical feature in severe COVID-19 ARDS and should be considered by healthcare personnel.
102 August Tenforde MW 10.15585/mmwr.mm6930e1 2020 USA From April 15 to June 15, 2020 To interview adults tested positive at an outpatient visit about symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 outpatients 274 N/A Telephone interview, 2-3 weeks after testing N/A Baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether subjects had returned to their usual state of health at the time of interview N/A N/A N/A N/A N/A N/A
  • 274 (94%) out of 292 patients reported one or more symptoms at testing;
  • Return to Usual State of Health: Ninety-five (35%) reported that they had not returned to their usual state of health at the time of interview (median 16 days from test to interview (IQR = 14–19 days)) - AGE: 26% of the interviewees aged 18–34 years, 32% aged 35–49 years, and 47% aged ≥50 year - CHRONIC CONDITIONS: 28% of the interviewees with no or one chronic medical condition, 46% with two chronic medical conditions, and 57% with three or more chronic medical conditions;
  • Resolution of Symptoms and Duration: Fatigue (71%), cough (61%), and headache (61%) were the most commonly reported symptoms at the time of testing; among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview;
  • COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults with no chronic medical conditions.
103 August Trifan G 10.1016/j.jstrokecerebrovasdis.2020.105167 2020 USA N/A To report the case of a young female with history of CADASIL with COVID-19 with acute ischemic stroke as the sole manifestation. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patients with CADASIL developing acute stroke and COVID-19 1 A 37 years old African American female with a genetically proven CADASIL mutation referred to ICU presenting with left leg weakness, dysarthria and ataxia. MRI brain without contrast revealed an acute ischemic stroke in the right pons along with extensive chronic white matter signal abnormalities characteristic of CADASIL. N/A N/A N/A N/A N/A N/A N/A N/A N/A The authors reported a paradigmatic case of a woman with CADASIL and positive to SARS-CoV2 showing an acute stroke. They affirmed that CADASIL associated imaging changes have remained stable throughout the years. Thus, while it is possible that SARS-Cov-2 infection may have contributed to the etiology of the acute pontine stroke, the authors could not conclusively prove the causation.
104 August Turgut A 10.5152/j.aott.2020.20209 2020 Turkey From March 16 to May 22, 2020 To evaluate the types and the frequency of fractures, both in the pediatric and adult population during the COVID-19 pandemic and to find out the differences in comparison to the non-pandemic period. Analytical: Cross-sectional study N/A Epidemiology - Prevalence N/A N/A Patients with a new fracture 3996 N/A N/A Patients with new fractures admitted to the hospital in the same date range in 2018 and 2019. N/A N/A N/A N/A N/A N/A N/A The frequency of fractures decreased by approximately one-third during the pandemic period compared with that in the non-pandemic period (1794, 1747, 670 fractures in 2018, 2019, and 2020, respectively). The mean age of the patients with a fracture in the pediatric group was found to have decreased also. Finger fractures in pediatric patients and metatarsal fractures in adult patients were found to have significantly decreased during the pandemic. The decreased mobility on the streets directly affects the fracture frequency.
105 August Vitali M 10.1016/j.tcr.2020.100336 2020 Germany and UK March-April 2020 To report a case of axillary nerve palsy in a patient affected by COVID-19 who kept a wrong decubitus position while receiving CPAP therapy. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 A 46 year-old Caucasian male referred to ICU with shortness of breath, body temperature 38 °C and RR=30 breaths per minute; oxygen saturation was 95% on room air. An orthopedic consult revealed that patient had left shoulder abduction and extension limited to 45° each, left deltoid muscle hyposthenia of 3⁄4 on MRC, without sensitivity disturbances. CPAP four times a day for 3 h each time, alternating with Venturi oxygen mask with 60% FiO2 oxygen flow and a cycle of passive physical therapy N/A N/A N/A N/A N/A N/A N/A N/A This clinical case highlights an uncommon side effect, axillary nerve compression, that might occur while keeping the lateral decubitus for a long time during CPAP.
  • Healthcare workers have to be aware of this possible complication and must implement proper precautions to prevent it and its further disability.
  • In order to avoid peripheral nerve compression, it's important to maintain a proper body positioning, to change the side of the lateral decubitus, and to abduct the arm of the patients during invasive and non- invasive mechanical ventilation
106 August Weerahandi H 10.1101/2020.08.11.20172742 2020 USA N/A To characterize overall health, physical health and mental health of patients one month after discharge for severe COVID-19 Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 patients 161 N/A N/A N/A - degree of residual pulmonary impairment
- overall health status and mental health
N/A N/A N/A N/A N/A N/A
  • 152 of 161 patients discharged home after severe COVID-19 completed the survey (consisting of PROMIS® Dyspnea Characteristics and PROMIS® Global Health-10, two validated survey instruments)
  • 36.8% required home oxygen on hospital discharge and for 92,9% of them home oxygen was a new requirement 74.3% participants reported some shortness of breath, compared to 30.9% pre-COVID-19 infection
  • For those that did have shortness of breath prior to COVID-19, intensity, frequency, and duration of the shortness of breath worsened after COVID-19
  • The PROMIS® Global Health-10 instrument scores indicated worse general health after COVID-19 illness compared to baseline, with significantly lower score in the physical health and mental health domains
  • Patients also reported worsened ability to carry out social activities after COVID-19
107 August Whittemore P 10.1136/bcr-2020-236586 2020 UK N/A To present a case of a 60-year-old man who developed extensive COVID-19 pneumonitis and was successfully managed with low-flow oxygen and awake proning Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Significant and worsening shortness of breath, COVID-19 symptoms and SpO2 of 88% Awake proning N/A SpO2, need of MV N/A N/A N/A N/A N/A N/A A 60-year-old man with extensive COVID-19 pneumonitis was successfully managed with low-flow oxygen therapy and awake proning, avoiding the need of increasing oxygen therapy or of invasive MV, and discharged home. Awake proning, lasting as much as possible but ideally at least 18 hours/day, could be used in mechanically ventilated as well as non-mechanically ventilated patients to improve oxygenation and avoid the need of MV.
108 August Wurm H 10.1177/1352458520943791 2020 Germany and UK April 2020 To report the case of a MS patient who had received B-cell-depleting immunotherapy with rituximab for about 3 years and developed COVID-19 symptoms Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patient with relapsing MS developing COVID-19 1 A 59-year-old female MS patient showed mild paraparesis and paraspasticity and a limited walking distance; after 4 days she devolped dry cough, dyspnea, fatigue, headache, nausea, fever of 39°C and low oxygen saturation Prophylactic IV antibiotic (ampicillin/sulbactam) N/A N/A N/A N/A N/A N/A N/A N/A This MS patient, in treatment with immunotherapy for 3 years, recovered 14 days after COVID-19 symptoms onset despite having a 0% B lymphocyte count and not developing SARS-CoV-2 IgG antibodies. This case suggests that MS patients receiving B-cell-depleting therapy are not at higher risk of severe complications from primary SARS-CoV-2 infection, and demonstrates that viral clearance is possible without B-cell involvement and antiviral therapy.
109 August Zha L 10.21037/apm-20-753 2020 China From March 4, 2020 to May 5, 2020, To present a modified version of rehabilitation exercises aimed at improving the pulmonary function of patients and easing the expectoration process with acupressure integrated into the exercises to facilitate the recovery and maintenance of pulmonary function Analytical: Cohort study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 60 At baseline the prevalence for dry cough, productive cough, difficulty in expectoration and dyspnea were 41.7%, 43.3%, 35.0% and 50.0%, respectively Modified rehabilitation exercise which is a full-body exercise retrieved from Chinese martial art Eight-section Brocade N/A Over time prevalence of self-reported symptoms of: - Dry cough - Productive cough - Difficulty in expectoration - Dyspnea N/A N/A N/A N/A N/A N/A The current study found that pronounced improvement occurred in all four investigated respiratory symptoms in COVID-19 patients who performed the Modified rehabilitation exercise during both hospitalization and quarantine period. In particular, after one month, the prevalence rates were - 11.7% in dry cough,
- 11.7% in productive cough,
- 8.3% in difficulty in expectoration
15% of patients reported dyspnea as a remained symptom.
110 September Anzalone N 10.1007/s00415-020-09966-2 2020 Italy N/A To report four cases of subacute encephalopathy occurring in patients with SARS-CoV-2 infection Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 4 agitation and spatial disorientation Treatment for SARS- CoV-2 infection N/A N/A N/A N/A N/A N/A N/A N/A This study reported four cases of subacute encephalopathy occurring in COVID-19 patients.None of the patients had a relevant clinical history or previous treatment or hypertension.
  • A multifocal involvement of the cortex (from punctiform to some millimeters in the parietal, occipital and frontal regions) was evident in all cases.
  • All patients (2 men, 2 women; age range 46–63 years) have been intubated in the first week from onset of ARDS and presented neurological signs of agitation and spatial disorientation after weaning from mechanical ventilation.
  • The authors speculated that this unusual pattern of MRI lesions, the cortical involvement, may be related to a possible transient dysregulation of vasomotor reactivity.
  • The report may alert neurologists and radiologists to the existence of this subacute neuroimaging picture in COVID-19 patients, clearly different from cortical ischemia, and it may inform clinicians about the possible spontaneous reversibility of the picture.
111 September Bellinghausen AL 10.1186/s13054-020-03289-4 2020 USA N/A To present two cases of COVID-19-associated ARDS treated with prone positioning who developed meralgia paresthetica Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Sensory functions and pain b2) Post-acute COVID-19 2 left anterior thigh numbness N/A N/A N/A N/A N/A N/A N/A N/A N/A This study reported two cases of meralgia paresthetica in prone positioning for COVID-19-ARDS.
  • The patients (aged 53 and 57 years) were mechanically ventilated, and had one (the 1st patient) and 3 (the 2nd one) sessions of proning for 16 h and 42 total hours, respectively.
  • They developed meralgia paresthetica during their ICU recovery clinic visit 7-8 weeks after discharge.
  • The authors suggested a prevention strategy regarding padding of the anterior hips while patients are in the prone position to more evenly distribute pressure over the hip, with egg-crate style foam padding between the “down” hip and the bed.
  • This study describes a potentially preventable complication of prone positioning in the ICU, and highlights the value of the feedback given by an ICU recovery clinic, to improve the quality of care that patients receive in ICU
112 September Beom J 10.23736/S1973-9087.20.06406-0 2020 Republic of Korea February 2020 To report the comprehensive evaluation and inpatient rehabilitation for physical functional recovery in a critically ill COVID-19 inpatient Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 Severe weakness, fatigue, impossibility to sit without back support, mild tendency to aspirate when swallowing solid food Rehabilitation intervention with 3 sessions for 5 days (day 34 to day 38), consisitng of: sitting and standing balance training, sit-up and sit-to-stand training, gait training with a low walker, and lower limb strengthening exercise starting from low intensity. N/A HGS, MRC sum score, itting balance, 1-min STS test, Berg balance scale, FAC, 4-meter walking speed N/A N/A N/A N/A N/A N/A A 58-year-old woman with COVID-19 on day 30 after diagnosis was assessed by a physiatrist and underwent rehabilitation from days 34 to 38; as a result, lower limb muscle strength, balance function, and gait speed considerably improved and on day 39 she was discharged from hospital, with FAC=2, considering that she could walk about 100 meters using a low walker. At the 1-month follow-up, she was able to walk alone without assistance and BIA showed increased ASMM (6.35 kg/m2). Therefore, inpatient rehabilitative treatment, including pulmonary rehabilitation, has to be recommended in COVID-19 patients, taking into account the the intriguing findings of this case report
113 September Blauwet CA 10.1002/pmrj.12481 2020 USA December 2019 - April 2020 To provide a step-by-step guide on the design and implementation of a virtual adaptive sports program Analytical: Cross-sectional study N/A Meso Level Any other body structure and function-generic (s/b) N/A People with disabilities 219 Disabilities (SCI, osteoarthritis, muskoloskeletal conditions, stroke, MS, muscular dystrophy, post-polio, brain injury and other conditions) Virtual Adaptive Sports Traditional Adaptive Sports Likert scale for rating: Physical Domain (Flexibility, Strength, Endurance, Balance), Emotional Domain (Confidence, Self-esteem, Mood) Functional Domain (Self-care/ADLs, Ambulation, WC Mobility, Transfers) N/A N/A N/A N/A N/A N/A Significant differences, favoring traditional programming, were noted in terms of endurance (2.99 vs 2.70; P=0.04), confidence (3.31 vs 2.74; p< 0.001), and self-esteem (3.19 vs 2.74; p=0.005). Activities that required minimal home equipment might be considered as viable options, including: yoga, meditation, dance, group and individual fitness, group drum circles, and off-season sled hockey training. Adaptive sports and recreation provide many potential benefits for persons with disabilities, including increased opportunities for physical activity and social interaction
114 September Brown EJ 10.3233/JPD-202249 2020 USA From April 23 to May 23, 2020 To understand the symptoms and outcomes of SARS-CoV-2 infection in people with and without PD to determine how the disease may affect people with PD differently, to determine the effects of COVID-19 on motor and non-motor symptoms related to PD, to understand the effects of the pandemic and associated public health measures on people with and without PD. Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Parkinson Disease 7209 N/A N/A Healthy subjects. Answer to Fox Insights survey. N/A N/A N/A N/A N/A N/A The survey, administred to 7209 subjects (5,429 people with PD and 1,452 without PD), showed that 51 people with PD and 26 without PD were diagnosed with COVID-19. Complications were more frequent in people with longer PD duration. The vast majority of people with PD did not have COVID-19, yet most reported significant disruptions in many aspects of their daily lives. Disruptions were more common for those living alone, with lower income and non-white race.
115 September Cao X 10.2147/JPR.S274199 2020 China January-July,2020 To describe clinical features, treatments and outcome of herpes zoster and postherpetic neuralgia in a 70-year-old woman with critical COVID- 19. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Sensory functions and pain b2) Post-acute COVID-19 developing Herpes zoster 1 N/A Intravenous and then oral acyclovir; Pregabalin and ibuprofen was used for analgesia N/A N/A N/A N/A N/A N/A N/A N/A This is a case of 70-year-old woman who developed herpes zoster in the right 10 to 12 lumbar dermatomes in the recovery period of COVID-19 (about 7 weeks after symptoms onset) . The lesions resolved 21 days after the onset of rash but she continued to have persistent pain in the same dermatomal distribution. 4 months after herpes zoster eruption, the patient still complained intermittent pain in the dermatomes. It is reported that herpes zoster cases substantially increase during COVID-19 pandemic. For COVID-19 patients with herpes zoster, antiviral treatment should be started as early as possible and lastlonger than a typical course. The use of analgesics should be based on the dermatome involved, severity of pain and the comorbidities.
116 September Carroll E 10.1111/epi.16683 2020 USA March 2020 To describe a case of refractory status epilepticus (RSE) after recovery from acute COVID-19 Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 1 Refractory status epilepticus Lorazepam, Levetiracetam, Clonazepam, Lacosamide, Midazolam, steroids and intravenous immunoglobulin N/A N/A N/A N/A N/A N/A N/A N/A The paper describe the clinical history of a 69-years-old with previous history of diabetes and consequent severe nephropathy necessitating a renal transplant. He developed COVID-19 and was admitted in ICU for severe hypoxia that needed mechanical ventilation. On day 2 of hospitalization she had a 2-minute episode of spontaneous, symmetric, tonic movements of her arms and left gaze deviation without reported head turn that resolved with Lorazepam. 6 weeks after hospiltazion, after improvement of her clinical conditions and discharge to sub-acute rehabilitation she developed refractory status epilecticus. Her clinical condition improved after therapy with steroids and intravenous immunoglobulin.
117 September Cavalagli A 10.23736/S1973-9087.20.06452-7 2020 Italy April - June 2020 To report a case of cranial nerves impairment in post-acute oropharyngeal dysphagia after COVID-19 Descriptive: Case Report General postacute rehabilitation Epidemiology - Clinical presentation Digestive functions (b510) Post-acute COVID-19 patient 1 Involvement of both sensitivity and motor IX and X CNs components, selective sensitivity right impairment of V in lingual nerve component and impairment of right XII, resulting in mild dysphagia. Rehabilitation program with objective to regain endurance, strength, independence and swallowing (exercises to improve base tongue strength and pharyngeal movements), coordination and coughing, until functional swallows with ice chips and airway protection exercises N/A POMA, MBS, IOPI, FOIS, DOSS, I&I Test N/A N/A N/A N/A N/A N/A I&I test, a useful scale to detect the major deficits affecting the cranial nerves in patients with swallowing disorders, showed gradual and partial recovery after rehabilitation. Moreover, the patient was able to walk for short distances without O2 therapy after 30 days. The patient started a complete oral feeding with pureed food and water with protective maneuvers after 40 days. This case report could expand knowledge about clinical picture after COVID-19, taking into account that cranial, particularly bulbar nerves might be involved as late complications
118 September Chan JL 10.1007/s11102-020-01080-w 2020 USA N/A To report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 pregnant female 1 Blurry vision, left dilated pupil, and headache corticosteroid administration and surgery N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a 28-year-old pregnant female (38weeks 1day) presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection. She presented with 4 days of blurry vision, left dilated pupil, and headache. She had central hypothyroidism and a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy at MRI. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. She made a full recovery and was discharged home two days after surgery.
119 September de Havenon A 10.1136/neurintsurg-2020-016777 2020 USA April-July 2020 To compare the outcome of acute ischemic stroke patients who received EVT with confirmed COVID-19 to those without. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute EVT-treated acute ischemic stroke patients with comorbid COVID-19 3165 (104 with confirmed COVID-19) N/A EVT-treated acute ischemic stroke patients with COVID-19. . EVT-treated acute ischemic stroke patients without COVID-19. Moreover, as a sensitivity analysis, the authors compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection. in-hospital death, favorable discharge, defined as a discharge to home or acute rehabilitation N/A N/A N/A N/A N/A N/A In AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19. Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. However, AIS EVT patients with COVID-19 had a near-identical rate of death as 2139 AIS patients who did not undergo EVT but had COVID-19, suggesting the higher rate of adverse outcomes was inherent to COVID-19 infection. These results argue that eligible AIS patients with COVID-19 should receive EVT, given the overwhelming benefit of that intervention.
120 September De Paulis M 10.1097/INF.0000000000002834 2020 Brazil N/A To report the case of a 4-year-old child with a post-infectious multisystem inflammatory syndrome associated with COVID-19 Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 1 Somnolence and mental confusion (Glasgow coma score 11), a mild multiforme skin rash on trunk and legs, cracked lips, and swelling of palpebrae, hands, and feet. Intubation, dobutamine, antibiotics, Acyclovir, intravenous immunoglobulin N/A N/A N/A N/A N/A N/A N/A N/A Thi is the case of a 4-year-old child with a post-infectious multisystem inflammatory syndrome associated with COVID-19, presenting with shock, Kawasaki-like and neurologic dysfunction (somnolence, lethargia, mental confusion) for whom a cytokine storm and decreased levels of BDNF were well documented. The girl was discharged home, fully recovered after 17 days from skin rash onset. The development of a cytokine storm, either during or following SARS-CoV-2 infection, is strongly suspected as the main feature in the pathogenesis of the multisystem inflammatory syndrome. The causal relationship between reduced BDNF and neurologic symptoms in patients with COVID-19, as well as the long- term consequences on neurocognitive function in children, remains to be elucidated and should be further explored.
121 September Di Gennaro F 10.4084/MJHID.2020.063 2020 Italy From March, 2020 To report outcomes and clinical features of a cohort of 14 patients who had been admitted to a Neurorehabilitation Unit and subsequently found to be positive for SARS-CoV-2 infection on nasopharyngeal swabs. Analytical: Cohort study Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Patients with severe neurological disabilities developing COVID-19 14 One out of 14 patients (7%) developed severe manifestations of COVID-19 (BCRSS=3) starting with fever, cough, and dyspnea, followed by a rapidly evolving acute respiratory distress syndrome. The other 13 patients did not present fever, respiratory symptoms, or oxygen desaturation on both pulse oximetry and blood gas analysis (BCRSS=0). Symptomatic patient: oxygen therapy, Lopinavir/Ritonavir, Hydroxychloroquine, enoxaparin. Asymptomatic patients: enoxaparin. N/A Clinical outcome. N/A N/A N/A N/A N/A N/A The study describe 14 patients suffering from severe neurological disabilities, who tested positive for SARS-COV-2 during inpatient neurorehabilitation. Out of 14 patients, only 1 developed symptomatology and was consequently treated. However, he developed acute respiratory distress, leading to exitus. All the other patients did not develop symptomatology and consequently recovered.
122 September Garnero M 10.1016/j.jns.2020.117114 2020 Italy February - May 2020 To report the natural history of patients with GBS, both COVID and not-COVID related, hospitalized in Liguria region, during lock down period, evaluating possible managements pitfalls due to pandemic emergency. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients with GBS 6 Dysphagia and dysphonia were present in 3 patients; arterial pressure instability in 1 patient; paralytic ileus in 1 patient; bradycardia in 1 patient IVIG 9 GBS patients without COVID-19 MRC score, GBS-DS N/A N/A N/A N/A N/A N/A Multi-organ involvement, delay in the diagnosis, incomplete work up and start of therapy, were registered in 50% of cases with a GBS-Disability scale ≥4 at follow-up evaluation. In not-COVID-19 related GBS, main problem was diagnostic delay. The Authors concluded that not only SARS-COV-2 infection can cause GBS, but it can also indirectly, due to effects of pandemic on the health organization, affect the outcome of patients with not-COVID-19 related GBS.
123 September Gaspari CH 10.1093/ptj/pzaa175 2020 Brazil From March to May, 2020 To describe the role of physical therapists in a neurosurgical center that was converted into a COVID-19 center for critically ill patients. Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 116 N/A Proning, respiratory and neuromuscular rehabilitation. N/A Discharge setting. N/A N/A N/A N/A N/A N/A During COVID-19 outbreak a brazilian public neurosurgical center was reallocated for treatment of COVID-19 patients. Physical therapists were heavily involved since acute stage of the disease, coordinating proning, and later in helping patient to regain physical function. Of the 116 patients treated, 49% of patients died, 3% were transferred to another institution, 20% were discharged home and 28% continued hospitalization.
124 September Grewal P 10.3389/fneur.2020.00910 2020 USA March - April 2020 To report on patients with acute ischemic stroke and concomitant COVID-19 in a diverse patient population Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients with AIS 13 Most strokes were cortical (84.6%) and more than 50% of patients had no identifiable source, and were categorized as embolic stroke of unknown source N/A Historic patients with AIS without COVID-19 admitted in the same time frame in 2019 and 2020 NIHSS, mRS N/A N/A N/A N/A N/A N/A A trend toward less alteplase administration was noted in the COVID-19 stroke patients compared to the non-COVID group from 2020 and 2019 (7.1 vs. 20.7% p 0.435 and 7.1 vs. 27.2% p 0.178). Endovascular thrombectomy was performed in 3 (23%) patients. Eight patients (63.8%) were discharged home or to acute rehabilitation, and two deceased from COVID-19 complications. Five patients were discharged to Acute Rehabilitation Units
125 September Hallifax RJ 10.1136/bmjresp-2020-000678 2020 UK From March to May, 2020 To describe the first 48 patients admitted to a respiratory HDU, requiring additional respiratory support. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 48 N/A Respiratory support: CPAP, HFNO, or NIV. N/A Discharge setting. N/A N/A N/A N/A N/A N/A The study describe 48 patients admitted to a HDU because of COVID-19. Patients were transferred to HDU if there was an increasing oxygen requirement, or an absolute oxygen requirement of: either FiO2≥40% or ≥8 L/min via mask face. Of the 48 patients, 11 (22.9%) were successfully managed with respiratory support in HDU alone and were discharged home, 26 (54.2%) patients died, 11 (22.9%) required ICU admission for intubation and invasive ventilation. Awake proning was attempted in 30/48 (62.5%) patients. Successful proning was achieved in 11/30 (36.7%), and semiproning in 17 (56.7%) patients. Achievement of full proning was associated with lower mortality than failed or semiproning in the HDU setting.
126 September Jiandani MP N/A 2020 India From June 5th to July 5th, 2020 To describe how COVID-19 patients received physiotherapy interventions in acute care setup of a tertiary hospital in Mumbai. Descriptive: Historical cohort Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 300 N/A Rehabilitation program in ICU and a step-down unit. N/A ICU Mobility Scale, Oxygen Support Needed N/A N/A N/A N/A N/A N/A During ICU and step down unit stay patients underwent respiratory rehabilitation, and their clincal condition improved in the first 7 days of stay in all the outcome considered. Namely, ICU mobility scale improved in a statistical significant way, and, as far as oxygen support needed is concerned, 23.1% of patients using face mask and nasal prongs were weaned to room air, 32.8% of patients using non rebreather masks were weaned to face mask and nasal prongs, 31.3% on non invasive ventilation were weaned to non rebreather masks or face mask,while where was no change in intubated patients. However, 30.8% of patents on face mask and nasal prongs, 18.8% on non rebreather masks, 6.3% on non invasive ventilation had increased oxygen requirement. Early physiotherapy intervention seems to be beneficial for restoring ambulation and assuring early discharge in severe COVID-19 patients.
127 September Johnson JK 10.1093/ptj/pzaa181 2020 USA From beginning of pandemia to June 10, 2020 To examine the relationship of physical therapy visit frequency and duration in the hospital with patients’ mobility status at discharge and probability of discharging home Descriptive: Historical cohort Rehabilitation in acute care Micro - Interventions (efficacy/harms) Any Activity limitation and participation restriction (d) Acute COVID-19 312 N/A Physical therapy visit N/A Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility (JH-HLM) scales, Discharge to home vs. to a facility N/A N/A N/A N/A N/A N/A The frequency of physical therapy visits in acute care hospitals was variable with a mean of 0.5 visits per day (ie, one visit every other day), but which ranged from 0.1 to 1.5. The mean visit duration was 25.3 minutes. Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. Physical therapy should be an integral component of care for patients hospitalized due to COVID-19 (more frequent and longer physical therapy visits)
128 September Lampe A 10.1186/s42466-020-00066-0 2020 Germany March 2020 To report the case of a 65-years old man infected with SARS-CoV-2 and acutely presented with typical symptoms of Guillain-Barré syndrome Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Distally accentuated paresis of the right arm and a slight paraparesis of the lower limbs. No sensory deficits. Deep tendon reflexes reduced generally. intravenous immunoglobulin and physioteraphy N/A N/A N/A N/A N/A N/A N/A N/A This study described a case of a 65-years old man infected with SARS-CoV-2 with Guillain-Barré syndrome. 5 days-treatment with IVIG in combination with physiotherapy quickly led to a significant improvement in GBS symptoms. The patient was discharged from the hospital 12 days after admission without residual paresis.
129 September Malik GR 10.1016/j.bja.2020.08.045 2020 USA From April 24, 2020 to June 30, 2020, To describe 11 patients who were diagnosed with acquired peripheral nerve injury in association with the use of prone positioning for COVID-19-related ARDS. Descriptive: Case Series General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 with ARDS developing peripheral nerve injuries 11 peripheral nerve injury N/A N/A N/A N/A N/A N/A N/A N/A N/A Out of 83 patients admitted to rehabilitation hospital after hospitalisation for COVID-19- related ARDS, 12 patients (14.5%) were diagnosed with peripheral nerve injury. All but one patient had a confirmed history of prone positioning in acute care (91.7%). In total, there were 21 focal peripheral nerve injury sites across these 12 patients and one newly acquired distal symmetric polyneuropathy. The majority of these peripheral nerve injuries occurred in the upper limb (76.2%). Peripheral nerve injury after prone positioning for management of severe COVID-19-related ARDS patients is surprisingly common. Physicians must be aware of an increased susceptibility to peripheral nerve injury in severe COVID-19 and refine standard protocols in order to reduce the risk.
130 September McWilliams D 10.1513/AnnalsATS.202005-560OC 2020 UK March and April, 2020 To describe the demographics, clinical status, level of rehabilitation and mobility status at ICU discharge of patients with COVID-19 Analytical: Cohort study Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 177 N/A N/A N/A Manchester Mobility Score N/A N/A N/A N/A N/A N/A The present study focused on patients admitted to ICU and mechanical ventilated for longer then 24 hours. Out of 177 patients, 110 survived to discharge. The mean time at first mobilization was 14 ± 7 days, with a median Manchester Mobility Score at ICU discharge of 5 (interquartile range: 4-6), which represents participants able to stand and step round to a chair with or without assistance. The study showed that it is possible to practice rehabilitation in ICU, but not at the time of admission because of the severity of the clinical conditions of the patients. Because of the weakness and high levels of delirium acquired during ICU stay, rehabilitation looks to be necessary in an hospital setting, and this should be taken into account in planning for the care of COVID-19 patients.
131 September Nakayama A 10.1186/s12199-020-00885-2 2020 Japan From January, 2019, to May, 2020 To demonstrate the effectiveness of a remote cardiac rehabilitation program. Analytical: Cohort study Specialized postacute rehabilitation Meso Level Cardiovascular functions (Heart b410) N/A Hospitalized patients suffering from heart failure 236 N/A Home-based tele cardiac rehabilitation. Outpatient cardiac rehabilitation and non cardiac rehabilitation groups EQD-5 at discharge and 30 days after discharge, emergency readmissions. N/A N/A N/A N/A N/A N/A In this study post-hospitalization patients suffering from heart failure could choose between remote, outpatient or non cardiac rehabilitation. Patients who underwent remote rehabilitation showed better quality of life after the treatment and lower rate of emergency readmission.
132 September Negrini F 10.1016/j.apmr.2020.09.376 2020 Italy From March 3rd to April 8th, 2020 To report the cognitive features of severe COVID-19 patients in the post- acute phase, to understand whether COVID-acute respiratory distress syndrome itself could result in long-term cognitive deficits and whether neuropsychological treatment might represent a specific rehabilitation need. Descriptive: Case Series Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 9 N/A N/A N/A Mini-Mental State Examination Test. N/A N/A N/A N/A N/A N/A A general cognitive decay was observed in three patients (33.3%) as for MMSE score. The cognitive decline was negatively correlated to the length of stay (in days) in the ICU. Some COVID-19 patients might benefit from a neuropsychological rehabilitation, especially the patients who are treated in the ICU care.
133 September Pironi L 10.1016/j.clnu.2020.08.021 2020 Italy April 2020 To know the prevalence of malnutrition as well as the provided nutritional therapy in COVID-19 patients Analytical: Cross-sectional study N/A Epidemiology - Prevalence Digestive functions (b510) Post-acute COVID-19 268 N/A N/A N/A Patient nutritional assessment N/A N/A N/A N/A N/A N/A A total of 268 patients was evaluated: intermediate care units (61%), sub-intensive care units (8%), intensive care units (17%) and rehabilitation units (14%).
  • This study showed a very high prevalence of nutritional risk (77.2%, higher in ICUs and rehabilitation units) and malnutrition (49.7%, higher in ICUs) in adult patients hospitalized for COVID-19.
  • Hospital Diet intake <50% of the prescribed diet was observed in 39% (higher in intermediate care units and ICUs); oral nutritional supplement, enteral and parenteral nutrition were prescribed to 6%, 13% and 5%, respectively.
  • The frequency of nutritional risk, malnutrition, disease/inflammation burden and decrease intake of hospital diet differed among the intensity of care settings, where the patients were managed according to the severity of the disease.
  • The patient energy and protein intake were at the lowest limit or below the recommended amounts, indicating the need for actions to improve the nutritional care practice.
134 September Priftis K 10.1007/s10072-020-04768-w 2020 Italy April 2020 To investigate the specific and focal neuropsychological consequences of SARS-CoV-2 in a patient affected by left emisphere stroke Descriptive: Case Report General postacute rehabilitation Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 patient with stroke 1 Patient presented mild interstitial pulmonary signs at chest X-ray scan and antibodies for SARS-CoV-2 at serological tests. She showed showed some signs of conduction aphasia and impairment in writing. N/A N/A Language, number processing and calculation tests N/A N/A N/A N/A N/A N/A The patient had a largely intact neuropsychological profile, except for the presence of severe agraphia and some signs of conduction aphasia. These deficits were fully compatible with the presence of a temporo-parieto-insular lesion documented by FLAIR MRI. The authors suggested that COVID-19 patients and stroke might not only show diffuse neurocognitive and neurobehavioural signs (e.g. confusion, agitation, psychosis), but they can also present with highly focal neuropsychological disorders, such as agraphia and conduction aphasia.
135 September Ramalingam MB 10.1097/PHM.0000000000001606 2020 Singapore From February to April, 2020 To describe the case of a severe COVID-19 patient undergoing rehabilitation. Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1 Respiratory insufficiency, recurrent pneumonia, proximal myopathy, post-critical illness musculoskeletal deconditioning, bilateral hand tremors from weakness, pulmonary deconditioning, poor endurance and effort tolerance, moderate oropharyngeal dysphagia, psycho-emotional issues, fatigue, poor appetite. Respiratory and muskoloskeletal rehabilitation. N/A FIM, PHQ-9, 6MWT N/A N/A N/A N/A N/A N/A The case study described a 64 years-old severe COVID-19 patient who needed mechanical ventilation and tracheostomy during the acute phase. He was later discharged to an inpatient rehabilitation ward where he underwent a comprehensive rehabilitation program. After 10 days of rehabilitation botrh autonomy, measured using FIM, and endurance, measured using 6MWT were improved and the patient was discharged.
136 September Slessarev M 10.1007/s12630-020-01661-0 2020 Canada N/A To propose HFNC combined with patient self-proning in a COVID-19 patient with hypoxemia and normal work of breathing. Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Bilateral Pneumonia, hypoxemia and normal work of breathing. HFNC combined with patient self-proning N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a 68-yr-old COVID-19 patient with bilateral pneumonia that rapidly worsened, who was placed in a negative pressure room, treated with HFNC and instructed to self-prone via telephone by lying with his chest down for as long as possible. Total proning time was 16–18 hr each day. The patient felt better while prone and this positioning resulted in cyclical improvements in his oxygenation. The patient was discharged to a dedicated COVID-19 ward after 4 days without requiring intubation. HFNC combined with patient self-proning can be broadly applied in COVID-19 patients with hypoxemia and normal work of breathing. In addition to preserving ventilator capacity in resource replete settings, this care approach would have important applications to resource-limited countries where sophisticated ICU techniques may not be available.
137 September So H 10.1016/j.semarthrit.2020.07.012 2020 Hong Kong From 23 January, 2020 to 27 May, 2020 To examine the incidence and outcomes of all COVID-19 patients with rheumatologic conditions in Hong Kong. Descriptive: Case Series N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Acute, post-acute, late-onset, or permanent on a pre-existing health condition COVID-19 patients with underlying rheumatologic diseases 5 N/A N/A Incidence of COVID-19 in the general population in Hong Kong; clinical course Incidence of COVID-19 in patients with rheumatologic conditions N/A N/A N/A N/A N/A N/A Out of the 39,835 patients with underlying rheumatologic diseases, there were 5 PCR confirmed COVID-19 cases with inflammatory arthropathies. The estimated incidence of COVID-19 was 0.0126% patients with rheumatologic diseases, compared to 0.0142% in the general population.
  • All patients made uneventful recovery without complications or flare of underlying diseases.
  • The results support avoidance of interrupting immunosuppressive therapies, at least before COVID-19 is diagnosed.
The authors found no alarming signals of increased frequency or severity of COVID-19 in patients with rheumatologic diseases. Whether rheumatologic disease is a poor prognostic factor for COVID-19 is debatable. In this study, the disease courses of the 5 patients with COVID-19 were largely uneventful.
138 September Sparr SA 10.1161/STROKEAHA.120.030434 2020 USA late April 2020 To report cases of infarction of the Splenium of the Corpus Callosum in the Age of COVID-19 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 4 Encephalopathy Three patients underwent hemodialysis and ventilator; one patient was treated with high flow oxygen, apixaban, hydroxychloroquine, and steroids N/A N/A N/A N/A N/A N/A N/A N/A During a 2-week period 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. Two patients improved and were discharged to acute rehabilitation. In one patient the mental status remained depressed and the last one died. -This small series of patients with an uncommon locus of injury suggests COVID-19 as an inciting agent,with the mechanisms to be elucidated.
139 September Stierli S 10.2340/16501977-2735 2020 Switzerland N/A To describe the case of a 62 year-old man with severe acute respiratory distress syndrome due to Covid-19 treated with dysphagia therapy and speech therapy and the use of ventilator-compatible speaking valves Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 N/A dysphagia and speech therapy, ventilator-compatible speaking valves N/A N/A N/A N/A N/A N/A N/A N/A The case report describes the case of a 62 year-old man with severe acute respiratory distress syndrome due to Covid-19. He presented with critical illness polyneuromyopathy, ventilator- associated diaphragm dysfunction, weaning failure, tracheotomized from 6 weeks, and completely mechanically ventilated with inflated cuff, nasogastric tube. In close collaboration between the speech-language therapists and intensive care nurses, a ventilator-compatible valve could be inserted and the speech therapy started. This led a gradual improvement in speaking and swallowing. Four weeks after admission to the ICU, it was possible to safely remove the patient’s nasogastric and tracheostomy tubes. Early intervention with dysphagia therapy and speech therapy and ventilator-compatible speaking valves, provided within an interprofessional collaborative team, can mitigate the potentially negative consequences of prolonged intubation, long-term use of cuffed tracheostomy, and post intensive care syndrome resulting from Covid-19.
140 September Ticinesi A 10.1007/s40520-020-01699-6 2020 Italy March - April 2020 To assess the incidence of delirium in a large number of patients hospitalized for suspect COVID-19 in Northern Italy, verify its clinical correlations and determine its impact on in-hospital mortality Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Acute Patients with suspect COVID-19 presenting with delirium 94 Patients with delirium presented more frequently atypical symptoms such as syncope, postural instability and thoracic pain (26% vs 16%; p=0.02), lower oxygen saturation values in room air (90% vs 93%; p=0.049), and lower functional autonomy in daily activities (31% vs 63%; p=0.02) N/A 758 patients with suspect COVID-19 without delirium Clinical and laboratory characteristics N/A N/A N/A N/A N/A N/A Ninety-four patients (11%) developed delirium during stay. At multivariate models, delirium was independently and positively associated with age [OR 1.093, 95% CI 1.046–1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204–17.027, p=0.025) at admission. The authors concluded that delirium could represent a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity.
141 September Trifan G 10.1016/j.jstrokecerebrovasdis.2020.105314 2020 USA March - May 2020 To describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex and vascular risk factors on outcome Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients with stroke 83 The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARSCoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p=0.04). N/A N/A Clinical characteristics, stroke onset, NIHSS, mRS N/A N/A N/A N/A N/A N/A Compared with females, males had higher mortality (38% vs. 13%; p=0.02) and were less likely to be discharged home (12% vs. 33%; p=0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR=1.47, 95% CI=1.03-2.09). The large majority of our patients had pre-existing VRFs and manifested changes in laboratory markers of inflammation and coagulability
142 September Vadukul P 10.1136/bcr-2020-238168 2020 UK N/A To report the case of a 52-year-old woman with COVID-19 pneumonitis who developed an acute massive pulmonary embolism, a week after the home discharge. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1 Acute massive pulmonary embolism with severe respiratory and cardiac failure intravenous thrombolysis N/A N/A N/A N/A N/A N/A N/A N/A TThe COVID-19 patient (obesity and undiagnosed type 2 diabetes mellitus) required mechanical ventilation for nearly 2 weeks.
  • Her condition improved, so after rigorous physiotherapy and step-down to the ward, she was discharged home after a total 3-week inpatient stay. During her hospitalisation she was given prophylactic dose anticoagulation.
  • Following a week at home, she was readmitted with acute massive pulmonary embolism.
  • After emergency care and thrombolysis she made a rapid recovery and with a long-term anticoagulation therapy was discharged after 5 days.
  • This case highlighted the increased thrombogenicity seen during infection and the potential need for extended anticoagulation following recovery particularly in those patients with severe illness and pre-existing risk factors.
143 September Vaes AK 10.3390/jcm9092946 2020 Netherlands and Belgium June 2020 To explore the level of care dependency in ADLs and the need for assistance with personal care in non-hospitalized COVID-19 patients Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any Activity limitation and participation restriction (d) Post-acute Non-hospitalized mild COVID-19 patients 1837 A high proportion of patients experienced long-term symptoms, including fatigue (98%), muscle weakness (90%), sleeping problems (88%), and pain (87%). Online questionnaire adminstered through Facebook N/A Clinical characteristics, USD, CDS N/A N/A N/A N/A N/A N/A The care need increased significantly after COVID-19 infection (7.7% vs 52.4%; p <0.05). Patients had a median CDS score=72, and 31% of the patients were considered as care-dependent (CDS score= 68). The authors concluded that the impact of COVID-19 on patients’ daily lives is tremendous, and more attention is needed to identify optimal treatment strategies to restore patients’ independency.
144 September Van Aerde N 10.1007/s00134-020-06244-7 2020 Belgium From March 13th to June 8th, 2020 To assess the incidence of ICU acquired weakness in critically ill COVID-19 patients, to identify factors associated with its occurrence, and to describe its short-term outcomes. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 74 N/A N/A N/A The incidence of ICUAW (MRC-sum score)at awakening, at ICU and hospital discharge; factors and short-term outcomes associated with weakness at ICU discharge N/A N/A N/A N/A N/A N/A -ICU Mortality in IMV patients was 11/74. -In 50/74 (67.6%) assessed IMV patients, the incidences of ICUAW at awakening, ICU, and hospital discharge were 72%, 52% and 27%. Weak patients had prolonged ventilation, higher mean morning glycemia, more frequently received dialysis, and had higher exposure to corticosteroids, sedatives and analgesics, except for dexmedetomidine, and NMBA. Weak patients had longer ICU stays and lower mobility scores at ICU discharge. Handgrip-strength, and Barthel at hospital discharge (8 versus 10.5) remained lower in weak patients. 15/26 (57.7%) weak versus 6/24 (25%) not-weak patients were referred for in-patient rehabilitation. -The ICUAW incidence in IMV patients is high and the impact on functional status remained substantial. -These data highlight the need for follow-up of post-ICU COVID-19 patients, to offer tailored rehabilitation, hopefully reducing long-term impact.
145 September Wijeratne T 10.7759/cureus.10366 2020 Australia March-April 2020 To describe the case of a 75-year-old man with COVID-19 complicated with severe neurological symptoms during the prolonged intensive care unit stay followed by recovery from both respiratory and neurological involvement. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 acute ischemic stroke-like symptoms and raised intracranial pressure invasive mechanical ventilation, anticoagulation, neurorehabilitation N/A N/A N/A N/A N/A N/A N/A N/A -This study illustrates the case of a 75 years old patient with COVID-19 complicated with severe neurological symptoms (acute ischemic stroke-like symptoms) during the prolonged intensive care unit stay (at day 26) followed by slow neurorehabilitation and normal recovery from both respiratory and neurological involvement. -The onset of acute stroke-like symptoms appears to be closely associated with changes of neutrophil-lymphocyte ratio and in C-reactive protein, and D-dimer levels, suggesting that a COVID-19-induced hyperimmune response led to significant inflammatory injury to the brain and suspected intracranial hypertension. -This highlights the critical clinical value of regular assessment of NLR, LCRPR (Lymphocyte to CRP Ratio) and LPR (lymphocyte to platelet ratio) which are low-cost prognostic tools available in almost all health services across the world.
146 September Zito A 10.3389/fneur.2020.00909 2020 Italy N/A To describe a case report with an axonal variant of GBS following COVID-19, and to review the available reports in the literature on other GBS cases related to SARS-CoV-2 infection Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 patient with GBS 1 Weakness in dorsiflexion of the foot, extension of the toes, extension of hand and fingers, and gait ataxia at the baseline IVIG cycle at 0.4 g/kg/day over 5 days; at the discharge, the patient underwent rehabilitation N/A N/A N/A N/A N/A N/A N/A N/A After IVIG cycle at 0.4 g/kg/day over 5 days, there was a significant improvement of the weakness in the upper limbs and the left foot but a poor benefit on the right foot and gait ataxic. After rehabilitation treatment, he slowly improved and he was able to walk without aid and was discharged at 1 month.
147 October Beathe JC 10.1177/2333721420956766 2020 USA N/A To describe the case of a 100-year-old COVID-19 hip fracture patient undergoing spinal anesthesia for hemiarthroplasty and subsequent hydroxychloroquine therapy Descriptive: Case Report N/A Epidemiology - Clinical presentation Any other body structure and function-generic (s/b) Acute COVID-19 patient with hip fracture 1 She had a baseline exercise tolerance <4 METs, complaining of a mild headache and denying shortness of breath, cough, fever, or chills. Initial oxygen saturation was 99% on 2 L/min oxygen via nasal cannula The patient tolerated the spinal anesthesia (performed at the L4-L5 level with bupivacaine 0.5%, 2.5 mL) without complications. Prior to incision, intravenous cefazolin (1000 mg) and tranexamic acid (10 mg/kg) were administered. Ninety minutes into the 130 min-long procedure, 20 mcg of fentanyl was administered. After the intervention, the patient underwent physical therapy from POD1, progressing from transferring to the edge of bed , completing sit-to-stand transfer and marching in place (on POD 2), to walking with moderate assistance six steps to bedside (on POD 7), when she was discharged to a Rehabilitation service N/A N/A N/A N/A N/A N/A N/A N/A A 100-year-old COVID-19 patient with displcaed left femoral neck fracture was able to undergo hemiarthroplasty and subsequent hydroxychloroquine therapy. The authors concluded that asymptomatic or mild COVID-19 might not present a prohibitive additional risk to operative hip fracture management among patients at otherwise high risk for perioperative complications.
148 October Bekelis K 10.1161/STROKEAHA.120.031217 2020 USA From January to April 2020 To investigate the association between COVID-19 and stroke. Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 and stroke 24808 N/A N/A COVID-19 without stroke Occurrence of new-onset stroke, case-fatality and discharge to rehabilitation for patients presenting with acute ischemic stroke. N/A N/A N/A N/A N/A N/A This study is based on 24808 discharged patients in New York State. 2513 subjects (10.1%) were diagnosed with COVID-19, and 566 (0.2%) presented with acute ischemic stroke. The authors did not observe a positive association of COVID-19 and ischemic stroke among patients of all ages. Patients with stroke with concurrent SARS-CoV-2 infection dem- onstrated increased case-fatality and a trend more discharge to rehabilitation. These findings do not support the concerns for an epidemic of stroke in young adults with COVID-19.
149 October Belghmaidi S 10.12659/AJCR.925897 2020 Morocco N/A To report the case of a COVID-19 patient that developed incomplete unilateral palsy of the third cranial nerve during the acute phase of the disease. Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Fever, dry cough, anosmia, strabismus and diplopia of the left eye. Chloroquine, azitrhomycin, vitamin C, zinc. N/A N/A N/A N/A N/A N/A N/A N/A The case-study describe a 24-year-old woman who developed exotropia, strabismus (that incresed in abduction) and diplopia of the left eye during acute phase of COVID-19 disease. After starting the therapy for COVID-19 the symptoms quickly improved, and after three days issues with the left eye were resolved. The case-study shows the possibility of transient unilateral diplopia and strabismus during COVID-19 acute phases.
150 October Bourguignon A 10.1016/j.thromres.2020.10.017 2020 Canada From March 2020 until June 27th 2020 To investigate incidence of thrombotic outcomes for patients hospitalized and discharged after COVID-19 infection Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Prevalence Any other body structure and function-generic (s/b) Late-onset COVID-19 454 N/A N/A N/A Incidence of arterial and venous thrombotic complications N/A N/A N/A N/A N/A N/A Of the 454 patients hospitalized with COVID-19 infection, 285 were admitted exclusively on the ward, 78 were admitted in the ICU, 91 patients were admitted to a COVID-19 rehabilitation ward. Thromboprophylaxis was administered to 91,2% of the ward population, 96,2% of the ICU population and 88% of the rehabilitation ward population. The incidence of arterial and venous thrombotic complications were 2,5% and 1,8% in the ward population, 3,9% and 21% in the ICU population. In the inpatient rehabilitation cohort, only one patient was found to have a pulmonary embolism. A cohort of 175 patients (140 patients were discharged from the medical ward and 35 from the rehabilitation ward) were assessed at follow up at 60-68,5 days. Overall, only one patient discharged from the hospital ward presented a pulmonary embolism 9 days after discharge. The incidence was 0% in patients discharged from the rehabilitation ward. Globally, this data suggests that even if acutely infected COVID-19 patients have a high incidence of thromboembolic complications, the risk diminishes quickly after the acute phase. This population should not systematically require prolonged thromboprophylaxis until prospective randomized trials are performed in this setting.
151 October Busillo V N/A 2020 Italy March - April 2020 To report a case of Guillain-Barrè syndrome in a 75-year- old female associated with SARS-CoV2 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient with GBS 1 The patient presented with fever and positive oropharyngeal swab for SARS-CoV-2. In ICU, after interruption of sedation, she showed tetraparesis (MRC scale 1/5 at upper and lower extremities) with generalized areflexia. She was treated with lopinavir/ritonavir and hydroxychloroquine; then, she was transferred to ICU, where started mechanical ventilation and received tocilizumab beyond antiviral drugs. After improvement, she underwent extubation. After diagnosis of GBS, the patient started IVIG at the dosage of 400 mg/kg for 5-day course. N/A N/A N/A N/A N/A N/A N/A N/A The patient showed a marked hyposthenia of upper and lower limbs (MRC: 1/5) with generalized areflexia. Cerebrospinal fluid examination showed normal cell count with increased protein level (130 mg/dL), suggestive of GBS, and she was treated with IVIG. The authors concluded that GBS should be considered by clinicians as possible complication of COVID-19 patient, requiring a rapid starting of IVIG or plasmapheresis. Cerebrospinal fluid examination showed normal cell count with increased protein level (130 mg/dL, normal range: 15-45 mg/dL) as in inflammatory polyneuropathy. The electromyographic test showed a severe decrease in compound muscle action potential amplitude, an increased motor distal latency with reduced conduction velocity and F waves absenceù
152 October Chia KX 10.1136/bcr-2020-237926 2020 UK March 2020 To report the case of a young patient with COVID-19 central nervous system vasculopathy and stroke Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Reduced Glasgow Coma Scale score, right-sided weakness with hemi- sensory loss and diplopia, paranoia, irritability, aggression, disinhibition, and cognitive impaiment antipsychotics, rehabilitation N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease (day 8) the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome requiring treatment with antipsychotics and transfer to neurorehabilitation. There was a fast resolution of the neuropsychiatric picture with mild residual cognitive impairment. Early brain imaging in COVID-19-positive patients with neuropsychiatric symptoms is of great importance to detect possible cerebrovascular events even in patients outside the ‘at risk’ group. Neuropsychological/neuropsychiatric evaluation in patients of working age with COVID-19 with suspected central nervous system involvement is highly desirable to facilitate access to cognitive rehabilitation and vocational therapy, and increase the chances of a successful return to employment.
153 October Daher A 10.1016/j.rmed.2020.106197 2020 Germany February - May 2020 To investigate pulmonary impairments, as well as the prevalence of other organ dysfunctions and psychological disorders in patients with COVID-19 six weeks after discharge from hospital. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 33 N/A N/A N/A Full pulmonary function tests, blood samples, electrocardiography, transthoracic echocardiography,PHQ-9, GAD-7, SGRQ, EQ-5D-5L, 6MWT, Borg scale N/A N/A N/A N/A N/A N/A Hospitalized COVID-19 patients not requiring mechanical ventilation at six weeks after discharge from hospital did not reveal pulmonary function limitations, echocardiographic impairments or thromboembolic complications. However, fatigue is a common symptom (45%) with significant limitations of mobility, which was also reflected by reduced 6MWT distance.
154 October De Lorenzo R 10.1371/journal.pone.0239570 2020 Italy From February 25, 2020, to May 7, 2020 To investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 185 N/A N/A N/A Primary outcome: need of follow-up, defined at the presence at follow up of at least one among: RR > breaths/min, uncontrolled BP, requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Secondary outcome: PTSD. N/A N/A N/A N/A N/A N/A The patients included in the study were analyzed after a median follow-up of 23 days (range 20-29) of discharge. Many patients, despite apparent clinical recovery at discharge, had clinically relevant medical problems when evaluated after approximately 3 to 4 weeks. One third of them complained of dyspnoea, and 22.2% had a RR >20 breaths/min. PaO2/FiO2 and BMI at presentation in the emergency department were the strongest independent predictors of the need of follow-up. PTSD was observed in 41 (22.2%) patients. Taken all together, more than half of the patients discharged after COVID-19 infection require follow-up evaluation, and programmes involving follow-up after hospitalization should be implemented.
155 October Dhont S 10.1007/s13760-020-01514-z 2020 Belgium From April 1, 2020 to April 30‐2020 To report the clinical course of COVID‐19 in three hospitalized patients with myotonic dystrophy type 1 Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute, post-acute, late-onset, or permanent on a pre-existing health condition Myotonic dystrophy type 1 patients developing COVID-19 3 N/A oxygen therapy, antibiotics, intensive respiratory physiotherapy and non- invasive positive pressure ventilation N/A N/A N/A N/A N/A N/A N/A N/A This study described the clinical course of COVID-19 in three patients with advanced Steinert’s disease receiving non-invasive nocturnal home ventilatory support. Two patients had a limited respiratory capacity, whereas one patient had a rather preserved functional capacity but more comorbidities. Two out of three patients were obese, none of them had diabetes mellitus. Despite maximal supportive care with oxygen therapy, antibiotics, intensive respiratory physiotherapy and non- invasive positive pressure ventilation, all three patients died due to COVID-19. This study confirms that p eople with myotonic dystrophy type 1 are at high risk for severe disease and poor outcome, so the primary advice is to prevent the infection.Once infected, they should be closely monitored.
156 October Ishkanian A 10.1007/s00455-020-10205-z 2020 USA N/A To report a case of a 58-year-old woman with COVID‑19 presenting with dysphagia and progressive muscle weakness Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID‑19 with myositis 1 She presented with shortness of breath, cough, and fatigue, slurred speech, left upper extremity weakness, nausea/vomiting, and difficulty with ambulation. She showed hoarse and wet vocal quality and over 5 days she developed worsening dysphagia, with poor management of oropharyngeal secretions and with reduced cough strength suspected. Then, she subsequently noted to develop right eye ptosis, facial weakness, and hypernasal dysarthria At 3 weeks post-admission, a PEG was placed because of a lack of improvement in swallow function; then, the patient underwnt a total spine MRI, bilateral thigh MRI, and a thigh biopsy. N/A N/A N/A N/A N/A N/A N/A N/A The patient underwent a bilateral thigh biopsy and was ultimately diagnosed with COVID-19-associated myositis. Four weeks after admission, she was transferred to acute rehabilitation unit. The patient underwent dysphagia therapy (starting from incentive spirometry, swallowing exercises, and training of oral care, and then including respiratory muscle strength training, therapeutic per os trials, and exercises targeting hyolaryngeal excursion and pharyngeal muscle strength). The authors concluded that dysphagia is a common symptom of myositis and their co-existence might be a sequela of COVID-19
157 October Leigh AE 10.1097/PHM.0000000000001614 2020 USA From March 1, 2020, to April 20, 2020 To describe the functional status dependency in a cohort of patients admitted to a medical center for veterans during the surge of COVID-19 cases in the city of New Orleans, Louisiana Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 119 N/A N/A N/A Functional status at discharge, measured as as measured by independence in ADLs. N/A N/A N/A N/A N/A N/A The study, conducted in a medical center for veterans in USA, showed a correlation between functional status at discharge, the main outcome, and older age, respiratory failure and thromboembolic complicatrions. On the other hand, pre-existing conditions (e.g. hypertension, obesity, lung disease or diabetes) were not correlated. Overall, patient age and severity of COVID-19 are the most important factor that can cause a loss in independence in ADLs in a post-acute phase of the disease.
158 October Lima MA 10.1007/s13365-020-00912-6 2020 Brazil From May to July 2020 To report 8 cases of peripheral facial nerve palsy associated with COVID-19 Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 8 Facial palsy steroids,acyclovir N/A N/A N/A N/A N/A N/A N/A N/A In three patients, facial palsy was the first symptom of COVID-19, while in the remaining five, it appeared from 2 to 10 days after onset of other clinical manifestations. All patients had mild respiratory and systemic COVID-19 symptoms, and none required hospitalization. According to the House-Brackmann grading system, nerve damage resulted in mild (grade 2) dysfunction in five patients and moderate (grade 3) in three. Complete recovery occurred in five patients, while the other three still had some degree of facial weakness at the last follow-up 30 days after onset of neurological symptoms. Peripheral facial palsy should be added to the spectrum of neurological manifestations associated with COVID-19.
159 October Lima MS 10.1590/2317-1782/20192020222 2020 Brazil N/A To describe the functional development of swallowing in ICU patients with COVID-19, who underwent a speech-language treatment for swallowing Analytical: Cohort study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Digestive functions (b510) Acute COVID-19 77 N/A speech-language therapy intervention N/A American Speech-Language-Hearing Association National Outcome Measurement System N/A N/A N/A N/A N/A N/A The results indicate that there was a significant recovery in the functional patterns of swallowing in the comparison before and after speech-language therapy intervention. 83% of patients need up to 3 interventions to recover safe swallowing patterns.Oropharyngeal dysphagia in ICU should be investigated and treated
160 October Mcloughlin BC 10.1007/s41999-020-00353-8 2020 UK April 2020 To investigate functional and cognitive outcomes among COVID-19 patients with delirium Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 71 N/A N/A N/A all-cause mortality, modified Telephone Instrument for Cognitive Status, Barthel Index and Nottingham Extended Activities of Daily Living N/A N/A N/A N/A N/A N/A In 71 patients, 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4-week follow-up, delirium was significantly associated with worse functional outcomes, independent of pre-morbid frailty. Cognitive outcomes were not appreciably worse. The presence of delirium is a significant factor in predicting worse functional outcomes in patients with COVID-19.
161 October Meyer C 10.1016/j.rehab.2020.09.010 2020 Belgium N/A To present 4 cases of patients with severe COVID-19 who required mechanical ventilation and exhibited Heterotopic ossification in hips and shoulders Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute COVID-19 4 Hip and shoulder pain and range of motion limitation N/A N/A N/A N/A N/A N/A N/A N/A N/A This case series reported heterotopic ossification in 4 severe COVID-19 patients who required mechanical ventilation. The patients complained pain and decreased range of motion after 30-40 days, so underwent imaging that revealed HO. The etiopathogenesis of HO and the association with COVID-19 is unclear. COVID-19 global inflammation, altered acid base homeostasis and tissue hypoxia during the mechanical ventilatory period may play a role in the pathophysiology. HO should be considered in COVID-19 patients with prolonged immobilization in the presence of a painful joint. Early management aims at limiting its progression and maximizing function of the affected joint.
162 October Nasuelli NA 10.1007/s10072-020-04820-9 2020 Italy March - May 2020 To highlight the relevance of neuromuscular involvement and its different clinical features in ICU patients with SARS-CoV-2 Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with CINM 4 Case 1: Drowsiness, tetraplegia with diffuse hypotonia, and hypotrophy, mainly at shoulder girdle and to the peroneal district, with neurophysiological findings at EMG compatible with CINM. Case 2,3,4 presented with hypotrophy of the peroneal district and/or of the shoulder girdle, with neurophysiological findings at EMG compatible with CINM Case 1: physiotherapy and cough machine therapy 4 times/day; Cases 2,3,4: invasive ventilation, pronation cycles due to respiratory distress, and physical therapy (intensive for Case 3) N/A N/A N/A N/A N/A N/A N/A N/A Case 1 had diagnosis of CINM and started physiotherapy but her respiratory function worsened, requiring to switch back to controlled ventilation, and a progressive deterioration of the clinical conditions occurred (related to new superinfection), until death. Case 3: The only patient with a positive outcome (probably due to a younger age), even if characterized by slow recovery of motor skills (foot flexion) after intensive physical therapy.
163 October Pilotto A 10.1136/jnnp-2020-323929 2020 Italy February - April 2020 To investigate the impact of COVID-19 by recording clinical presentations, laboratory characteristics and management/outcomes of a series of neurological patients who consecutively presented at the ED during the peak of the pandemic Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition COVID-19 patients with neurological diseases 147 The 29.1% of neurological patients assessed at the ED were positive for SARS-CoV-2; they presented with an increased frequency of cerebrovascular events and encephalitis N/A Non-COVID-19 patients with neurological diseases Demographic, clinical, laboratory characteristics, hospitalisation rate, mRS, in-hospital mortality N/A N/A N/A N/A N/A N/A COVID-19-positive patients had higher prevalence of ischaemic stroke (n=51, 34.7% vs n=105, 29.3%), delirium (n=24, 16.3% vs n=18, 5.0%) and meningitis/encephalitis (n=14, 9.5% vs n=7, 1.9%). Furthermore, COVID-19-positive patients showed a higher rate of hospitalisation following ED triage (91.2% vs 69.3%, p<0.0001) and in-hospital mortality (29.7% vs 3.1%, p<0.0001). Lastly, COVID-19-positive patients had higher levels of disability at discharge compared with non-COVID-19 patients (mRS: 2.6 ±1.6 vs 1.6±1.4, p<0.0001)
164 October Pirau L 10.3389/fneur.2020.00964 2020 USA N/A To describe the clinical course, radiological findings and outcome of two COVID-19 patients, initially intubated for ARDS while neurologically intact, who demonstrated prolonged unresponsiveness following discontinuation of sedation, with evidence of borderzone ischemia on cerebral MRI Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients with prolonged unresponsiveness off sedation 2 A 59-year-old man and a 53-year-old man developed worsening COVID-19 associated ARDS. Both required benzodiazepine, opioid, neuromuscular blockade, therapeutic anticoagulation and vasopressor infusions in addition to renal replacement therapy. Both demonstrated only trace flexion to pain 7-10 days following discontinuation of all sedation. N/A N/A Laboratory, CT and electroencephalography findings N/A N/A N/A N/A N/A N/A At 90 days after he initial presentation, the 59-year-old man was oriented, with fluent speech and able to ambulate with assistance, while the 53-year-old man was at home and independent to basic ADL. The authors concluded that critically-ill COVID-19 patients with prolonged coma following sedation discontinuation might demonstrate imaging features of ischemic injury in borderzone regions despite the absence of documented sustained hypotension or hypoxia, despite a substantial neurological recovery seems possible
165 October Rajdev K 10.1177/2324709620961198 2020 USA N/A To highlight a rare case of GBS in a young patient with COVID-19 Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 patient with GBS 1 Two days after discharge at home without symptoms, the post-COVID patient began to develop numbness, tingling over his fingers, toes, and perioral region, which then progressed to weakness in legs. Two days later, he presented to the ED and was admitted for progressive and ascending weakness in his legs along with difficulty walking. He showed a decreased muscle strength in upper limbs (MRC=4) and lower limbs (MRC=3), where he presented also with hyporeflexia IVIG therapy for five days at a dose of 0.4 mg/kg/day. Then, he received 5 plasma exchange treatments and was successfully weaned from mechanical ventilation N/A Motor nerve conduction study findings at EMG N/A N/A N/A N/A N/A N/A The patient was diganosed with GBS and was treated by IVIG and 5 plasma exchanges. He required mechanical ventilation for a total of 13 days and then he was successfully extubated on day 19 of his LOS, when he was able to pass the spontaneous breathing trial. Following extubation, his motor strength continued to improve, and he was noted to recover muscle strength in proximal (MRC=4) and distal muscle groups (MRC=5), bilaterally before discharge. Thus, he was discharged to a rehabilitation facility for physical therapy in a stable condition without any supplemental oxygen after a hospital stay of 23 days. The authors concluded that GBS is a neurological emergency and physicians should pay close attention to neurologic complications including GBS in COVID-19 patients
166 October Requena M 10.1016/j.jstrokecerebrovasdis.2020.105225 2020 Spain March - April 2020 To uncover the rate of acute stroke in COVID-19 patients admitted in a high-volume center and identify those cases in which a possible causative relationship could exist Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients with stroke 17 Seventeen out 25 stroke patients reported COVID-19 symptoms before stroke onset, lasting 12 days. A severe COVID-19 infection was diagnosed in 14 patients, 8 of them were admitted to the ICU. N/A Non-COVID-19 patients with stroke Vascular risk factors, presence of COVID-19 prestroke symptoms, days of evolution, ICU admission, presence of severe infection N/A N/A N/A N/A N/A N/A Seventeen (68.0%) patients presented COVID-19 symptoms before stroke onset with a mean duration of 12 days; 6 patients without symptoms were diagnosed at admission by screening test, the 2 others presented symptoms in the first 48 hours after hospital admission. Severe COVID-19 infection was diagnosed in 14 (56.0%) patients, 8 of them were admitted to the ICU. The study showed that the frequency of acute stroke in patients with COVID-19 requiring hospital admission is low (1%) and in most cases a usual cause of stroke was identified.
167 October Steere HK 10.1002/pmrj.12506 2020 USA May 2020 To report the main characteristics of a cohort of US-based rehabilitation ambulatory referrals and interventions for previously hospitalized COVID- 19 patients. Descriptive: Historical cohort General outpatient rehabilitation Meso Level Any Activity limitation and participation restriction (d) Post-acute COVID-19 102 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Several key findings emerged: (1) teams were able to rapidly develop physiatry-run outpatient COVID-19 recovery clinics via telehealth to safely address rehabilitation-related needs of patients who had become severely ill from COVID-19, (2) institutions differed in mechanisms for patient flow and referrals to the recovery clinic, and (3) patient demographics differed among institutions.
168 October Wootton SL 10.1002/rcr2.669 2020 Australia N/A To present COVID-19 telehealth rehabilitation programme, delivered within a pulmonary rehabilitation setting, and discuss the management of three cases Descriptive: Case Series Rehabilitation services at home Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 3 N/A The telehealth rehabilitation programme consisted of (1) a comprehensive initial rehabilitation assessment within the PR context; an initial six-week rehabilitation programme, with weekly contact by a physiotherapist with multidisciplinary team input as required; and (3) a reassessment N/A Outcome measures at hospital discharge, commencement and after six weeks of rehabilitation: FSS, mMRC dyspnoea scale, 5STS, 1minSTS, heart rate and oxygen saturation N/A N/A N/A N/A N/A N/A This is a single-centre report of three cases undergoing rehabilitation via telehealth provided by experienced pulmonary rehabilitation clinicians. The patients ( males with a median age of 73 years) at hospital discharge ( length of stay 9-15 days) presented with persistent limitations and/or symptoms (e.g. breathlessness, fatigue, and reduced exercise capacity). Patients underwent an individualized rehabilitation programme and demonstrated improvements in exercise capacity and breathlessness; however, fatigue levels worsened in two cases and this was attributed to the difficulties of managing returning to work and/or carer responsibilities whilst trying to recover from a severe illness. The data suggested that the programme provided was feasible and acceptable to patients.
169 November Akhtar N 10.1016/j.jstrokecerebrovasdis.2020.105435 2020 Qatar March - May 2020 To compare the types of ischemic strokes in patients with or without confirmed COVID-19 infection to a busy tertiary care hospital during the pandemic Descriptive: Case Series N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with stroke 32 N/A N/A 216 COVID-19 negative patients with ischemic stroke (Mar - May 2020) Demographics and risk factors; Stroke Classification (TOAST and Banford); Prognosis  At Discharge N/A N/A N/A N/A N/A N/A COVID-19 patients with ischemic stroke were younger (48.9 vs 54.9 years) and presented with significantly lower rates of hypertension, diabetes and dyslipidemia. Moreover, COVID-19 patients had more cortical strokes (34.4% vs 5.6%; p = 0.001), severediseases (NIHSS>10: 34.4% vs 16.7%; p=0.001) prolonged hospitalization and lower probability of good recovery (mRS 0-2: 28.1% vs 51.9%; p = 0.001).
170 November Ballesteros Reviriego G 10.1097/TGR.0000000000000283 2020 Spain N/A To demonstrate the improvements in the respiratory mechanics during the weaning trial of subjects with pneumonia secondary to COVID-19 infection who underwent respiratory physiotherapy. Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 Acute respiratory failure Six sessions of lung physiotherapy, three in a pre-extubation phase and three in a post-extubation phase. N/A N/A N/A N/A N/A N/A N/A N/A The paper describe the case of a 38-years-old asthmatic woman that presented an acute respiratory failure and needed intubation. The patient was hemodynamically stable, so early rehabilitation was performed. The patient underwent six sessions of lung physiotherapy, three in a pre-extubation phase and three in a post-extubation phase. After 12 days from admission the patient, already extubated, was discharged to a ward with low-flow oxygen support, and after 19 days from admission the patient was discharged home.
171 November Bowles KH 10.7326/M20-5206 2020 USA From April to June, 2020 To describe characteristics of patients with COVID-19 upon admission to HHC, the home visits received, the extent of recovery among COVID-19 survivors discharged from HHC and to profile the risk factors associated with rehospitalization or death. Descriptive: Historical cohort Rehabilitation services at home Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1409 N/A Home health care N/A Rate of discharge, ADL dependency, Risk of rehospitalization or death,. N/A N/A N/A N/A N/A N/A The study analyzed 1409 patients discharged from hospital that underwent home health care. After 32 days most patients were discharged (94%) and achieved an improvement in symptoms and functions. Patients at discharge were much more independent in ADL. Risk of rehospitalization were higher for male patients (HR, 1.45 [CI, 1.04 to 2.03]); and patients presenting comorbidity such as heart failure (HR, 2.12 [CI, 1.41 to 3.19]) or diabetes with complications (HR, 1.71 [CI, 1.17 to 2.52]). 1% of patients died, 10% were rehospitalized and 2% remained on service.
172 November Brika M 10.1007/s42399-020-00613-5 2020 France March 3, 2020, to june 8, 2020 To underline the global approach that is necessary in a geriatric rehabilitation context associated with the COVID-19 infection Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 1 N/A Physical therapy (one session of 30 min per day) and nutritional monitoring N/A Frail’BESTest N/A N/A N/A N/A N/A N/A This is the case of a 93-year-old frail patient, hospitalized after a COVID-19 infection. After one month he was transferred to the rehabilitation unit for respiratory dysfunction, subsequent effort incapacity, and postural-motor deficiencies.The assessment process of this patient has been supported by an innovative multisystemic tool developed in view of the COVID-19 clinical consequences and a systemic evaluation of motor functions by the Frail’BESTest. This process allowed a mixed clinical picture associated with significant respiratory distress and an evident motor frailty. The care plan was developed accordingly, and the patient returned home just over a month with a high level of independency. This case report illustrates the importance of a global approach and of rehabilitation in the COVID-19 context.
173 November Brugliera L 10.1016/j.apmr.2020.10.131 2020 Italy N/A To present prone positioning-related complications from 7 critically ill COVID-19 patients intubated and mechanically ventilated in a prone position for a prolonged time at the ICU Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 7 All COVID-19 patients showed nerve injuries after being intubated and mechanically ventilated in a prone position for a prolonged time at the ICU N/A N/A Nerve injuries assessed by EMG and ENG N/A N/A N/A N/A N/A N/A This case series suggested that compressive neuropathies could be considered as frequent complications of ventilation with prone position in COVID-19 patients. Risk factors as a poor BMI should be taken into account before undergoing shorter prone positioning cycles aimed to prevent nerve damage
174 November Castillo-Pinto C 10.1177/1941874420966845 2020 USA N/A To report the case of a healthcare worker who presented with a large vessel acute ischemic stroke in setting of a mild COVID-19 infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Right-sided hemiparesis, aphasia and dysarthria thrombectomy N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a A 43-year-old female with minimal vascular risk factors who presented with acute ischemic stroke due to a Large Vessel Occlusion that was incidentally found to have COVID-19 on screening prior to transfer to a comprehensive stroke center for thrombectomy. At discharge, she had mild right facial droop, mild hemiparesis (4þ/5) with NIHSS 1. She was discharged home after a 6-day hospitalization with subcutaneous enoxaparin and atorvastatin for secondary stroke prevention. This case highlights suspected mechanisms of hypercoagulability in SARS-CoV-2 infection and the importance of optimizing stroke care systems during the COVID-19 pandemic.
175 November Daia C 10.1016/j.ijid.2020.11.146 2020 Romania July - September 2020 To characterize the action of COVID 19 on muscular fibers through electrophysiology studies in post-COVID-19 patients with myalgia Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Late-onset Post-COVID-19 3 Case 1: generalized myalgia (pronounced in the calves), fatigue and dizziness; Case 2: bilateral calf myalgia and fatigue; Case 3: bilateral calf myalgia, fatigue, and exhaustion under stress. N/A N/A Nerve injuries assessed by EMG and ENG N/A N/A N/A N/A N/A N/A Three patients showing fatigue and myalgia of both calves , in teh recovery phase after COVID-19 infection, were submitted to nerve conduction studies (NCS) and electromyography (EMG). NCS showed signs of demyelinating polyneuropathy due to SARS-COV-2, whereas EMG supported the hypothesis of myopathy, indicating a direct action of COVID 19 on muscular fibers, especially in the lower limbs. COVID-19 related polyneuropathy and myopathy should be taken into consideration in the COVID-19 management.
176 November Dawson C 10.1017/S0022215120002443 2020 UK From 21/3/2020 until 21/5/ 2020 To describe the dysphagia and functional swallow outcomes during recovery from COVID-19 in a large cohort of patients Descriptive: Historical cohort Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Digestive functions (b510) Acute COVID-19 208 N/A Therapy and compensation strategies included: exercise prescription, postural adaptations, practice swallows, augmentation of texture or complexity of diet and or fluid if required, portion volume control, adaptations to environmental factors, and reducing distractions N/A length of stay on the ICU, timing of speech and language therapy assessment, timing of oral intake commencement, and swallow competence at various timepoints N/A N/A N/A N/A N/A N/A The prevalence of dysphagia was high: 208 out of 736 patients (28.9 percent) admitted to the institution with SARS-CoV-2. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. -All patients were assessed by the SLT team within 24 hours of a referral as part of 7-day service. - Dysphagia was multi-factorial, and co-existed with delirium, fatigue and difficulty achieving effective breathe/swallow coordination -On average, the SLT team provided clinical interventions to patients for 8.6 days. This increased to 11.3 days for those who underwent endotracheal tube intubation alone, and was highest for those who had a tracheostomy (12.9 days). -Mean (SD) time to starting oral intake from extubation for the endotracheal tube only group was 5.3 (2.3) days. For patients with a tracheostomy, mean (SD) time to starting oral intake from the date of tracheostomy insertion was 14.8 (6.6) days. -The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. -Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. A whole systems approach from an integrated multi-disciplinary team is required to manage COVID-19 patients. With intensive therapy, most patients can regain normal swallow function following COVID-19.
177 November de Lorenzo Alvarez A 10.1007/s13730-020-00553-y 2020 Spain N/A To describe the case of an 80-year-old male undergoing peritoneal dialysis with a moderate COVID-19 infection who developed a purpuric dermatitis and ischemic stroke after successful recovery from his bilateral pneumonia. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Late-onset COVID-19 1 Erythemato-papular lesions affecting trunk and lower limbs, right lower limb paresis and unsteadiness of gait. corticoesteroids , heparin N/A N/A N/A N/A N/A N/A N/A N/A The authors described the case of an 80-year-old male undergoing peritoneal dialysis with a moderate COVID-19 infection who developed a purpuric dermatitis (17 days after the COVID-19 symptoms onset) and ischemic stroke (30 days after the onset of COVID-19 symptoms) after successful recovery from his bilateral pneumonia. The purpuric dermatitis was treated with corticoesteroids achieving complete resolution. Arterial thrombosis occurred 5 days after withdrawal of antithrombotic prophylaxis that the patient received from his admission until 2 weeks after discharge. He completely recovered from his paresis and continued on his regular antiaggregation therapy. The authors highlight the importance of define an appropriate length of antithrombotic prophylaxis after successful recovery from COVID-19 pneumonia in individuals with preexisting cardiovascular conditions, especially in dialysis patients.
178 November Forni R 10.4414/smw.2020.20397 2020 Switzerland From March to May, 2020 To present the protocols developed to support the process of weaning patients from tracheotomy and the reprisal of feeding by mouth, in a tracheotomy ward, within a COVID hospital served by a interdisciplinary rehabilitation team Descriptive: Historical cohort N,A. Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 53 N/A N/A N/A Percentage of complication of tracheostomy, percentage of successful weaning from tracheostomy, length of stay in hospital N/A N/A N/A N/A N/A N/A The article presents the protocols adopted by an interdisciplinary rehabilitation team for weaning COVID-19 patients from tracheotomy and recovering oral feeding and reports the outcome in 53 cases admitted to a tracheotomy ward. The authors conclude that concentrating the COVID-19 patients in one hospital and the creation of a tracheotomy ward were successful strategies, simplifying the allocation of available resources. Undertaking percutaneous tracheotomy on patients subsequently transferred to adapted subacute wards helped to free up beds in the ICU. Patients with percutaneous tracheotomy can be ventilated efficiently by means of instruments normally used for home ventilation, simpler than the conventional ventilators in use in the ICU and successfully handled by nursing staff. The positive outcome of this experience was guaranteed by excellent interprofessional cooperation.
179 November Gale A 10.1136/bcr-2020-239241 2020 UK From April 9, 2020 to June 2020 To report aGBS before developing clinical and radiological findings of COVID-19. Descriptive: Case Report Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 1 Progressive ascending weakness affecting all four limbs and impaired mobility invasive ventilation , tandard supportive intensive care management,tinzaparin,dexamethasone N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a 58-year-old man with features of GBS before developing clinical and radiological findings of COVID-19. He suffered from a severe form of GBS and the nasopharyngeal swab for Coronavirus was initially negative. He underwent invasive ventilation and weaned from the ventilator after about 20 days. By the 27th day of admission, he was stepped down from critical care to the respiratory ward for ongoing physiotherapy and speech and language therapy. After about 36 days he was discharged to a community rehabilitation unit to continue his recovery for 15-20 days, then he returned to his own home. Raising awareness of a possible association between GBS and COVID-19 t is important so both are considered allowing appropriate investigations to be arranged to optimise the chance of neurological recovery and survival, while also protecting staff from potentially unrecognised COVID-19. Consider doing multiple samples when radiological investigations show typical features of COVID-19.
180 November Kacem I 10.1007/s10072-020-04866-9 2020 Tunisia March-May 2020 To describe the neurological symptoms associated with COVID-19, their main characteristics, and their evolution in the Tunisian population Descriptive: Historical cohort N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 646 The 72.1% showed neurological symptoms N/A N/A Prevalence of neurological symptoms (headaceh, smell impairment, taste impairment, myalgia, sleep disturbance, visual loss, focal weakness, disorientation, behaviour disorders) N/A N/A N/A N/A N/A N/A Out of 646, 466 patients (72.1%) had neurological symptoms. Headache was the most frequent one (n = 279, 41.1%). Smell and taste impairment were found in 37.9% (n = 245) and 36.8% (n = 238) respectively. Myalgia (n = 241, 37.3%) and sleep disturbances (n = 241, 37.3%) were also frequent. In 14.5%, neurological symptoms preceded the respiratory signs that resulted to be associated with more frequent (p=0.006) and numerous (p<0.001) neurological symptoms.
181 November Kataria S 10.1016/j.ensci.2020.100287 2020 USA N/A To present three MS patients affected by COVID-19 an to review the existing data on this topic Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute, post-acute, late-onset, or permanent on a pre-existing health condition COVID-19 with MS 3 Case 1: A 65-year old man with RRMS, presenting with fever, pulse oximetry 85%, fatigue, generalized weakness and shortness of breath, concerning for worsening MS symptoms. Case 2: A 52-year old man with RRMS, presenting with constant nagging cough, generalized weakness, fever, and increasing shortness of breath, as a pseudoexacerbation of MS. Case 3: A 69-year female with RRMS, presenting with fever and cough Case 1: hydroxychloroquine and azithromycin for 5 days, and glatiramer acetate as DMT. Case 2: CPAP and hydroxychloroquine and anti-viral ritonavir for a week, and dimethyl fumarate as DMT. Case 3: non-steroidal anti-inflammatory agents, advising to quarantine, and ocrelizumab as DMT. N/A EDSS N/A N/A N/A N/A N/A N/A Case 1: Symptoms improved after 4 days of treatment and no additional oxygen supplementation was required; the clinical course of COVID-19 lasted approximately 2.5 weeks. His EDSS was 2.0 at the admission and at the discharge. Case 2: Symptoms resolved within a week of treatment. His EDSS was 4.0 at the admission and 3.0 at the discharge. Case 3: The patient was advised to quarantine herself and recommended to follow up in the neurology clinic.
182 November Levin SR 10.1016/j.apmr.2020.10.104 2020 USA by June 3, 2020 To present the challenges and opportunities involved in adapting to a pandemic surge as well as some of the operational considerations in moving patients throughout the continuum of acute and postacute care. Descriptive: Historical cohort General postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 300 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A The challenge faced required the adaptation and modification of options within the health system’s continuum of care, both regarding clinical assessment (electronic consultation service was created) and discharge pathways: to home care, to inpatient rehabilitation facilities, or to a skilled nursing setting. For transitions of care, they created a new set of screening criteria for postacute care with social work and the acute medical teams, which included both review of laboratory and respiratory care needs but also rapid social clearance. In the final tally, Montefiore Medical Center admitted 5691 patients with COVID-19 by June 3, 2020. Out of them, 1291 (22.7%) died and 4400 (77.3%) were discharged as follows: approximately 300 (6.8%) to inpatient rehabilitation facilities, 450 (10.2%) to home care, 220 (5.0%) to skilled nursing facility, while 3400 (77.3%) were discharged home without services. The intrahospital transfers were less than 45.The framework for the pathways success is because of the expertise and relationships Rehabilitation Medicine has within the hospital system and with postacute care providers.
183 November Li L 10.1093/ptj/pzaa198 2020 China From January 31 to March 8, 2020 To report on a physical therapy service, commissioned to manage COVID-19 during patients‘ stay in the ICU Analytical: Cohort study Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 16 Severe and critical COVID-19 Neuromuscolar and respiratory rehabilitation N/A PaO2/FiO2, PEFR, MIP, MBDS, Medical Research Council Sum Score for muscle strength, Physical Function in Intensive Care Test, De Morton Mobility Index, MBI N/A N/A N/A N/A N/A N/A Most of the patients admitted to the ICU and treated with neuromuscolar and respiratory rehabilitation achieved outcomes in the range of normality at the time of discharge. However, 61% of the discharge patients had PEFR below 80%, 31% had MIP below 80% and 46% of the patients had De Morton Mobility Index values below the normative value. These findings point out that many ICU patients need rehabilitation even after discharge.
184 November Lowery MM 10.2478/jccm-2020-0038 2020 USA N/A To present a case of an atypical variant of GBS in COVID-19 patient Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 with GBS 1 A 45-year-old man complaining gait ataxia and weakness self-referred to the Hospital and presented with left facial and bilateral lower extremity numbness and dysgeusia. A nasopharyngeal swab was positive for COVID-19 PCR. His neurological symptoms worsened progressing to dysphagia and quadriparesis. IVIG, mechanical ventilation, and tracheostomy (on Day 26 ost-admission) N/A N/A N/A N/A N/A N/A N/A N/A The patient had a spine MRI consistent with GBS, but clinical symptoms and positivity of anti-GQ1B antibodies were consistent with Miller Fisher Syndrome and GBS overlap. After a 5-week hospitalization, the patient was transferred to a long-term acute care hospital for ventilator weaning and physical therapy. At five and half months after diagnosis the patient was able to control his head, right thumb, left foot, right toe, and had extraocular and tongue movements. Thus, this case highlighted the severity of neurological symptoms and the prolonged course of COVID-19 patients with overlapping Miller Fisher Syndrome and GBS
185 November Lyadov KV 10.18093/0869-0189-2020-30-5-569-576 2020 Russia March - April, 2020 To create the protocol for the first stage rehabilita tion of patients with the COVID-19 infection under the conditions of respiratory failure based on literature data and clinical experience, to select the treatment group from among patients who meet the inclusion and exclusion criteria and received an appropriate early rehabilitation according to the protocol, to form the comparison group using the pseudo-randomization method from the number of patients who meet the inclusion and exclusion criteria, but have not received an appropriate early rehabilitation according to the protocol, to compare clinical results in the two groups. Non randomised controlled trial Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 146 (73 treatment group + 73 control group) N/A Respiratory rehabilitation Retrospective control group Required time of continuous oxygen support, Frequency of transferring patients to artificial lung ventilation, Dynamics of the oxygenation index measurement, Evaluation of subjective general state according to SF-36, Break-in exercise therapy for 2 or more days, Patient survival rate at 10 days from starting exercise therapy. N/A N/A N/A N/A N/A N/A The study propose a respiratory rehabilitation program for acute patients in ICU setting undergoing continuous oxygen support. Control group was selected retrospectively with a pseudo-randomization method. The primary outcome considered was the required time of continuous oxygen support and resulted significantly lower in treatment group vs control group (5.1 ± 3.3 vs 8.0 ± 4.6 days). This result suggest that a respiratory rehabilitation protocol is feasible and likely efficacious in the acute setting.
186 November Mandal S 10.1136/thoraxjnl-2020-215818 2020 UK N/A To follow-up COVID-19 patients fout to six weeks after discharge Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Chronic COVID-19 384 N/A N/A N/A Phone or in-person interview. Severity of symptoms was graded by a 11-point scale N/A N/A N/A N/A N/A N/A In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post-discharge, 53% reported persistent breathlessness, 34% cough, and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5% had persistently elevated d-dimer and C reactive protein, respectively. 38% of chest radiographs remained abnormal with 9% deteriorating. Systematic follow-up after hospitalization with COVID-19 identifies the trajectory of physical and psychological symptom burden, recovery of blood biomarkers, and imaging which could be used to inform the need for rehabilitation and/or further investigation.
187 November Meshcheryakova NN 10.18093/0869-0189-2020-30-5-715-722 2020 Russia From February 28 to June 4, 2020 To present the data of two clinical cases of patients with different types of pulmonary rehabilitation. Descriptive: Case Series Specialized outpatient rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 2 Fever, dry cough, shortness of breath, weakeness Respiratory rehabilitation N/A CT scan, clinical blood tests, spirometry. N/A N/A N/A N/A N/A N/A The study present two clinical cases of patients with COVID-19 that underwent outpatient respiratory rehabilitation. Both patients suffered from COVID-19 related pneumonia. After the acute phase they underwent 10 sessions of high-frequency oscillation of the chest, and inspiratory muscle training, with subjective benefit, and reduction of the symptoms, especially coughing. However, in the first patient that underwent a control spirometry after the treatment, there was no improvement in bronchial patency.
188 November Moradian ST 10.18502/ijph.v49i11.4729 2020 Iran February - April 2020 To assess the frequency of delayed symptoms at 6 weeks after discharge in post-COVID-19 patients Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Late-onset Post-COVID-19 200 At the admission the study population showed: dyspnoea in the 59.5% of cases, weakness in the 55.5%, myalgia in the 53.5%, and shivering in the 1.5% N/A N/A Clinical symptoms N/A N/A N/A N/A N/A N/A At 6 weeks after the discharge, 94 patients (42%) were asymptomatic. On the other hand, fatigue was the most frequent delayed symptom (19.5%) and then dyspnea (18.5%), weakness (18%), and activity intolerance (14.5%). The authors concluded that follow-up evaluation are needed in COVID-19 patients and rehabilitation might be helpful even in a late phase.
189 November Murat S 10.1007/s11845-020-02433-x 2020 Turkey March - June 2020 To evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in COVID-19 patients Descriptive: Historical cohort N/A Epidemiology - Clinical presentation Any other body structure and function-generic (s/b) Post-acute COVID-19 193 Main complaints of the COVID-19 patients were: fatigue (76.6%), pain (69.3%), fever (62%), cough (45.3%), and loss of taste and/or smell (43.5%) N/A N/A General symptoms at the first admission to the hospital; presence of pain at admission; localization, severity, and persistence of pain N/A N/A N/A N/A N/A N/A Pain was the chief complaint in of 46.61% of the patients and started on 2.2±2.8 days before admission. Among 133 patients reporting pain, the most common pain symptoms were myalgia/arthralgia (69.2%) and headache (50.4%). Therefore, pain is one of the most common complaints of admission to the hospital in COVID-19 patients ans dhoeld be adequately assessed
190 November Paneroni M 10.1097/PHM.0000000000001641 2020 Italy April 2020 To describe muscle strength and performance at discharge from a post-acute COVID-19 Department in COVID-19 patients without pre-existing locomotor disabilites Analytical: Cross-sectional study Specialized postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 41 N/A N/A N/A MVC, 1min-STS, SPPB, Modified Borg Scale N/A N/A N/A N/A N/A N/A At discharge from post-acute COVID-19 Department, patients presented with a mean MVC of 18.9 Kg for quadriceps and of 15.0 Kg for biceps, mean number of chair rises in the 1min-STS was 22.1, while the mean SPPB score was 7.9. Therefore, the authors concluded that the high prevalence of impairment in muscle strength and performance in hospitalized patients recovering from COVID-19 suggested the need for rehabilitation even after their discharge.
191 November Petersen MS 10.1093/cid/ciaa1792 2020 Denmark From April to August 2020 To describe symptoms in the acute phase and especially long COVID in mainly non-hospitalized patients from the Faroe Islands. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Chronic COVID-19 180 N/A N/A N/A Phone interview, The fatigue impact scale . The number of interviews was dependent on how long symptoms persisted, and the time from onset of symptoms to first interview. N/A N/A N/A N/A N/A N/A Of the 180 participants (96.3% of the 187 eligible COVID-19 patients), only eight individuals were hospitalized. During the acute phase of COVID-19, 4.4% (n=8) were asymptomatic and 7.2% (n=13) reported one or two symptoms while more than 30% had nine or more symptoms. 53.1% reported persistence of at least one symptom after a mean of 125 days after symptoms onset, 33.3% reported one or two symptoms, and 19.4% three or more symptoms. The most prevalent symptoms during the acute phase were fatigue, fever, headache, chills, and loss of smell and taste, while the most persistent symptoms were fatigue, loss of smell and taste, and arthralgias. The results show it might take months for symptoms to resolve, even among non-hospitalized persons with milder illness course in the acute phase.
192 November Picchi G 10.12659/AJCR.926921 2020 Italy March and April, 2020 To describe three cases of pulmonary fibrosis developed after SARS-CoV-2 infection in patients who had not received high-flow oxygen support. Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Late-onset COVID-19 3 All three patients: cough, fever, shortness of breath. Corticosteroids and Oxygen support. N/A N/A N/A N/A N/A N/A N/A N/A The three patients described in the case series were all female with no history of respiratory diseases and that did not smoke in the past. They had mild respiratory symptoms, that not needed high-flow oxygen support. Nevertheless, in all three cases, a follow-up CT around one month after symptom onset showed lung fibrosis. The findings suggest that a clinical and radiographic follow-up to assess the possibility of late onset of pulmunary fibrosis might be needed in all patients that developed pneumonia, and not only in severe cases.
193 November Prasad A 10.1016/j.clinimag.2020.09.010 2020 USA N/A To present a case of multifocal ischemic stroke in a patient with COVID-19. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 1 encephalopathy and dysarthria aspirin and high-intensity atorvastatin N/A N/A N/A N/A N/A N/A N/A N/A This is the case of a 51-year-old man with COVID-19 who had persistent encephalopathy and dysarthria after recovering from hypoxic respiratory failure and subsequently he developed ischemic stroke in multiple vascular territories during hospital admission (at day 23 of admission by MRI, the CT did not show abnormalities). The patient was started on aspirin and high-intensity atorvastatin. The patient was then discharged to the acute rehabilitation unit with a cardiac event monitor for 30 days. When suspecting stroke timely performing MRI brain imaging could be very essential in all critically ill COVID-19 patients. Though there is lagging data on the use of anticoagulants to prevent stroke in COVID-19 patients, therapeutic anticoagulation should be kept under consideration especially in patients with a high risk for hypercoagulopathy.
194 November Sangare A 10.3390/brainsci10110845. 2020 France N/A To describe a case of a patient suffering from COVID-19 related encephalitis, who recovered after immunotherapy. Descriptive: Case Report General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 1 Fever, cough, dyspnea, acute respiratory distress syndrome, encephalitis. Mechanical ventilation, corticosteroids, Therapeutic Plasma Exchange with Albumin, neuromotor rehabilitation. N/A N/A N/A N/A N/A N/A N/A N/A The case study describe a patient who suffered from severe COVID-19 causing an acute respiratory distress symptoms that required mechanical ventilation. The patient became unresponsive, even after weaning from sedation, and did not recover until day 65. At day 65 as a last resort a course of corticosteroids infusion and therapeutic plasma exchange with albumin was administred. The patient quickly recovered from day 68 and at day 88 it was possible to extubate him. At day 116 he was transferred to a rehabilitation facility where he was treated with neuromotor rehabilitation for a critical illness polyneuropathy. After 5.5 months he was discharged home with only mild cognitive and motor symptoms.
195 November Senthil P 10.36295/ASRO.2020.231510 2020 India N/A To report the case of a 72-year-old male with COVID-19 infection and respiratory difficulties who underwent structured exercises protocol and tele-counseling Descriptive: Case Report General outpatient rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 1 N/A Chest percussion techniques, deep breathing and thorax mobility exercises, incentive spirometry exercise, performed daily twice a week, 30 min each session, for 3 weeks. Tele-counselling was given by the experts through the telephone conversation thrice a week for 15 minutes session to improve his mental health. N/A Oxygen saturation level (digital pulse oximeter)and rate of perceived exertion rate (Modified Borg’s Scale) N/A N/A N/A N/A N/A N/A The present case is that of a 72-year-old male, with respiratory difficulties due to COVID-19, who underwent structured exercises and tele-counseling for 3 weeks. The Pre and Post–test of the patient demonstrated significantly greater improvements in oxygen saturation level and rate of perceived exertion also. This case study provides a promising exercise intervention and tele-counseling that may improve chest compliance and improved activities in older men with COVID 19 respiratory issues.
196 November Townsend L 10.1371/journal.pone.0240784. 2020 Ireland N/A To establish whether patients recovering from SARS-CoV-2 infection remained fatigued after their physical recovery, and to investigate whether there was a relationship between severe fatigue and a variety of clinicopathological parameters. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 128 N/A N/A N/A Demographic and clinical information, routine laboratory parameters, CFQ-11 N/A N/A N/A N/A N/A N/A The 55.5% of COVID 19 patients required hospitalization, while the others were managed at home as outpatients. At a median follow up of 10 weeks after discharge (hospitalized patients), or after the last day of acute COVID 19 symptoms (outpatients), most patients included in the study complained of fatigue, with half of the patients reporting severe fatigue. The 51.6% of the patients were healthcare workers, of which 31% were still not back at work at followup. Fatigue did not seem to be related to initial disease severity. From the data collected, fatigue seems to play an important role in post-acute recovery from COVID-19, and intervention targetting this symptom could potentially speed up the process.
197 November Yang SS 10.9778/cmajo.20200159. 2020 Canada From March to August, 2020 To describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia in the ICU of a designated pandemic centre. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 106 N/A N/A N/A Demographic information, comorbidities, initial vital signies, laboratory results, severity of COVID-19, therapy administered, linical outcomes including lenght of stay, morbidity and mortality. N/A N/A N/A N/A N/A N/A The study described a series of critically ill patients, their clinical course and outcomes. Out of 106 patients, 21 died during hospital stay (19.8%), 18 of them during ICU stay (17.0%). 65 patients required mechanical ventilation, and prone positioning was used in 29 patients, including 10 who were spontaneusly breathing. Acute kidney injury was the most common complications (20 patients, 18.9%). All the survivors were discharged from ICU at the time of the writing of the paper, strenghening data about ICU mortality (17.0%). The author suggest that the relatively low mortality rate can be linked to the fact that the ICU were put under heavy stress but not overwhelmed by the large number of COVID-19 patients.
198 December Arnold DT 10.1136/thoraxjnl-2020-216086 2020 UK N/A To report a prospectively recruited UK cohort of hospitalised patients with COVID-19. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 163 N/A N/A N/A Baseline demographics, comorbidities, blood test results, chest radiograph, pulmonary function testing, clinical data. N/A N/A N/A N/A N/A N/A In the present study 163 COVID-19 patients consecutively admitted to hospital were enrolled. At 8–12 weeks postadmission, survivors were invited to a systematic clinical and radiological follow-up. At the follow up 74% patients reported at least one ongoing symptom: 39% breathlessness, 39% fatigue and 24% insomnia. Fourteen percent of the patients had a abnormal radiograph follow-up. Eleven patients had restrictive spirometry and 15 had a significant desaturation on the 1 minute STS test. SF-36 scores demonstrated a reduction in reported health status across all domains compared with age-matched population norms. Overall, the study show persistency of clinical and radiological abnormalities at 8-12 weeks postadmission in COVID-19 patients.
199 December Arzani P 10.34171/mjiri.34.106 2020 Iran March 2020 To show the effects of pulmonary rehabilitation and exercise therapy in a patient with COVID-19. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1 Fever and dyspnea. Pulmonary rehabilitation and physical activity. N/A N/A N/A N/A N/A N/A N/A N/A The case study reports of 49-year-old female COVID-19 patients. Because of COVID-19 related pneumonia she needed hospitalization and suffered from severa dyspnea. On the third day of admission pulmonary rehabilitation was started. Pulmonary rehabilitation involved, in the first phase, when the patient was inconscious, mainly passive mobilization, in a second phase a combination of active and passive mobilization and breathing exercises. She continued rehabilitation for a week after discharge, using telerehabilitation with a smartphone. As soon as the patient was able to move autonoumously she was encouraged to walk 50 meters every day. She underwent a total of 42 physical training sessions in 3 weeks. At the end of the program the patient scored better in all the outcome considered, including modified Borg scale, Saint George’s Respiratory Questionnaire, SF36.
200 December Battaglini D 10.3389/fneur.2020.602114 2020 Italy From February 28 to June 30, 2020. To describe the type and the frequency of neurological complications in a cohort of critically ill patients with COVID-19 receiving invasive mechanical ventilation in an intensive care unit (ICU) and the effects of these complications on outcome. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 94 N/A N/A N/A Clinical data, rate of neurological complications, invasive and non-invasive neuromonitoring (e.g. transcranial Doppler, ONSD, and automated pupillometry). N/A N/A N/A N/A N/A N/A The study described a cohort of 94 patients referred to an ICU. Neurological complications were detected in 50% of patients, and delirium was the most common manifestation. Patients with neurological complications did not have an incresead ICU mortaliy, but had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days) stay. 53 patients underwent noninvasive neuromonitoring. Patients with increased intracranial pressure measured using ONSD (19%) had longer ICU stays. Overall, patients with neurological complications needed longer ICU and hospital stays.
201 December Cabrera Muras A 10.1111/ene.14561 2020 Spain N/A To report a case of Bilateral Facial Nerve Palsy associated with COVID-19 and Epstein-Barr Virus co-infection Descriptive: Case Report N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 with Epstein-Barr Virus co-infection 1 He presented with significant asthenia with headache, myalgia, nausea, and vomiting; after a week he presented right facial weakness; 2 weeks later he had diagnosis of bilateral facial paresis Levofloxacin 500mg for 7 days; prednisone 60 mg/24h with a tapering schedule N/A N/A N/A N/A N/A N/A N/A N/A The patient referred to a an Emergency Room underwent a neurological examination that diagnosed a bilateral facial palsy. The RT-PCR performed for SARS-CoV-2 showed positive results. Moreover, he also had a positive heterophile test indicating a recent Epstein-Barr virus infection. Brain MRI raised the diagnosis of bilateral facial neuritis. He was treated with prednisone and at a follow-up examination 3 weeks later showed an almost complete facial palsy recovery
202 December Cardoso ER 10.12659/AJCR.927011 2020 USA N/A To describe a case of superficial cerebral venous thrombosis and intracerebral hematoma in a 48-year-old man weeks af­ter recovering from the acute phase of SARSCoV-2 infection Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Late-onset COVID-19 1 Left upper-limb numbness, weakness, and impairment of positional sensation. Enoxaparin anticoagulation therapy. N/A N/A N/A N/A N/A N/A N/A N/A The 48-year-old male patient included in this case-study, 36 days after being diagnosed for SARS-COV2 infection and 19 days after recovering from the infection and coming back to work, presented sudden onset of left upper-limb numbness, weakness, and impairment of positional sensation. CT scan showed a small acute cortical hemorrhage in the right parietal lobe, with a rim of surrounding vasogenic edema. The patient remained neurologically stable during hospitalization. He was treated with enoxaparin anticoagulation therapy with benefit, and he slowly improved. At 4 and 8 weeks follow-up after the stroke, the only residual deficit was a mild numbness of the left pointer finger.
203 December Fayed I 10.1016/j.jocn.2020.08.026 2020 USA N/A To report three cases of spontaneous intracranial hemorrhage in COVID-19 patients Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 3 Persistent Encephalopathy, Fixed and Dilated Pupils N/A N/A N/A N/A N/A N/A N/A N/A N/A This study reports a spontaneous intracranial hemorrhage (including intracerebral and subarachnoid hemorrhages, ) in three severe COVID-19 patients (two females of 57 and 54-year-old, and a 71-year-old man) who required intubation and ventilatory support. The hospital stays prior to hemorrhage was 20 days in two cases and 8 in the remainder. The 57-year-old woman was subsequently discharged to an acute rehabilitation facility one week later, the 54-year-old female progressed to brain death and expired due to asystole four days later, while the man succumbed to multi-system organ failure one week later. These cases support the predisposition of COVID-19 patients to the development of intracranial hemorrhage during critical illness, maybe for the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. These cases highlighted the need for heightened vigilance for intracerebral hemorrhage events and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations.
204 December Ferraro F 10.1002/jmv.26717 2020 Italy April - June 2020 To characterize the COVID-19 late consequences and to investigate the role of rehabilitation in reducing COVID-19 related fatigue and improving functional outcome in a case series of post-COVID-19 inpatients. Descriptive: Case Series Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 7 The 85.7% showed a COVID-19 related fatigue, but only Case 2, that needed ICU in the acute phase, presented a severe perception of exertion (Borg CR10 scale=7). Rehabilitation plan (1-2 session per day of 30 minutes each for 6 days/week), consisting of a progressively increased intensity physical exercises: a) posture changes; b) breathing control exercises; c) passive mobilization of upper and lower limbs; d) passive muscle stretching; e) muscle strengthening exercises of upper and lower limbs, trunk, and gluteus muscles, aimed at reaching the control of sitting position and standing; f) balance and coordination exercises. N/A Borg CR10 scale; HGS; 6MWT; SPPB; BI dyspnoea; FIM N/A N/A N/A N/A N/A N/A After the rehabilitation treatment the 71.4% showed no fatigue and the other 2 cases reported only a very light perception of exertion. We evidenced a considerably improvement of functional outcome after rehabilitation, particularly showed by two patients: Case 2 (6MWT=306 vs 120 m; 10MWT=6 vs 15 sec; SPPB=9 vs 2) and Case 3 (6MWT=330 vs 100 m; SPPB=9 vs 2). The Authors concluded that that a patient-tailored rehabilitation is mandatory for reducing fatigue and improving functional outcome in ADL.
205 December Galván-Tejada CE 10.3390/ijerph17249367 2020 Mexico From 25 July to 20 September 2020. To identify the risk of presenting persistent symptoms in recovered from COVID-19 Analytical: Case-control study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 141 N/A N/A 78 controls: people who do not meet clinical and laboratory criteria to diagnose SARS-CoV2 N/A N/A N/A N/A N/A N/A N/A A total of 219 participants were studied: 141 recovered (at least 14 days since the appearance of symptoms) and 78 controls (without diagnosis of COVID-19). Fifty-one controls were free of COVID-19 associated symptoms at the time of the interview (Symptom Questionnaire), while 27 had at least one of the most significant symptom, which means that the risk of symptoms in the controls is 0.3461, that is 34.61%. For the recovered population, 22 had no symptoms and 119 had at least one symptom, that is, a risk of 0.8439 (84.39%). All symptoms show an associated risk of persisting in people recovered from COVID19. The relative risk of the selected symptoms in the recovered patients goes from 3 to 22 times, being infinite for the case of dyspnea, due to the fact that there is no control that presents this symptom at the moment of the interview, followed by nausea and the anosmia with a RR of 8.5. Therefore, public health strategies must be rethought, to treat or rehabilitate, avoiding chronic problems in patients recovered from COVID-19
206 December Kanjwal K 10.19102/icrm.2020.111102 2020 USA N/A To report a case of POTS in an otherwise healthy female after COVID-19 infection. Descriptive: Case Report N/A Epidemiology - Natural history/Determining and modifying factors Cardiovascular functions (Heart b410) Late-onset COVID-19 1 Fatigue, headache, dizziness, chest pain, and palpitations, espe cially while getting up from the sitting position. N/A N/A N/A N/A N/A N/A N/A N/A N/A A patient recovered from a mild form of COVID-19, three to four weeks after diagnosis presented fatigue, headache, dizziness, chest pain, and palpitations, especially while getting up from the sitting position. Electrocardiography was negative for acute events. Physical examination revealed a sitting heart rate of 86 bpm and blood pressure of 115/65 mmHg; after standing up, however, her heart rate was 115 bpm and her blood pressure was 105/70 mmHg. Because of her orthostatic increase in heart rate, she underwent head-up tilt-table testing and findings of the test were suggestive of POTS. She was treated with Ivabradine with improvement of the symptoms both subjectively and objectively at follow-up visit.
207 December Livingston T 10.1093/ptj/pzaa204 2020 USA N/A To illustrate how the technology and COVID-19 specific decision-making frameworks were used to deliver acute rehabilitation. Descriptive: Case Series Rehabilitation in acute care Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute COVID-19 2 N/A In-room video communication system and PT/OT co-treatment strategies. 1 case: For acute care rehabilitation sessions co-treatments PT/OT of 30 minutes; on rehabilitation unit, session of 40-60-minute separate sessions per physical therapy and occupational therapy ; 2 case: 30 co-treatment minutes with a physical therapist and occupational therapist N/A N/A N/A N/A N/A N/A N/A N/A The two case reports (A 65-year-old and a 40-year-old, males) highlight a model of care that used technology and two COVID-19 specific decision-making processes to provide safe and patient-centered care. The use of in-room video communication system and PT/OT co-treatment strategies enabled patients to receive both PT and OT services, while concurrently conserving PPE and reducing provider contact. Furthermore, the capability for virtual rehabilitation following hospital discharge allowed the rehabilitation team and patient to comfortably make an informed decision to discharge the patient from the hospital to home. The authors developed also two decision-making models regarding care delivery and discharge planning in the context of the challenges to delivering care. Both patients with COVID-19 demonstrated functional gains after 2-4 weeks of acute rehabilitation (length of stays: 7 days in acute care, 17 days in COVID-19 acute rehabilitation unit; 17 days including 11 days in ICU) and discharged home. The use of technology and decision-making models allows for delivery of safe acute rehabilitation care that minimizes contact, conserves personal protective equipment, and prepares for COVID-19 surges.
208 December Meys R 10.3390/jcm9123993 2020 The Netherlands and Belgium N/A To assess the respiratory-specific quality of life in addition to generic quality of life in non-hospitalized COVID-19 patients Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Chronic COVID-19 210 N/A N/A The subjects were also categozied as Confirmed COVID-19, Symptom-Based COVID-19, and Suspected COVID-19 The EQ-5D-5L, Clinical COPD Questionnaire N/A N/A N/A N/A N/A N/A 210 non-hospitalized patients (79 ± 17 days after symptom onset) were included in the study. Both generic (EQ-5D) and respiratory-specific quality of life (CCQ) was affected in these patients, approximately three months after the onset of symptoms. The combined use of the EQ-5D and the CCQ could identify the broad impact of COVID-19 on quality of life. The correlation between EQ-5D index score/EQ-VAS score and CCQ total score was moderate. Given the moderate association and limited discriminative ability of both questionnaires, the combined usage of the EQ-5D and the CCQ can be regarded as a promising approach to best describe the quality of life in patients with COVID-19. This will help to reveal patients’ needs in order to identify relevant rehabilitative interventions to effectively restore health and quality of life.
209 December Mizrahi B 10.1038/s41467-020-20053-y 2020 Israel From 1/3/2020 to 07/06/2020 To assess the longitudinal dynamics of symptoms prior to and throughout SARS-CoV-2 infection. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) COVID-19 2471 N/A N/A 6,227 negative cases and 147,679 individuals who had no record of a PCR test for SARS-CoV-2 N/A N/A N/A N/A N/A N/A N/A The authors extracted data from primary-care electronic health records and nationwide distributed surveys to assess the longitudinal dynamics of symptoms prior to and throughout SARS-CoV-2 infection. Information was available for 206,377 individuals, including 2471 positive cases. The two data sources were discordant, with survey data capturing most of the symptoms more sensitively. The most prevalent symptoms included fever, cough, and fatigue. Conjunctivitis, rash, sore throat, dyspnea and/or shortness of breath and speech disturbance, had a higher prevalence in children who were positive to COVID-19 compared to positive adults. Loss of taste and smell 3 weeks prior to testing, either self-reported or recorded by physicians, were the most discriminative symptoms for COVID-19. Additional discriminative symptoms included self-reported headache and fatigue and documentation of syncope, rhinorrhea, and fever. Children had a significantly shorter disease duration. Long duration of symptoms, specifically fatigue, myalgia, runny nose and shortness of breath was observed weeks after recovery. This study highlights the power of survey derived data to enhance understanding of the evolving COVID-19 pandemic. The study provides additional information on the natural history of mostly mild cases of COVID-19 and may alert physicians for the possibility of infec- tion and direct the need for testing and self-isolation.
210 December Ortelli P 10.1016/j.jns.2020.117271 2020 Italy April and May, 2020 To provide a comprehensive clinical, neurophysiological, and neuropsychological profile of fatigued patients suffering from neurological manifestations related to SARSCoV-2, who recovered from the acute phase of COVID-19. Analytical: Cross-sectional study Specialized postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 12 N/A N/A 12 healthy controls Neuropsychological assessment and neurophysiological evaluation. N/A N/A N/A N/A N/A N/A The 12 patients included in the study were all post-acute COVID-19 patients who suffered from neurological complications, and were still suffering from fatigue. All patients met the World Health Organization criteria defining the state of recovery from COVID-19. Neuropsychological and neurophysiological examination were collected in both patients and healthy controls. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: CMAP amplitude in FDI following ulnar nerve stimulation, resting motor threshold, MEP amplitude and silent period duration in right FDI following transcranial magnetic stimulation of the left motor cortex . Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. Silent period duration did not differ between groups PRE, increased in controls but decreased in patients POST. Taken all together, the study demonstrated the presence, in post COVID-19 patients who suffered from neurological complications, of central neuromotor and cognitive fatigue, apathy, and executive dysfunction.
211 December Pancera S 10.1097/MRR.0000000000000450 2020 Italy March - April 2020 To evaluate the feasibility of a subacute rehabilitation program for mechanically ventilated patients with severe consequences of COVID-19 infection Descriptive: Case Series Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 7 Seven male COVID-19 patients (age 37–61 years) referred for inpatient rehabilitation after ICU stay (14–22 days) Pulmonary and physical rehabilitation, consisting of 11–24 treatment sessions for the duration of rehabilitation stay (13–27 days), including 6–20 sessions in the COVID unit. N/A BI, BID, MRC, SPPB N/A N/A N/A N/A N/A N/A The 6 mechanically ventilated patients were successfully weaned off before transfer to a COVIDfree unit where they stayed for 7–19 days. At discharge, all patients increased limb muscle strength and thigh circumference, reduced activity-related dyspnea, regained functional independence and reported better quality of life. The Authors concluded that rehabilitation might play a crucial role in the recovery of seriously ill post-COVID-19 patients.
212 December Roberts P 10.1016/j.apmr.2020.11.005 2020 USA from January 1 to April 30, 2020. To identify functional limitations in relation to demographic, medical, encounter characteristics; and discharge destination, in COVID-19 patients admitted to acute care hospitals Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 230 N/A N/A Discharge Home (51) VS discharge institution (51) Demographic, encounter, medical, and functional variables were tested against the dependent variable of discharge destination (discharge home vs discharge institution). N/A N/A N/A N/A N/A N/A This is a cross-sectional, retrospective study of 230 adult patients with COVID-19 who were discharged from 2 different types of hospitals within 1 health care system, from January 1 to April 30, 2020: 165 were discharged home and 65 to an institution. In the group of people discharged home, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs 25.5%) and mental health (49.0% vs 23.5%, deficits than patients discharged home. Marital status and physical function deficits were associated with an increase odds ratio of discharge to an institution. This research highlights that functional status is a strong predictor for discharge destination to an institution for patients with COVID-19. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the health care system for these vulnerable patients.
213 December Sabayan B 10.1016/j.jstrokecerebrovasdis.2020.105454 2020 Iran February - March 2020 To present data on patients who initially presented with COVID-19 respiratory symptoms, but subsequently developed ischemic stroke or subarachnoid hemorrhage Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 15 Fever, cough, dyspnea, myalgia, and COVID-19 respiratory symptoms N/A N/A Type of stroke, NIHSS, mRS N/A N/A N/A N/A N/A N/A Interval time between systemic COVID-19 manifestations and neurological symptoms ranged from one to 16 days (median: 7 days). Out of 15 COVID-19 patients, 14 had acute ischemic stroke and 1 patient had subarachnoid hemorrhage. Stroke severity in 2 patients (13%) was mild (NIHSS  6), in 6 patients (40%) was moderate (NIHSS: 7-12) and in 7 patients (47%) was severe (NIHSS 13). Six patients (40%) died. In those who survived, significant disability (mRS>2) was seen in all but one patient. The Authors concluded that there is a need for further investigation of the links between COVID-19 and cerebrovascular events.
214 December Scelfo C 10.2147/TCRM.S275779 2020 Italy March 2020 To report two cases of early lung fibrosis following COVID-19 pneumonia Descriptive: Case Series N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Late-onset COVID-19 2 Both patients showed fever, cough, and dyspnoea. N/A N/A N/A N/A N/A N/A N/A N/A N/A At one month later the onset of COVID-19 symptoms, Case 1 showed at the new contrast-enhanced CT scan signs of reticular interstitial thickening; instead, after discharge, Case 2 showed the presence of sub-pleural consolidations and reticular thickening involving the upper lobes. Thus, the Authors concluded that these cases represent two examples of early lung fibrosis in patients with COVID-19 pneumonia with different severity disease evolution and highlight the need for long-term follow-up strategies.
215 December Sinha RK 10.26452/ijrps.v11iSPL1.3608 2020 India N/A To investigate the effectiveness of structured exercise protocol on functional performance in COVID-19 patients Non randomised controlled trial Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 150 Functional impairment assessed by FIM (72.4±21.7) and POMA (11.9±3.6) Exercise protocol consisting of three satgaes: Stage I, during ICU stay (deep breathing exercises, bed mobility exercises, functional mobility in and around the bed); Stage II, during Recovery Ward stay (Stage 1 exercises continuation, graded upper limb and lower limb, strengthening exercises, and graded spinal exercises); Stage III, during isolation at home (Stage I and II exercises continuation, aerobic exercises) N/A FIM, POMA N/A N/A N/A N/A N/A N/A There was a significant improvement in both FIM (72.4±21.7 vs 91.2±25.2, p<0.05) and POMA (11.9±3.6 vs 21.9±5.5, p<0.05). The authors suggest that the structured exercise protocol helped in maintaining the physical functional performance of the subjects through-out the hospital stay and also after discharge during follow up
216 December Sonnweber T 10.1183/13993003.03481-2020 2020 Austria April 2020 To systematically evaluate the persisting cardiopulmonary damage of COVID-19 patients 60 days and 100 days after COVID-19 onset Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Chronic COVID-19 145 N/A N/A N/A At 60 and 100 days after the COVID-19 onset, the following outcomes were assessed: cardiorespiratory, gastrointestinal, and neurological symptoms, mMRC dyspnoea score, lung function testing, low-dose CT scan of the chest N/A N/A N/A N/A N/A N/A At the second follow-up visit (100 days after the onset), a relevant number of patients still reported an impaired performance status and persisting symptoms including dyspnea (36%), night sweat (24%), sleep disorders (22%), or hyposmia/anosmia (19%). Notably, severe symptoms, such as a severely impaired performance status or severe dyspnea (mMRC 3-4) were only found in 2% and 4%, respectively. The authors concluded that relevant percentage of post-COVID-19 patients presented with persisting symptoms and lung function impairment along with pulmonary abnormalities more than 100 days after the diagnosis of COVID-19.
217 December van der Sar S 10.1016/j.rmed.2020.106272 2020 Netherlands From March 16 to April 15, 2020 To examine the impact of COVID-19 pneumonia on pulmonary function and HRQoL. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 101 N/A N/A N/A Pulmonary function testing, SF-36, Borg, mMRC, HADS. N/A N/A N/A N/A N/A N/A In this study, the majority of COVID-19 pneumonia survivors had abnormal diffusion capacity six weeks after discharge. Namely, in a sample composed of 28 (27.7%) moderate cases of COVID-19 pneumonia and 73 (72.3%) severe cases, diffusion limitation was found in 71.7% of cases, obstruction in 25.7% of cases, and restriction in 21.2% of cases. Clinical anxiety and depression was still present after 6 weeks from discharge in respectively 12.5% and 16.6% of patients. SF-36 was defcitary in all domains, except for bodily pain. Overall, in COVID-19 pulmonary function and health related quality of life after 6 weeks are still impaired.
218 December Vilches-Moraga A 10.1186/s12916-020-01856-8 2020 UK, Italy From 27 February to 10 June 2020. To investigate the association between pre-admission frailty and change in the level of care needs on discharge from hospital in patients admitted with COVID-19 Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 831 N/A N/A N/A Clinical Frailty Scale, increased care needs at discharge N/A N/A N/A N/A N/A N/A Of the 831 patients who were discharged (the median length of hospital stay was 12 days, IQR 6-24), 438 (47.0%) were already living with frailty prior to COVID 19 infection (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1–3). So, around a quarter of COVID-19 patients had increased care needs at discharge, and the pre-admission frailty was strongly associated with the need for an increased level of care at discharge. These results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilized for predictive modeling and early individualized discharge planning.
219 December Woo MS 10.1093/braincomms/fcaa205 2020 Germany until 14 July 2020 To establish a screening approach fto detect cognitive deficits in patients who suffered from mild and moderate COVID-19 Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Chronic COVID-19 18 N/A N/A 10 Healthy controls The interviews were either conducted by phone or directly with the patient: TICS-M, Fatigue Assessment Scale, Patient Health Questionnaire-9 Depression Scale N/A N/A N/A N/A N/A N/A In this cross-sectional study, the authors recruited mostly young patients 20– 105days (median, 85days) after recovery from mild to moderate disease. Out of them, 14 (78%) reported sustained mild cognitive deficits and performed worse in the TICS-M for mild cognitive impairment compared to 10 age-matched healthy controls. While short-term memory, attention, and concentration were particularly affected by COVID-19, screening results did not correlate with hospitalization, treatment, viremia, or acute inflammation. Additionally, TICS-M scores did not correlate with depressed mood or fatigue. The results demonstrate that young patients who recovered from uncomplicated COVID-19 can have sustained neuropsychologic deficits that can be unmasked by targeted screening.
220 December Yang ZL 10.3389/fmed.2020.605088 2020 China January - February 2020 To analyze follow-up CTs of patients recovering from COVID-19 in Wuhan, focusing on fibrotic change and its relevant risk factors Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 166 N/A N/A N/A Chest CT exam N/A N/A N/A N/A N/A N/A Of the 166 COVID-19 patients included, at the follow-up CTs (obtained on 56 days after symptom onset), the 46% (76/166) showed CT evidence of fibrotic change and 77% (127/166) were severe or critical cases. Among patients with fibrotic change on CT, 84% (64/76) got a minimal or mild score of fibrosis. The Authors concluded that an extended follow up by CT imaging and pulmonary function testing is necessary to fully assess the sequela of COVID-19.
221 December Zhang X 10.7189/jogh-10-020514 2020 UK From March 16 to June 29, 2020 To analyse whether PA influences the risk of COVID-19. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) COVID-19 1746 N/A N/A 415,596 healthy controls Self-reported moderate-to-vigourous PA, AMPA, Clinical outcomes N/A N/A N/A N/A N/A N/A The study analyzed the data from The UK Biobank, a prospective cohort study including more than 500000 participants aged from 40 to 69 years in the United Kingdom. In this study, participants who have not been tested positive for SARS-CoV-2 and not died of COVID-19 were taken as controls. Using multivariate logistic regression, AMPA is associated with a decreased probability of both overall (OR 0.80, 95% CI.69 - 0.93) and outpatient (OR 0.74, 95% CI.58 - 0.95) COVID-19. on the other hand, no association was found between self-reported PA and COVID-19 related outcomes. The author tested causality by using Mendelian randomisation analyses that did not support casuality, possibly due to insufficient power. The results indicate a protective effect of objectively measured PA and COVID-19 outcomes.
222 December Zhu S 10.1371/journal.pone.0243883 2020 China From February 21 to April 7, 2020 To estimate the prevalence of disability and anxiety in Covid-19 survivors from eight Provinces/centrally governed municipalities of the PR China at discharge from acute inpatient treatment, and investigate relative risk of adverse outcomes by various determinants including gender, age, comorbidity,setting, ethnicity and disease severity. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 432 N/A N/A N/A IADL, BI, Zung’s self-reported anxiety scale, clinical outcomes, demographical data, comorbidity, setting. N/A N/A N/A N/A N/A N/A In this multi-center study patients were analyzed at discharge from different Chinese hospitals after the acute phase. At discharge, 36.81% of patients presented at least one IADL problem, 16.44% had at least moderate-dependence measured using BI, and 28.70% resulted positive for clinical anxiety at Zung’s self-reported anxiety scale. Severe COVID-19 patients had eleveted adjusted risk ratio of IADL limitations, ADL dependency and probable clinical anxiety. Overall, a singificative number of discharged patients suffered from limitation in IADL, ADL dependency and clinical anxiety.
223 January-February Fisher et al. 10.1111/irv.12832 2020 USA July 2020 To compare symptom prevalence and recovery among adults with and without COVID-19 who were tested at outpatient health facilities for SARS-CoV-2 infection during July 2020. Analytical: Case-control study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute COVID-19 157 N/A N/A 163 healthy controls Frequency and duration of reported symptoms N/A N/A N/A N/A N/A N/A COVID-19 patients were more likely than controls to have experienced fever, body aches, weakness, or fatigue during illness, and to report ≥1 persistent symptom more than 14 days after symptom onset (50% vs 32%, P<0.001). Cases reported significantly more days of poor physical health during the past 14 days than controls (P<0.01).
224 January-February Huang C et al. 10.1016/S0140-6736(20)32656-8 2021 China January 2020 - May 2020 To describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Chronic COVID-19 1733 N/A N/A N/A Disease severity scale, mMRC dyspnoea scale, EQ-5D-5L, EQ-VAS, symptom questionnaire, 6MWT N/A N/A N/A N/A N/A N/A At 6 months after COVID-19 onset, fatigue or muscle weakness (63%) and sleep difficulties (26%) were the most common symptoms. The proportions of median distance AT 6MWT less than the lower limit of the normal range were: 24% for Those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The authors concluded that patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and might be considered as the main target population for intervention of long-term recovery.
225 January-February Puchner B et al. 10.23736/S1973-9087.21.06549-7 2021 Austria April - July To explore the dysfunctions and outcome of COVID-19 survivors after early post-acute rehabilitation. Analytical: Cohort study Specialized postacute rehabilitation Micro - Outcome Measures Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 23 N/A An individualized, multi-professional treatment plan lasting at least 3 weeks, which focused on respiratory function, mobilization, and psychosocial management N/A FVC, FEV1, FEV1/FVC, TLC, RV, DLCO, blood gas analysis (pH, pO2, and pCO2), 6MWT, MIP, and BI N/A N/A N/A N/A N/A N/A Rehabilitative intervention resulted in a significant improvement in lung function, as reflected by an increase of FVC (p=0.007) and FEV1 (p=0.014), TLC (p=0.003), and diffusion capacity for carbon monoxide (p=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of 6MWT distance by 176±137 meters. However, the 83% of patients still had limited diffusion capacity.
226 January-February Tuzun S et al. 10.23736/S1973-9087.20.06563-6 2021 Turkey May - June 2020 To reveal musculoskeletal symptoms in COVID-19 patients, to evaluate myalgia, arthralgia, fatigue, muscle strength, and to examine the relationship of these parameters with the severity and laboratory findings of the disease Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 150 103 patients (68.7%) were non-severe, and 47 (31.3%) were severe according to ATS guidelines. N/A N/A Myalgia severity, assessed by a NRS scale; fatigue severity, assessed by Chalder Fatigue Scale were used for fatigue severity; muscle strength, assessed by HGS N/A N/A N/A N/A N/A N/A The mean value of NRS for myalgia was 7.20 (6.76–7.64), 120 patients (80%) showed fatigue at the Chalder Fatigue Scale. There was a muscle weakness in both female (HGS: 21.83 kg) and male (HGS: 36.93 kg). The authors concluded that muscle involvement in COVID-19 seemed to be related to hypoxia leading to ischemic myalgia and physical fatigue. Although there is muscle weakness in all patients, the loss of muscle function is related to the disease activity, especially in women.
227 January-February Cerillo AG et al. 10.1111/jocs.15326 2021 Italy From March 23 to April 14, 2020, To describe the benign course of the COVID‐19 in cardiac surgical patients Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 18 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A This study described a cohort of 18 patients who contracted the SARS‐CoV2 infection in a rehabilitation clinic (after a median period of 9 days) while recovering from cardiac surgery. This was a group of critically ill, elderly patients (mean age was 70 years) with multiple severe comorbidities and high surgical risk scores. Seven patients had a fever and were hospitalized, and only one patient needed admission to the COVID‐19 ICU for dyspnea and mild hypoxemia, which was treated by continuous positive airway pressure. The remaining 11 asymptomatic or mildly symptomatic patients ( 6 and 5, respectively) were discharged home or to a COVID‐19 hotel. At the latest follow‐up (after 6 months), all patients had been discharged home. The patients, despite having all the risk factors for the development of severe symptoms and death (older age, obesity, arterial hypertension, chronic obstructive pulmonary disease, and cardiovascular diseases), had a benign course. The hypothesis is 1) the low rate of symptoms and complications was simply due to chance; 2)all patients received low‐ molecular‐weight heparin during the perioperative period, and all except one were discharged on oral anticoagulants that might have exerted a protective effect; 3) the cardiac surgery promoting a strong systemic inflammatory response caused a secondary immunodeficiency in these patients, resulting in a blunted immune response to the SARS‐CoV2 infection. Further studies are needed to investigate the relationship between the surgery‐induced inflammatory response, some potentially protective therapies (e.g., anticoagulants), and severity of COVID‐19.
228 January-February Spielmanns M et al. 10.1097/PHM.0000000000001686 2021 Switzerland From March to May 2020 To analyzed a cohort of nosocomial infected COVID-19 patients in a single center inpatient rehabilitation clinic and describe performance and outcome. Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 27 N/A N/A 786 Neuro-musculoskeletal rehabilitation inpatients of 2019 N/A N/A N/A N/A N/A N/A N/A COVID-19 patients were mostly male (66.7%) with an age of 71.5 ±12.3 years. Age, sex, and cumulated comorbidities were not different between groups (COVID-19 vs non-COVID-19). 92.6% of COVID-19 patients had a mild or moderate course and two patients had to be referred to acute hospital due to respiratory failure and one of these patients died in the acute hospital. The rehabilitation duration was significantly longer in the COVID-19 group, 54.2±23.6 days versus 32.1±17.7 days. Daily therapy duration was lower during COVID-19. However, after discontinuation of isolation measures, therapy duration increased significantly. The baseline FIM score was higher in the COVID-19 group and FIM improvements were lower in COVID-19 patients than in the 2019 comparison group. In conclusion, COVID-19 infection itself had a strong negative impact on FIM change reducing the FIM at discharge by 8.9 points after correction for FIM at admission, age, sex, and morbidity index at admission.
229 January-February Loerinc LB et al. 10.1016/j.hjdsi.2020.100512 2021 USA From March 26 to April 21, 2020 To describe the demographics, baseline comorbidities, hospital course, and post-discharge care plans of patients with COVID- 19 discharged from hospitals within an academic healthcare system Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 310 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A A total of 310 patients were included (median age 58, range: 23–99; 51.0% female; 69.0% African American) with a median length of hospitalization was 5 days (range: 0–33). The analysis was stratified into four groups: (1) all patients who survived to discharge (N=310), (2) patients with no ED visit or readmission after discharge (N=284), (3) patients with ED treat and release after discharge (N=10), and (4) patients who were readmitted (N=16). The most common complications recorded in discharge documentation for all patients were electrolyte abnormalities, acute kidney injury, and sepsis. 31 of 310 patients had a neurological complication: delirium (N=27), cerebral vascular accident (N=3), and seizure (N=1). Patients who were readmitted had overall similar hospital course in duration, treatments received, intensive care requirements, and complications recorded compared to the overall population. The majority of patients (281, 90.6%) were discharged directly home. Twenty-five patients (8.1%) were discharged to a skilled nursing facility (SNF) and four patients (1.3%) were discharged to a quarantine facility. Seventy-five patients (24.2%) required any home service at discharge, including physical or occupational therapy (42, 13.5%), nursing (16, 5.2%), and new home oxygen therapy (41, 13.2%). Only 162 patients (52.3%) had a caregiver or family support identified in the medical record. Two hundred thirteen patients (68.7%) were documented to have at least one ongoing symptom at discharge with the most common being cough (44.5%) and shortness of breath (44.2%). The post-discharge ED visit rate was 7.7% with 54.2% of these attributable to COVID-19. The post- discharge readmission rate was 5.2% with 68.8% of these attributable to COVID-19. The most common COVID-19 related reason for readmission was worsening pneumonia or bacterial superinfection, noted in four patients (1.3%). Only one patient (0.3%) was suspected to have a pulmonary embolism. Two patients (0.6%) died during rehospitalization, and both had sepsis present on readmission. One patient (0.3%) was placed on hospice after discharge. The patients have significant recommended post- discharge care in the outpatient setting. There are specific transitions of care that must be anticipated and addressed by healthcare systems and the primary care community including post-hospital visits, home health supervision, monitoring of medications, discontinuation of isolation, and follow-up laboratory and radiology needs.
230 January-February Li X et al. 10.1148/radiol.2021203998 2021 China From May to September 2020 To evaluate cardiac involvement in participants recovered from COVID-19 without clinical evidence of cardiac involvement using cardiac MRI Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Cardiovascular functions (Heart b410) Chronic COVID-19 40 N/A N/A 25 healthy controls matched for age and sex Cardiac MRI N/A N/A N/A N/A N/A N/A Forty participants (54±12 years; 24 men) who recovered from COVID- 19 with moderate(n=24) or severe(n=16) pneumonia and without clinical evidence of cardiac involvement, were enrolled with a mean time between admission and cardiac MRI of 158 ±18 days and discharge and examination of 124 ±17 days. Cardiac MRI revealed extracellular volume fraction (ECV) was elevated in 24 of 40 participants (60%) recovered from COVID-19 compared to healthy controls. Moreover, 28 of 40 participants (70%) had subclinical changes of myocardial dysfunction demonstrated by a reduction in left ventricle 2D-global longitudinal strain compared with healthy controls, regardless of the severity of pneumonia. Long-term cardiovascular consequences of COVID-19 need to be investigated, and cardiac MRI can be a sensitive imaging tool. The clinical significance of these results is unknown, and this work highlights the need for longitudinal follow-up to understand the importance and progression of subclinical myocardial findings in COVID-19 participants.
231 January-February Curci C et al. 10.23736/S1973-9087.20.06660-5 2021 Italy From March 10th to April 30th, 2020 To describe the role of a patient-tailored rehabilitation plan on functional outcome in hospitalized COVID-19 patients. Descriptive: Historical cohort General postacute rehabilitation Micro - Interventions (efficacy/harms) Any other body structure and function-generic (s/b) Post-acute COVID-19 41 N/A Rehabilitation protocol according to patients baseline FiO2 (30 minutes/set, 2 times/day), aimed to improve gas exchanges, reducing dyspnoea, and improving muscle function. N/A BI, mMRC Dyspnoea Scale, 6-MWT, Borg RPE scale, length of stay in Rehabilitation Unit. N/A N/A N/A N/A N/A N/A 41 post-acute COVID-19 patients (25 male and 19 female), mean aged 72.15±11.07 years were included in the study. Their mean LOS was 31.97±9.06 days, as 39 successfully completed the rehabilitation treatment and 2 deceased (pulmonary thromboembolism in a case and spontaneous pneumothorax with acute respiratory failure in the other one). After rehabilitative treatment, the patients' disability was significantly reduced as described by the improvement in BI scale. Moreover, there was an improvement in resistance ( 6-MWT) and fatigue ( Borg RPE scale). These findings suggest that post-acute COVID-19 patients might beneficiate from a motor and respiratory rehabilitation treatment.
232 January-February Wright EV et al. doi: 10.1186/s13037-020-00279-x 2021 UK From March 11, 2020 to April 30, 2020 To compare the established mortality of patients presenting with femoral neck fractures during the COVID-19 pandemic to the equivalent period in 2018 Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute Patients presenting with femoral neck fractures 68 N/A N/A N/A 30-day mortality N/A N/A N/A N/A N/A N/A 68 patients presenting with femoral neck fractures were included in the study at hospital arrival. Mean age was 81 years old and 73% of patients where females. 25% of the patients resulted positive for SARS-CoV-2 at arrival or during hospital stay. The average length of stay of COVID-19 positive patients were 17 days, and they had a 30-day mortality of 11.76%. 30-day mortality was significantly different from that of the equivalent 2018 period (6%, p=0.045). No data were presented about the severity of COVID-19 presentation in these patients. Orthogeriatrics reviews were conducted in 71% of the cases within 72 hours, while in 2018 the percentage was 88%. Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. The authors conclude that the augmented mortality is possibly due both to the COVID-19 pneumonia, and the reorganisation of orthogeriatric care due to the pandemic.
233 January-February Bellan M et al. doi: 10.1001/jamanetworkopen.2020.36142 2021 Italy From March 1, 2020 to June 29, 2020 To investigate prevalence and clinical associations of functional and psychological impairment 4 months after recovery from COVID-19. Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 238 N/A N/A N/A Clinical and demographical data, Pulmonary function testing, SPPB, IES-R N/A N/A N/A N/A N/A N/A Seven hundred sixty seven consecutive post-acute COVID-19 patients were contacted by telephone 3 to 4 months after hospitalization. 4.6% of the patients died after discharge, and only 238 (35.6%) agreed to partecipate. Out of 219 patients that were able to perform pulmonary function testing, 51.6% patients (113) presented a diffusing lung capacity for carbon monoxide reduced to less than 80% of estimated value, and in 15.5% (34) of patients was reduced of less than 60%. SPBB score was reduced (score <11) in 22.3% of patients (53). Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). The study suggest that a significative percentage of hospitalized patients still suffer from respiratory, physical and psychological sequelae 3-4 months after discharge.
234 January-February Guler SA et al. doi: 10.1183/13993003.03690-2020 2021 Switzerland From May 1, 2020 to September 15, 2020 To assess pulmonary sequela of COVID-19. Analytical: Cross-sectional study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 113 47 patients mild/moderate, 66 patients severe/critical COVID-19 N/A N/A Clinical and demographical data, Pulmonary function testing, CT scan. N/A N/A N/A N/A N/A N/A One hundred thirteen COVID-19 patients were indagated 4 months after COVID-19 symptoms onset (median: 128 days). Patients were divided in two groups: mild/moderate (47 patients) and severe/critical COVID-19 (66 patients). Severe/critical disease was associated with impaired lung function, reduced percentage of diffusing lung capacity for carbon monoxide predicted, exercise-induced oxygen desaturation. Percentage of diffusing lung capacity for carbon monoxide predicted was the strongest independent factor associated with previous severe/critical disease when age, sex, BMI, 6MWD, and minimal SpO2 at exercise, were included in the multivariable model. Abnormalities for CT scan at follow up were also associated with severe/critical COVID-19
235 January-February Mandora E et al. doi: 10.1111/jocn.15637 2021 Italy From March 10, 2020 to June 10, 2020 To evaluate the level of frailty in a large cohort of COVID-19 patients with acute respiratory failure admitted to a subacute unit to stabilise their clinical condition after discharge from acute care. Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 271 N/A N/A N/A Clinical and demographical data, respiratory support needed, SPPB, BRASS N/A N/A N/A N/A N/A N/A In the present study COVID-19 patients were investigated at admission in sub-acute care, during recovery from acute respiratory failure. 236 patients were recruited in the study, with a median age of 77. All patients were administred BRASS and classified into three different levels of frailty risk. Furthermore, SPPB was collected together with clinical data. The median BRASS index was 14.0 (interquartile range 9.0–20.0). On the whole, the patients presented mostly intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). The author concluded that the majority of COVID-19 patients recovering from acute respiratory failure presented lintermidiate or high risk of frailty and require a continuity of care.
236 January-February Ozyemisci T et al. doi: 10.23736/S1973-9087.21.06551-5 2021 Turkey From March 15, 2020 to May 11, 2020 To evaluate the effects of physical rehabilitation in ICU on the overall muscle strength in patients with COVID-19 following discharge. Analytical: Case-control study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 35 N/A Rehabilitation group (N=18) underwent passive, active assisted and active joint mobilization, and, if possible, sit to stand and walking exercises. Neurmuscular electrical stimulation was performed on quadriceps and tibialis anterior. Control group who did not perform rehabilitation in ICU (N=17). Clinical and demographical data, handgrip strength, manual muscle strength using MRC scale in 3 muscle groups in each limb (arm abduction, forearm flexion, wrist extension, hip flexion, knee extension and ankle dorsiflexion), ROM, SF-36 N/A N/A N/A N/A N/A N/A In the study 35 patients with acute respiratory distress syndrome due to COVID-19 were enrolled in ICU. The first 17 patients did not undergo a rehabilitation program, while the last 18 were treated during ICU stay with mobilization and strenghtening exercises and neurmuscolar electrical stimulation on quadriceps and tibialis anterior. Of the rehabilitation group only 11 patients were stable enough during ICU stay to perform rehabilitation. At ICU discharge patients in the rehabilitation group showed no difference in no difference in hand grip or manual muscle strength compared to control group. No adverse event was found. Authors noted that the present study do not support early rehabilitation on improving muscle strength; however rehabilitation was performed safely, and the short follow-up do not allow to understand the possible medium and long term effect of the rehabilitation programme.
237 January-February Townsend L et al. doi: 10.1513/AnnalsATS.202009-1175OC 2021 Ireland March - May, 2020 To evaluate medium-term respiratory complications following SARS-CoV-2 infection. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 153 N/A N/A N/A Clinical and demographical data, Brixia score for chest radiography, 6-MWT, Rockwood’s Clinical Frailty Scale. N/A N/A N/A N/A N/A N/A At a median of 75 days after diagnosis, 153 patients were re-evaluated as outpatients and investigated for respiratory and functional sequalae. Almost half of the patients (48%) needed hospital admission during acute phase of the disease and 12% needed ICU stay. More than half (62%) of patients felt that they had not returned to full health. The median distance covered during 6-MWT was 460 m, and a shorter distance was associated with frailty (measured using Rockwood Clinical Frailty Scale) and lenght of inpatients stay. Only 4% of the patients had persistent abnormality at chest x-ray. Overall, after 2 to 3 months after diagnosis, most patients still presented objective and subjective signs of COVID-19.
238 January-February Bertolucci et al. doi: 10.23736/S1973-9087.21.06674-0 2021 Italy March - August 2020 To describe the baseline characteristics and rehabilitative outcomes of patients with complex disabilities related to pneumoniae due to COVID 19 referring to a Rehabilitation Unit Analytical: Cohort study General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 39 N/A N/A N/A BI, FAC, CIRS, nonrespiratory manifestations; dysphagia, mental confusion; PaO2/FiO2 N/A N/A N/A N/A N/A N/A BI score increased significantly (p<0.001) from 7.5 at admission to 65 at discharge. Even FAC score increased signifcantly (p<0.001), from 0 at admission to 3 at discharge. Thirty-eight patients were discharged at their home. The authors concluded that the activation of comprehensive rehabilitation settings able to assist subacute COVID-19 patients would be desirable to counteract this pandemic.
239 January-February Cortes Telles et al. doi: 10.1016/j.resp.2021.103644. 2021 Mexico N/A To compare spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), and 6-minute walk distance (6MWD) in Mexican survivors of COVID-19 with and without persistent dyspnoea. Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 with dyspnoea 70 Study participants showed mild COVID-19 in the 27%, moderate COVID-19 in the 14%, and severe COVID-19 in the 59%. N/A COVID-19 with no dyspnoea (n=116) FVC, FEV1, FEV1/FVC, DLCO, 6MWT, Borg 0-10 Dyspnoea, Borg 0-10 Fatigue N/A N/A N/A N/A N/A N/A Patients with persistent dyspnoea had significantly lower FVC (p=0.03), FEV1 (p=0.04), and DLCO (p=0.01), with 47 % having a restrictive ventilatory pattern compared to 33% in the non-dyspnoea group. Patients with persistent dyspnoea also had significantly lower 6MWT (p=0.03) and significantly higher Borg 0-10 dyspnoea (p<0.001) and fatigue (p<0.001) compared to those without dyspnoea.
240 January-February Paneroni et al. doi: 10.1016/j.apmr.2020.12.021 2021 Italy March - April 2020 To report the level of physical function in COVID-19 patients after acute respiratory failure admitted to a subacute Rehabilitation Unit. The secondary aim was to investigate which clinical characteristics during hospitalization could predict physical function. Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 184 N/A N/A N/A SPPB score and ins sub-items: standing balance, 4-MGS, and sit-to-stand test. N/A N/A N/A N/A N/A N/A The total SPPB score was 3.1±3.9, with 64% of patients exhibiting SPPB≤3. Patients with a better functional status (SPPB>3) was inversely related to previous disability (p<0.001), age (p<.0001), invasive mechanical ventilation (p<0.001), use of NIV or CPAP (p=0.001). The Authors concluded that the majority of COVID-19 patients experienced acute respiratory failure could exhibit substantial physical dysfunction.
241 January-February Pant et al. doi: 10.31729/jnma.5980. 2021 Nepal December 2020 To determine the prevalence of functional limitation in COVID-19 recovered patients using the PCFS Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other environmental factors - generic (e) Chronic Post-COVID-19 106 N/A N/A N/A PCFS N/A N/A N/A N/A N/A N/A More than half of the POST-COVID-19 patients (56.6%) reported having no functional limitation (PCFS=0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients. The majority of patients (89.6%) had at least one of the pulmonary or extra-pulmonary symptoms during COVID-19 infection. The 45.3% showed fatigue and 9.4% showed myalgia.
242 January-February RIch et al. doi: 10.1177/1751143721991060 2021 UK April - May 2020 To collect the incidence and frequency of physiotherapy interventions performed during the COVID-19 pandemic in a critical care setting. Descriptive: Historical cohort Rehabilitation in acute care Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 163 N/A N/A COVID-19 patients (n=50) Physiotherapy interventions for example, endotracheal suctioning, functional rehabilitation for every patient in the critical care setting, CPAx N/A N/A N/A N/A N/A N/A The most frequent critical care physiotherapy interventions resulted to be: suctioning (430 occasions), followed by positioning (101 occasions), assisted cough (140 occasions), ventilator hyperinflation (67) and manual techniques (83 occasions); weaning interventions were completed on 271 patients. Seventy-six COVID-19 patients completed both an initial and discharge CPAx reporting a mean admission CPAx=9.1 in COVID-19 positive and a mean CPAx=10.5 in COVID-19 negative patients. On discharge. COVID-19 positive patients demonstrated a mean CPAx=24.3 versus a mean score of 28.9 in COVID-19 negative patients.
243 January-February Tay et al. doi: 10.3389/fmed.2020.615997 2021 SIngapore January - May 2020 To describe the acute functional outcomes and associations of dependence in walking in critically ill COVID-19 patients after ICU stay; to describe the cardiopulmonary and neurological sequelae of critical illness contributing to functional dependence. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other environmental factors - generic (e) Post-acute COVID-19 51 N/A N/A N/A FAC, Charlson Comorbidity Index, PaO2/FiO2 ratio at the admission to ICU, length of ICU stay, the ICU therapies received, number of patients with continuous supplementary oxygen required, dependent in walking, dependent in 1 or more basic ADLs N/A N/A N/A N/A N/A N/A The 47.1% of patients were dependent ambulators upon transferring out of ICU. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (OR: 14.02; p=0.039) and a longer length of ICU stay (OR: 1.50; p=0.029) were associated with dependent ambulation upon discharge from ICU.
244 January-February Turcinovic et al. doi: 10.1016/j.arrct.2021.100113. 2021 USA April - June 2020 To optimize the ability of hospitalized patients isolated due to COVID-19 to participate in physical therapy Analytical: Cohort study Community-based rehabilitation (CBR) Epidemiology - Natural history/Determining and modifying factors Any other environmental factors - generic (e) Post-acute COVID-19 39 N/A Hybrid approach to delivery of physical therapy, with a combination of in-person and tele-rehabilitation visits, consisted of therapeutic exercise in supine, sitting and/or standing positions (depending on the patient’s functional ability determined from the in-person sessions). Tele-rehabilitation exercises are focused on deep breathing, balance and strengthening and were tailored to patient’s current abilities. N/A AM-PAC 6 N/A N/A N/A N/A N/A N/A There was an improvement from admission to discharge in terms of AM-PAC 6 (19.0±4.8 vs 21.8±3.3). The authors concluded that this pilot quality improvement project showed the feasibility of a hybrid combination of in-person and tele-rehabilitation sessions for hospitalized patients isolated with COVID-19
245 January-February Udina et al. doi: 10.14283/jfa.2021.1. 2021 Spain N/A To describe the pre-post impact on physical performance of multi-component therapeutic exercise for post-COVID-19 rehabilitation Analytical: Cohort study Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Chronic Post-COVID-19 20 N/A The 30-minute 7 days/week multi-component therapeutic exercise intervention consisted of: a) resistance training (1-2 sets with 8-10 repetitions each with an intensity between 30-80% of the Repetition Maximum); b) endurance training (up to 15-minutes aerobic training with a cycle ergometer, steps or walking); c) balance training (walking with obstacles, changing directions or on unstable surfaces). Post-COVID-19 patients not referred to ICU previously (n=13) BI; SPPB score and its sub-items (standing balance, 4-MGS, and sit-to-stand test), single leg stance test, unassisted gait, 6MWT N/A N/A N/A N/A N/A N/A Furthermore, post-ICU patients experienced a greater improvement compared to non-ICU in terms of SPPB (4.4±2.1 vs 2.5±1.7, p<0.01) and gait speed (0.4±0.2 vs 0.2±0.1, p<0.01). None of the patients died during the intervention and all were discharged home. Moreover, mean 6MWT walked distance improved from 158.7±154.1 to 346.3±111.5 m (p<0.001) in a subsample of 22 participants.
246 January-February Alemanno F et al. 10.1371/journal.pone.0246590 2021 Italy From March 27th to June 20th, 2020 To investigate the impact of COVID-19 on cognitive functions of patients admitted to the COVID-19 Rehabilitation Unit Analytical: Cohort study General postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 87 N/A N/A N/A MMSE, MoCA, FIM, Hamilton Rating Scale for Depression N/A N/A N/A N/A N/A N/A 87 patients, about 10 days after symptoms onset, were included and they were separated in 4 different groups according to the type of respiratory assistance they benefited in the acute phase: Group1 (orotracheal intubation), Group2 (B-PAP), Group3 (Venturi Masks), Group4 (no oxygen therapy). Out of the 87 patients, 80% had neuropsychological deficits and 40% showed mild-to-moderate depression. Group1, the most young, had higher scores than Group3 for visuospatial/executive functions, naming, short- and long-term memory, abstraction, and orientation. Cognitive impairments correlated with patients’ age. FIM (<100) did not differ between groups. Patients partly recovered at one-month follow-up and 43% showed signs of post-traumatic stress disorder. Patients with severe functional impairments had important cognitive and emotional deficits which might have been influenced by the choice of ventilatory therapy, but mostly appeared to be related to aging, independently of FIM scores. These findings should be integrated for correct neuropsychiatric assistance of COVID-19 patients in the subacute phase, and show the need for long-term psychological support and treatment of post-COVID- 19 patients.
247 January-February Wiertz CMH et al. 10.1016/j.arrct.2021.100108 2021 The Netherlands From April 2 to May 13, 2020 To describe clinical characteristics of post-ICU COVID-19 patients, admitted for inpatient rehabilitation. Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Prevalence Any other body structure and function-generic (s/b) Post-acute COVID-19 60 N/A N/A N/A ICU-stay parameters, Muscle strength, sensory neuropathy and range of motion , BI, NRS (fear, fatigue or dyspnoea) N/A N/A N/A N/A N/A N/A This study included 60 patients, mean age of 59.9, 75% of them were men. In the first week after discharge to the rehabilitation centre 38.3% of all patients experienced exercise-induced oxygen desaturation, in 72.7% muscle weakness was present in all major muscle groups and 21.7% had a reduced mobility in one or both shoulders. Furthermore 40% suffered from dysphagia and 39.2% reported symptoms of anxiety. These data confirm the importance of being aware of PICS in post-ICU COVID 19 patients and support the need for an early and effective multidisciplinary rehabilitation program that is adapted to the specific needs of COVID-19 patients.
248 January-February Xu F et al. 10.1016/j.sleep.2021.02.002 2021 China From February to April 2020. To investigate sleep and mood status, and detect the influencing factors of the psychological status of the COVID-19 patients after recovery. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Chronic COVID-19 125 N/A N/A N/A Insomnia Severity Index (ISI), Center for Epidemiology Scale for Depression (CES-D) N/A N/A N/A N/A N/A N/A This study included 121 COVID-19 patients, mean age 41.72 and 69 males (57.02%) at two weeks after hospital discharge. The patients had a high prevalence (26.45%) of insomnia and a relatively low percentage of depression (9.92%). There were significant differences in physical, mental impairment, and the need for psycho- logical assistance between the COVID-19 recovered patients with depression and the patients without depression. Age and health status may be the influencing factors for insomnia. Caring about the views of others may be the influencing factors of depression. We need to pay more attention to their sleep condition than mood status
249 January-February Piquet V et al. 10.1016/j.apmr.2021.01.069 2021 France From March 25, 2020. To determine the benefits associated with brief inpatient rehabilitation for COVID-19 patients Descriptive: Historical cohort Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Any Activity limitation and participation restriction (d) Post-acute COVID-19 100 N/A Overall motor strengthening with body weight exercises, elastics, and weights, respiratory rehabilitation exercises, aerobic work included bicycle ergometer sessions at submaximal intensity N/A Barthel Activities of Daily Living Index, 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry), ICU lenght of stay N/A N/A N/A N/A N/A N/A In this retrospective study on the first 100 patients (mean age 66 years, 66%men) with COVID-19 infection admitted to a specialized rehabilitation unit (mean delay from symptom onset was 20.4 day), inpatient therapy (mean length of rehabilitation stay was 9.8 days) was associated with substantial functional, motor, and cardiorespiratory improvement, particularly in patients who had undergone severe acute disease: Barthel index increased from 77.3 to 88.8 without recovering baseline values, there was a 37% improvement in sit-to-stand frequency, a 13% decrease in post-test respiratory rate, and a 15% increase in grip strength. Nonetheless, loss of autonomy and motor weakness persisted at discharge, which occurred approximately a month after the onset of COVID-19. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.
250 January-February Simioli F et al. 10.5152/TurkThoracJ.2021.20158 2021 Italy From mid-March to April 2020 To investigate the effects and feasibility of PP on COVID-19-associated awake patients with ARDS in a subintensive setting of care Analytical: Case-control study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 29 N/A Prone positioning No Prone positioning artery blood gases N/A N/A N/A N/A N/A N/A A total of 29 patients (25 men, mean age 64 years) underwent noninvasive ventilation, and PP was initiated 12 h from admission; 18 patients tolerated prone and side positioning for at least 10 h/d and cycled their position every 2 h, and 11 patients had no complaints with PP. The data demonstrated that the Severity of gas exchange impairment in COVID-19 is not correlated to inflammatory status. PP may be an effective adjunctive therapy in patients with COVID-19-related ARDS. Oxygenation improves when PP is initiated early and performed for more than 10 h/d. The patient’s compliance is crucial, and several attempts should be made to find the best interface to fit every patient.
251 January-February Nikam PP et al. 10.18311/jeoh/2020/25676 2021 India N/A To study the effect of twist and raise walking technique on ICU-acquired Weakness Analytical: Cohort study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 32 N/A twist and raise walking technique for a period of 7 days N/A inspiratory hold duration and forced expiratory volume N/A N/A N/A N/A N/A N/A The aim of the twist and raise walking technique was to facilitate chest expansion along with initiation of early ambulation in order to reduce the possible complications of ICU acquired weakness in 32 COVID-19 subjects. Clinically significant results were seen in post-test scores of all the subjects in terms of Inspiratory Hold Capacity as well as Forced Expiration Volume This technique can be advocated as a effective rehabilitation intervention especially in COVID-19 patients to minimize the possible complications of ICU-acquired weakness.
252 January-February Al Chikhanie Y et al. 10.1016/j.resp.2021.103639 2021 France From 2019 to 2022 To evaluate the effects of pulmonary rehabilitation post-ICU in COVID-19 patients Analytical: Cohort study General postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 21 N/A Pulmonary rehabilitation: respiratory exercises, muscle strengthening, balance and walking when possible, cycling and gymnastic Non-COVID-19 Respiratory failure post-ICU (N=21) 6MWT N/A N/A N/A N/A N/A N/A Twenty-one COVID-19 patients were evaluated pre- and post-polmunary rehabilitation and compared retrospectively to a non− COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. Polmunary rehabilitation induced greater 6-min walking distance improvement in COVID-19 patients than in other respiratory failure patients post-ICU. The sooner Polmunary rehabilitation was performed post-ICU, the better patients recovered. This treatment induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained.
253 January-February Jaywant A et al. 10.1101/2020.10.28.20221887 2020 USA From April-July 2020 To evaluate the frequency, severity, and profile of cognitive dysfunction in hospitalized patients recovering from COVID-19. Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 57 N/A N/A N/A Brief Memory and Executive Test N/A N/A N/A N/A N/A N/A This study included a cohort of 57 patients participating in inpatient rehabilitation (75% male, mean age 64.5 years). Patients were evaluated at a mean of 43.2 days post-admission. 81% of patients had cognitive impairment, ranging from mild to severe. Deficits were most common in working memory (55% of patients impaired), set-shifting (47%), divided attention (46%), and processing speed (40%). Medically stable inpatients recovering from COVID-19 commonly have deficits in attention and executive functions. These deficits were not significantly correlated with length of intubation or time since extubation. Findings suggest that easy to disseminate interventions that remediate attention and executive dysfunctions may be important in this population.
254 January-February Hall J et al. 10.1136/thoraxjnl-2020-215861 2021 UK Until the end of May, 2020 To understand outcome of post COVID-19 patients at 4 weeks follow-up. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 200 N/A N/A N/A Persistence of symptoms, radiological follow-up (dual energy CT or high-resolution CT), 6-MWT. N/A N/A N/A N/A N/A N/A COVID-19 patients that needed hospitalization in a UK hospital where interviewed telephonically 4 weeks after discharge. If there was a persistance of symptoms a clinical and radiological follow up was offered. More than a third of 1,272 patients interviewed (321, 34%) reported persistance of symptoms and were invited to a follow-up; the study reports the firs 200 cases. Of those 200, 170 were able to perform 6-MWT. In 80/200 (40%) patients it was possible to find at follow up a cardiorespiratory cause for breathlessness: 64 patients had persistent parenchymal abnormality, 4 had pulmonary embolism, 8 cardiac complications, 2 lung infarcts and 2 bacterial infections. Due to these findings, the authors suggest symptoms screening in the following weeks after COVID-19.
255 January-February Baricich A et al 10.23736/S1973-9087.21.06699-5 2021 Italy From March 1 to May 30, 2020 To assess the physical and functional mid-term sequelae in COVID-19 survivors. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 204 N/A N/A N/A SPPB N/A N/A N/A N/A N/A N/A The study analyzed 204 COVID-19 patients 6 to 3 months after discharge from hospitalization. Enrolled patients had a mean age of 57.9 years. Almost a third of recruited patients presented a SPPB score <=10 (32%, 66) indicating physical impairment. Those patients presented longer median hospitalization than patients with SPPB score>10 (14 vs 8 days, p=0.01). Furthermore, the authors observed a significant correlation between ICU hospitalization and mechanical ventilation and physical impairment.
256 January-February Hameed F et al 10.1002/pmrj.12578 2021 USA April - July, 2020 To provide clinical care to patients who were suffering from persistent symptoms of COVID-19. Analytical: Case-control study Rehabilitation services at home Micro - Interventions (efficacy/harms) Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 106 N/A Virtual Physical Therapy Home Physical Therapy, Independent Exercise Program, No therapy 30SSTS, 2MST N/A N/A N/A N/A N/A N/A The authors of the study recruited 106 patients still presenting symptoms such as weakness, fatigue, shortness of breath. After virtual assessment, based on physical tests such as 30SSTS and 2MST, and on the mini-MOCA test, patients were assigned either on a virtual physical therapy program, an independent exercise program, or, in case the patient was already undergoing home physical therapy, he was asked to continue the current program. Virtual physical therapy program consisted in one to two sessions per week, each lasting from 30 to 60 minutes, where the patients were given guidelines of how frequently to perform their exercise program independently at home, outside of therapy sessions. Out of 106 patients, 44 patients performed virtual physical therapy, 25 patients performed home physical therapy, seventeen patients performed independent unsupervised exercise, and 20 patients were referred to virtual or home physical therapy but did not perform any therapy. At two weeks follow-up, 65% of patients in the virtual physical therapy group and 88% of patients in the home physical therapy group met the clinically meaningful difference for improvement in sit-to-stand scores, compared with 50% and 17% of those in the independent exercise group and no-exercise group (p=0.056). 74% of patients in the virtual physical therapy group and 50% of patients in the home physical therapy group, independent exercise and no-exercise groups met the clinically meaningful difference for improvement in the step test (p=0.12).
257 January-February Archer SK et al 10.1016/j.apmr.2021.01.063 2021 UK From April 1 to May 31, 2020 To evaluate the presentations and outcomes of inpatients with coronavirus disease 2019 (COVID-19) presenting with dysphonia and dysphagia to investigate trends and inform potential pathways for ongoing care. Analytical: Cohort study Rehabilitation in acute care Epidemiology - Clinical presentation Any other body structure and function-generic (s/b) Post-acute COVID-19 164 N/A N/A N/A Clinical and demographical data, percentage of patients with dysphonia or dysphagia at discharge, percentage of patients decannulated. N/A N/A N/A N/A N/A N/A The authors present the data gathered by the Speech and Language Therapy about hospitalized COVID-19 patients. The majority of the 164 patients included were men (106). More than half (70.9%) of the 86 tracheostomized patients were decannulated during the study, with no failed decannulations. Patients were followed by the Speech and Language Therapist by a median of 11 days (range 6-20). Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all during the study (P<.0001). Most of the patients were eating and drinking normally on discharge, but 29.3% of those with dysphagia and 56.1% of those with dysphonia remained impaired at hospital discharge.
258 January-February Blair P et al 10.1093/ofid/ofab007 2021 USA From April 21 to July 23, 2020 To determine the progression of COVID-19 and determinants of hospitalization. Analytical: Cohort study N/A Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 118 N/A N/A N/A Clinical and demographical data, symptoms progression N/A N/A N/A N/A N/A N/A Patients resulted positive for SARS-COV-2 were recruited by phone. COVID-19 cases who needed hospitalization were excluded. Out of 475 patients assessed for eligibility, 118 were enrolled and were sent a kit containing a thermometer, a pulse oximeter, and supplies for self-testing. The day they received the kit was considered day 0 and patients were tested by phone. The other timepoints were day 3, 7, 14, 21. Finally, participants attended an in-person follow-up visit between day 28 and 60 if they were asymptomatic at the time. The median age of the selected patients was 56 (interquartile range 50-63). The patients at enrollment presented symptoms from a median of 8 days. Participants returned to their usual health a median of 20 days from symptom onset, and 66.0% of enrolled patients were at their usual health during the fourth week of illness. In day 28 of observation, only 7.6% patients required hospitalization.
259 January-February Núñez-Cortès et al 10.1177/1479973121999205 2021 Chile From August 4 to September 11, 2020 To evaluate the physical capacity and exertional desaturation one month after discharge in a sample of patients who survived COVID-19 pneumonia. Analytical: Cross-sectional study N/A Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 50 N/A N/A N/A 1STST, percentage of patients with decrease of oxygen saturation < 4% during the execution of the test. N/A N/A N/A N/A N/A N/A COVID-19 patients were recruited for this study 4 weeks after hospital discharge. A total of 50 partecipants were tested with 1STST, and were divided in two groups depending on the length of stay: 14 patients had an hospital stay of 10 days or under, while 36 patients had an hospital stay of more than 10 days. Patients were able, on average, to have 20.9 ± 4.8 repetitions; 42% were under the 2.5th percentile of predicted value, and 90% were under the 25th percentile. The group of patients who had a prolonged hospital stay had significant increase in exertional desaturation and dyspnea compared to patients with shorter hospital stay. Overall, the vast majority of hospitalized COVID-19 patients had decreased performance at 1STST after 4 weeks from discharge.
260 March-April Abodonya AM et al. 10.1097/MD.0000000000025339 2021 Saudi Arabia N/A To assess the efficacy of IMT on COVID-19 following mechanical ventilation. Pilot controlled trial Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 42 N/A 2-week IMT No treatment FVC%, FEV1%, DSI, 6-MWT, EQ-5D-3L. N/A N/A N/A N/A N/A N/A In this study patients were recruited after weaning from intubation. Half of the patients (21) were allocated in the IMT group, and half in the control group. The two groups were not different at baseline regarding their clinical characteristics. Patients that received a 2-weeks IMT program showed, at the 2 weeks time point, an improvement in pulmonary functions (FVC%, FEV1), dyspnea (DSI), functional performance (6-MWT), and QOL (EQ-5D-3L).
261 March-April Adly AS et al. 10.2196/23446 2021 Egypt N/A To compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system Randomised controlled trial Rehabilitation services at home Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 60 N/A Osteopathic manipulative respiratory and physical therapy techniques Oxygen therapy with B-PAP Primary outcome: Time needed to reach normal levels of both pO2 and pCO2, which were assessed every 48 hours. Secondary outcome measures were temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure, which were evaluated every 24 hours. N/A N/A N/A N/A N/A N/A In the present study patients were recruited during acute stage of COVID-19, and were divided in two groups of 30 patients each, one treated with oxygen therapy with B-PAP and one with osteopathic manipulative respiratory and physical therapy techniques. Since patients were isolated at their respective home, all the patients where monitored using telemedicine. A real-time videoconference was established between the patient and the physiotherapist for training, directing, and supervising the patient during self-application of osteopathic and physical therapy treatments. The results of the study show that home-based oxygen therapy with B-PAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia
262 March-April Ahmed I et al. 10.1080/21679169.2021.1909649 2021 Pakistan N/A To determine the effect of moderate to high-intensity aerobic and breathing exercise on cardiorespiratory fitness and health-related Quality of Life in post-discharge COVID-19 patients Analytical: Cohort study Specialized outpatient rehabilitation Micro - Interventions (efficacy/harms) Any Activity limitation and participation restriction (d) Post-acute COVID-19 20 N/A Five weeks (3 sessions/week) of aerobic training (20–60 min/session) and breathing exercise training (10 min/session). N/A 6-minute walking test, SF36, Modified Borg dyspnoea N/A N/A N/A N/A N/A N/A This study reports 20 post-discharge COVID-19 patients (13 males, mean age 39.6, mean 26.1 post-COVID-19 days) underwent five weeks of aerobic training and breathing exercise training. Sub-group analysis according to inpatient ventilatory support used in the active course of the disease was also performed (10 subjects per group). Cardiorespiratory fitness, dyspnoea, and quality of life significantly improved after training. Both subgroups improved over time in measures of endurance, dyspnoea, and quality of life. An increase in exercise tolerance was observed in subjects who did not use inpatient ventilatory support. The same subjects showed a trend towards greater improvement in General health and Body pain domains of health-related quality of life and dyspnoea. This study suggests that rehabilitation training may further functional recovery in post-discharge COVID-19 patients.
263 March-April Betschart M et al. 10.3390/ijerph18083978 2021 Switzerland From March 2020 to June 2020 To present feasibility data of outpatient pulmonary rehabilitation and to provide preliminary data on the outcomes of outpatient pulmonary rehabilitation with specific information on dose and training intensities. Analytical: Cohort study Specialized outpatient rehabilitation Micro - Interventions (efficacy/harms) Any other body structure and function-generic (s/b) Post-acute COVID-19 12 N/A Pulmonary Rehabilitation program :twice weekly, interval-based aerobic cycle endurance training, followed by resistance training; 60–90 min per session at intensities of 50% peak work rate; education and physical activity coaching were also provided. N/A Dropouts, number of training sessions undertaken, tolerability for dose and training mode, 6MWT, Medical Research Council Dyspnea Scale, EQ-5D-5L VAS , Post-COVID-19 Functional Status scale, FSS N/A N/A N/A N/A N/A N/A This study reports 12 patients underwent a rehabilitation program at 41,5 days from COVID-19 diagnosis. Three dropouts (25%) were reported after 11–19 sessions. Tolerability of interval-based training was 83% and 100% for exercise duration of aerobic cycle endurance and resistance training, respectively; 92% for training intensity, 83% progressive increase of intensity, and 83% mode in aerobic cycle endurance . The authors suggest from these preliminary findings that the protocol used may be feasible, and confer benefits to a small subgroup of patients recovering from COVID-19.
264 March-April Blanco et al. 10.1016/j.cmi.2021.02.019 2021 Spain N/A To describe lung function in patients recovering from COVID-19 hospitalization and to identify biomarkers in serum and induced sputum samples from these patients. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 100 N/A N/A N/A Clinical and laboratory parameters, pulmonary function tests, 6-MWT and chest CT. N/A N/A N/A N/A N/A N/A Patients hospitalized for COVID-19 were studied at a median time of 104 days after symptoms onset. Almost half of them (47%) had severe COVID-19. Thorax CT scan were normal in 48% of patients. DLCO was =>80% in just 48% of patients. DLCO < 80% and a lower serum lactate dehydrogenase level were associated with the severe disease. Patients with DLCO<80% were able to walk a significantly lower distance during 6-MWT than patients with DLCO=>80% (513 vs 577 meters on average). Furthermore, only 39.2% of patients with DLCO<80% were able to walk more than 550 meters at 6-MWT, compared to 66% of patients with DLCO=>80%. In total, 51 out of 100 patients were able to walk more than 550 meters at 6-MWT.
265 March-April Buccafusca M 10.1007/s10072-020-05001-4 2021 Italy From 08 March 2020 to 30 May 2020 To describe the natural history of PD patients hospidalized for COVID-19 infection Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute, post-acute, late-onset, or permanent on a pre-existing health condition COVID-19 with PD 12 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A This study reports 12 patients affected by PD who became infected with SARS-Cov-2 in a care residency, and thus hospitalised in a COVID hospital. Most PD patients had a long disease duration and multiple comorbidities. Despite lung conditions, most PD patients in this study had mild symptoms: 7 patients were clinically asymptomatic (58.3%); 3 patients had fever, cough, and myalgia (25%) and 2 patients had dyspnoea (16%) that needed high-flow oxygen therapy. All patients were discharged after a mean hospitalisation period of 30 days. The mortality rate during hospitalization was zero. SARS-CoV-2 infection did not have a poor prognosis in this cohort of PD patients.
266 March-April Cao J et al. 10.1177/ 17534666211009410 2021 China From January 22 to March 7, 2020 To evaluate the outcomes of patients with COVID-19 at 1 and 3 months after discharge using: clinical features, blood tests, chest CT, pulmonary function, exercise capacity, and SF-36. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 81 N/A N/A N/A Chest CT abnormalities, pulmonary function test, 6-MWT, SF36 N/A N/A N/A N/A N/A N/A At 3 months follow-up, chest CT abnormalities were present in more than half of COVID-19 survivors (54%) and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed.
267 March-April Chiu M 10.1016/j.jcjq.2021.02.007 2021 USA From March 30, 2020, to May, 22, 2020 To outline the development and implementation of an efficient interdisciplinary team dedicated to the critical need of PP interventions. Analytical: Cohort study Rehabilitation in acute care Meso Level Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 100 N/A Development of a Prone Team during the pandemic N/A number of daily interventions provided by the Prone Team, adverse events N/A N/A N/A N/A N/A N/A During the COVID-19 pandemic, the Prone Team was developed to respond to the rapidly growing number of patients with respiratory distress. A group of physical therapists and occupational therapists (PT/OTs) with ICU experience was redeployed from their regular roles to receive intensive training in PP from an experienced medical ICU registered nurses. As the workload increased, additional PT/OTs were recruited to the team. A coordinating structure comprising attending pulmonologists screened and advised on appropriate patients. A communication and feedback structure was also implemented. Over a period of seven weeks, the team provided PP to more than 100 patients, with 577 individual interventions in a total of 14 ICUs and one emergency department. The patients remained prone for a median of 19 hours per session.There were no major airway or central venous access complications, and only one anterior pressure injury was recorded.The rapid implementation of an interdisciplinary PP team in a crisis situation is feasible. It can provide a safe and efficient alternative to adding to the workload of an overloaded nursing staff.
268 March-April Darley et al. 10.5694/mja2.50963 2021 Australia May - July 2020 To assess the prevalence and nature of persistent symptoms; to evaluate lung function, health- related quality of life, neurocognitive and olfactory abnormalities during the recovery period, and to characterise the longitudinal immune response to infection. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Post-acute COVID-19 78 N/A N/A N/A Complex lung function testing, computerised CogState Cognitive Test Battery, NIH Toolbox Odor Identification test,Depression in the Medically Ill questionnaire (DMI- 10), post COVID-19 maniefestations N/A N/A N/A N/A N/A N/A Seventy-eight patients were assessed at a median 69 days after diagnosis. Thirty-one patients had persistent symptoms, including fatigue (n: 17), shortness of breath (n: 15), and chest tightness (n: 14). Sixty- five patients underwent complex lung function testing at a median of 113 days after COVID-19 diagnosis. Total lung capacity was abnormal in 18 patients, hospitalised patients have a significantly lower median total lung capacity compared to community-treated patients (P = 0.023). Eight patients were cognitively impaired, while five patients had mild and three had moderate cognitive impairment. Sixteen patients reported symptoms of depression.
269 March-April Daunter AK et al. 10.1002/pmrj.12624 2021 USA From March 4, 2020 and May 1, 2020. To examine the prevalence of functional decline and related rehabilitation needs at hospital discharge Analytical: Case-control study General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 288 N/A N/A N/A Discharge location; need for outpatient physical, occupational, or speech therapy; need for durable medical equipment at discharge; presence of dysphagia at discharge; functional decline measured by ?????. N/A N/A N/A N/A N/A N/A This study included 288 COVID-19 subjects (mean age 66.80±15.31 years, males 57.6%; Length of stay 13.40±12.84). 17% were deceased at the time of discharge, 63,5 % of COVID-19 survivors were discharged to home, 12,8 % to subacute rehabilitation or Skilled Nursing Facility, 1.7% were transferred to another acute care hospital or field hospital, 1.7% were transferred to a Long Term Acute Care Hospital. Additionally, 1.4% transferred to an unaffiliated acute inpatient rehabilitation hospital. 45% percent of survivors experienced functional decline impacting their discharge, as they required additional physical, occupational, or speech therapy at discharge (80.6%); new durable medical equipment needs (67.6%); or diet modifications for dysphagia (at least 26.7%). 40.6% of the survivors were never assessed by a PM&R physician, physical therapist, occupational therapist, or speech language pathologist during their hospitalization. Length of stay as well as days on ventilator differed significantly between those who did and did not show functional declines: Those who showed functional decline had significantly longer length of stay (21.70±14.64 vs 6.21±5.61) and were mechanically ventilated longer (mean =6.96±9.69). The authors conclude that the results support the need for rehabilitative services during and after hospitalization for COVID-19.
270 March-April Debeaumont D et al. 10.1093/ptj/pzab099 2021 France Up to November 2020 To assess physical fitness and its relationship with functional dyspnea in in COVID-19 survivors at 6 months after their discharge from hospital Descriptive: Historical cohort N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Chronic COVID-19 23 N/A N/A N/A mMRC dyspnea score, pulmonary function testing, respiratory muscle testing, arterial blood gas measurements and cardiopulmonary exercise testing, thorugh an electromagnetic ergometer, dyspnoea Borg scale, muscle fatigue Borg scale N/A N/A N/A N/A N/A N/A At 6 months after discharge from hospital, dyspnoea was the most frequent persistent symptom (78%) in post-COVID-19 patients. The mean mMRC dyspnea score was 1 and was significantly associated with VO2peak (%) (rho = -0.49; P = 0.019). Considering the hospitalization of study participants, the ones previously hospitalized in general ward had a slightly reduced VO2peak (87%), whereas the ones previously hospitalized in ICUs had a moderately reduced VO2peak (77%).
271 March-April Erben Y et al. 10.1016/j.jvsv.2021.03.009 2021 USA From March 11, 2020 to September 4, 2020. To assess the incidence of DVT and PE in hospitalized COVID-19 patients and to compare the incidence with that in a non-COVID-19 cohort, matched for cardiovascular risk factors. Secondary aim was to study the effects of DVT/PE on the hospital course and early outcomes. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Acute COVID-19 915 N/A N/A N/A Primary: incidence of DVT and PE N/A N/A N/A N/A N/A N/A This is a retrospective review of data from 915 hospitalized COVID-19 patients ( mean age was 60.8, 43.3% were women). The incidence of DVT and pulmonary embolism in 915 hospitalized patients with COVID- 19 was 9.0% at a mean point after admission of 13.1 (+-19.9 days) greater than the 0.6% incidence in the matched non-COVID-19 cohort. Patients with COVID-19 who developed DVT/PE had greater mortality, more ICU admissions, a longer ICU stay, and longer hospitalization compared with hospitalized COVID-19 patients without DVT/PE. The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. IL-6 was associated with a greater risk of rehabilitation placement after discharge. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.
272 March-April Fayol A et al. 10.1002/ehf2.13315 2021 France March - April 2020 To report the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID-19 infection Analytical: Case-control study N/A Epidemiology - Natural history/Determining and modifying factors Cardiovascular functions (Heart b410) Chronic COVID-19 48 N/A N/A N/A Rest and low-level exercise transthoracic echocardiography, presenc of chest pain, dyspnoea, asthenia, and cough N/A N/A N/A N/A N/A N/A At 6 months after discharge from hospital, 60.4% of post-COVID-19 patients still reported clinical symptoms including exercise dyspnoea for 56% and asthenia for 21%. Dividing the cohort in two sub-groups according to the occurrence of myocardial injury (MI) during COVID-19 hospitalization, a low-level exercise induced a significant increase in the average septal-lateral E/e′ ratio (10.1±4.3 vs. 7.3±11.5; p=0.01) and the systolic pulmonary artery pressure (33.4±7.8 vs. 25.6±5.3 mmHg; p=0.02) in patients that previously had a myocardial injury. However, in spite of increased cardiac diastolic abnormalities observed in patients who experienced MI, no significant differences were observed in the rate of the most prevalent symptoms between subgroups: dyspnoea was present in 62% cases with MI vs 53% in cases without MI, asthenia in 25% with MI vs 19% without MI.
273 March-April Gianella et al. 10.1186/s12890-021-01509-3 2021 Switzerland March - April 2020 To describe clinical, radiological, lung function parameters and self-reported quality of life (QoL) of patients with SARS-CoV-2 pneumonia, both at diagnosis and at three-month follow-up. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 39 N/A N/A N/A abnormalities on CT scans, complex lung function testing, St. George’s Respiratory Questionnaire, SF-12 N/A N/A N/A N/A N/A N/A Thirtynine patients were enrolled in the study. At three months, 82% of the cohort had persisting abnormalities on CT scans, while a statistically significant reduction in the CT score were recorded. Reduced DLCO and/or restriction were found in 64.1% of patients. In addition, SpO 2 impairment during 6MWT was reported (91.3% ± 3.5). Abnormal total score on the St. George’s Respiratory Questionnaire was reported in 79.5% of patients, while all patients reported an abnormal SF-12 score.
274 March-April González et al. 10.1016/j.chest.2021.02.062 2021 Spain Between March and June, 2020 To report a descriptive observational cohort of patients with COVID-19 admitted to ICU . Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 62 N/A N/A N/A Pulmonary function tests, 6-MWT, chest CT, HADS, SF-12. N/A N/A N/A N/A N/A N/A The study reports an observational cohort of post ICU COVID-19 patients including 62 patients, who were tested at 3-months follow-up. Pulmonary function testing showed a DLCO < 80% in 82% of patients. The median distance convered in the 6MWT was 400 m. CT scans showed abnormal results in 70.2% of patients, associated with decresead pulmonary function. Three months after hospital discharge, pulmonary structural abnormalities and functional impairment were highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.
275 March-April Hoyois A et al. 10.1002/jpen.2101 2021 Belgium From 15 April to 1 June, 2020. To assess the nutritional status of critical COVID-19 patients when discharged from the ICU, evaluate if and how the nutritional recommendations (30 kcal/kg/day and 1,5g of proteins/kg/day) are met during the rehabilitation period and measure the evolution of nutrition parameters such as weight, body mass index and muscular strength (hand grip and mid-arm circumference). Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Digestive functions (b510) Post-acute COVID-19 15 N/A N/A N/A Anthropometric measurements, handgrip strength. N/A N/A N/A N/A N/A N/A Fifteen patients were studied at ICU discharge and 15,30 and 60 days later. Inclusion criteria included previous mechanical ventilation and at least 14 days of stay in ICU. After ICU discharge all the patients presented malnutrition. All the patients underwent inpatient rehabilitation and nutritional supplement after ICU discharge (median stay 38 days, range 26-51). Dysphagia was present in 60% of patients, who needed enteral nutrition. After 2 months, a signfiicant improvement in handgrip strength and weight was observed
276 March-April Iqbal A et al. 10.7759/cureus.13080 2021 Pakistan September - December 2020 To investigate the stigma associated with being a COVID-19 survivor and explore probable post-COVID-19 rehabilitation strategies for the hospital- and home-treated COVID-19 patients. I MAIN FINDINGS NON PARLANO DISTIGMA MA DI ALTRE MISURE DI OUTOME Analytical: Cross-sectional study Specialized postacute rehabilitation Epidemiology - Prevalence Any other body structure and function-generic (s/b) Post-acute COVID-19 158 N/A N/A N/A Sociodemographic data, post-COVID-19 manifestations, questions relating to the stigma, EQ5D5L N/A N/A N/A N/A N/A N/A Almost all patients (94.9%) experienced at least one post-COVID-19 symptom. Fatigue (82.9%) was the most prevalent post-discharge manifestation. The patients affirmed to have dypnoea in 50% of cases and joint pain in 47.5%. There was a statistically significant relation of age with the presence of post-COVID-19 manifestations such as dyspnea (p=0.007) and joint pain (p<0.001). A significantly higher number of females suffered from persistent COVID-19-associated symptoms, as fatigue (58.8%), anxiety (66.7%), and joint pain (64%).
277 March-April Jain E et al. 10.1002/pmrj.12607 2021 USA From April 9th to September 1st, 2020 To determine the functional outcomes and utilization of follow up medical care 90 days following discharge from acute inpatient rehabilitation, as compared to rehabilitation impairment in age matched controls. Analytical: Cohort study General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 18 N/A N/A 18 Matched Control Patients were selected based on having the same admitting impairment group category and similar age Functional outcomes(GG Self-Care and Mobility Activities items), hospital readmissions, and follow- up care sought by patients N/A N/A N/A N/A N/A N/A Patients with COVID-19 compared to the control group had a significantly longer acute hospitalization length of stay of 18 days as compared to 9 days, respectively .More patients with COVID-19 required oxygen during acute hospitalization as compared to controls. The COVID-19 patient group had similar improvements in functional outcomes as compared to controls. All patients were discharged home, with the majority of patients in both cohorts receiving home care services such as visiting nurses or therapy. Patients with COVID-19 required fewer readmissions than their matched controls in the 30-90-day periods and required fewer follow up visits with specialists after discharge from the Inpatient Rehabilitation Facility .The functional outcome data suggest that COVID-19 patient group recovered with similar rehabilitation efficiencies to their controls. Patients with functional deficits as a result of COVID-19, requiring multiple therapy disciplines should be considered for acute inpatient rehabilitation as this study demonstrates their ability to participate in and benefit from Inpatient Rehabilitation Facility level care.
278 March-April Journeay et al. 10.2340/20030711-1000053 2021 Canada April-June 2020 To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation Analytical: Cross-sectional study General postacute rehabilitation Epidemiology - Prevalence Any Activity limitation and participation restriction (d) Post-acute COVID-19 41 N/A N/A N/A LOS in rehabilitation hospital, admission and discharge total FIM score; admission Montreal Cognitive Assessment (MoCA) score, number of readmissions to acute care N/A N/A N/A N/A N/A N/A Forty-one patients were assessed after 19 days from COVID-19 diagnosis at admission to a rehabilitation hospital. 9.8% of patients were already disabled before COVID-19. The most commonly affected body functions were: neuromusculoskeletal (73.2%), cardiovascular, hematological, immunological, and respiratory (65.9%), and mental functions (29.3%). The median rehabilitation LOS was 16 days (IQR 13–22), with an admission total FIM of 85 (IQR 75–97) and discharge total FIM of 108.5 (IQR 103–118).
279 March-April Kikutani T 10.3390/nu13041113 2021 Japan May -June 2020 To examine the relationship between eating/swallowing function and COVID-19 infection in schizophrenic patients Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Digestive functions (b510) Acute, post-acute, late-onset, or permanent on a pre-existing health condition COVID-19 with schizophrenia 44 N/A N/A N/A Food Intake Level Scale N/A N/A N/A N/A N/A N/A This study included 44 patients (mean age of 68.86 years) with confirmed COVID-19 who were admitted to the psychiatric ward to treat schizophrenia. The mean duration of hospitalization for COVID-19 infection was 32.1 ± 19.1 days (range: 8–83 days). Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score in 14 subjects. Six subjects transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. In schizophrenic patients, who are already prone to experiencing decreased swallowing function, weight loss due to COVID-19 infection is a major risk factor for further decrease in eating/swallowing function. Preventing malnutrition during treatment for COVID-19 is important to improve post-infection prognosis and maintain quality of life.
280 March-April Leite et al. 10.1016/j.apmr.2021.03.001. 2021 Brazil From March 15 to August 27, 2020 To report symptoms, disability and rehabilitation referral rates after COVID-19 hospitalization in a large, predominantly elderly population. Analytical: Cross-sectional study Rehabilitation services at home Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 1696 N/A N/A N/A Clinical history and actual clinical data, independece measured using BI and IADLs scale. N/A N/A N/A N/A N/A N/A In this cross-sectional study a total of 1,733 individuals were screened, and 1,696 were included in the study, 3 months after COVID-19 onset. Out of all the patients, 21.0% were admitted to the ICU at any point during their hospitalization. Patients who were admitted to ICU presented worse post-discharge outcomes, including higher incidence of symptoms like shortness of breath, and lower independence in ADLs and IADLs. A rehabilitation plan, consisting in an exercise booklets, was offered to 65.5% of patients. Post-discharge patients at 3-month follow up presented high levels of disability and dependance, especially patients who needed ICU stay.
281 March-April Liu K et al. 10.1016/j.ctcp.2020.101166 2020 China From January 1 to February 6, 2020 To investigate the effects of 6-week respiratory rehabilitation training on respiratory function, QoL, mobility and psychological function in elderly patients with COVID-19. Randomised controlled trial Specialized outpatient rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 72 N/A Respiratory rehabilitation (36 cases) No rehabilitation (36 cases) pulmonary function tests including plethysmography and DLCO, functional tests (6-MWT), QoL assessments (SF-36), ADL (FIM), and mental status tests (anxiety and depression). N/A N/A N/A N/A N/A N/A Seventy-two COVID-19 patients aged 65 years old or more with no cognitive impairment were recruited for this study. Patients were randomized to receive respiratory rehabilitation, including respiratory muscle training, cough exercises, diaphragmatic training, stretching exercises, and home exercises (intervention group) or no treatment. The results of the study show that the six-week respiratory rehabilitation program can improve respiratory function (FEV1, FVC%), endurance (6-MWT), QoL (SF-36) and anxiety of elderly patients with COVID-19, but it provides little benefit on depression in the elderly
282 March-April Liu M 10.3389/fmed.2021.636298 2021 China From February 10, 2020 to March 23, 2020. To verify the existence of long-term pulmonary sequelae in COVID-19 survivors Analytical: Case-control study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Chronic COVID-19 41 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 41 COVID-19 patients performed follow-up chest CT and cardiopulmonary exercise testing at 7 months after discharge. Patients were divided into fibrosis group (12 cases) and non-fibrosis group (29 cases) according to the evidence of fibrosis on follow-up CT. The predominant CT patterns of abnormalities observed at 7 months after discharge were parenchymal band (41%), interlobular septal thickening (32%), and traction bronchiectasis (29%). Sixty-one percent of the patients achieved complete radiological resolution, and 29% of patients developed pulmonary fibrosis. Compared with the patients in the non-fibrosis group, the patients in the fibrosis group were older, with a longer hospital stay, a higher rate of steroid and mechanical ventilation therapy, lower levels of lymphocyte and T cell count, higher levels of D-dimer and lactic dehydrogenase, and higher quantitative CT parameters at discharge. Age, steroid therapy, presence of traction bronchiectasis on chest CT at discharge, and opacity score at discharge, were independent risk factors for developing pulmonary fibrosis at 7 months after discharge. The combined clinical-radiological model may predict the formation of pulmonary fibrosis early.
283 March-April Liu Y et al. 10.1080/13548506.2021.1916956 2021 China From March 2020 To assess the effects of a psychological intervention combined with pulmonary rehabilitation exercises on anxiety and sleep disorders in patients with mild COVID-19 Randomised controlled trial General postacute rehabilitation Micro - Interventions (efficacy/harms) Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 140 N/A Group psychological intervention and pulmonary rehabilitation exercises (70 cases) Standard care according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (National Administration of Traditional Chinese Medicine, National Health Commission of China, 2020), which included monitoring body temperature, pulse and heart rate; effective oxygen therapy and aerosol inhalation; instructing patients to rest in bed, drink more warm water and eat nutritious and light meals. (70 cases) State Anxiety Inventory, Pittsburgh Sleep Quality Index N/A N/A N/A N/A N/A N/A The patients were enrolled in hospitals built to treat a huge number of mild COVID-19 patients to reduce ‘run-on-hospital’ phenomena. Through group psychological intervention combined with pulmonary rehabilitation exercises, anxiety and sleep disorders of the hospitalized patients with mild COVID-19 infections were significantly less than those of the control treated with conventional nursing methods . Many factors, e.g., gender, educational background, and underlying disease status, etc., were revealed at some extent to be related to the effects of the intervention and exercises. Since the COVID-19 disease has not been eliminated yet, this study could provide a nursing framework by establishing efficient social platforms and multiple interaction mechanisms among medical staff and patients.
284 March-April Mallia P et al. 10.1136/ bmjresp-2021-000908 2021 United Kindom From May 1 to July 21, 2020 To collect symptomatic, radiographic, biochemical and healthcare utilisation data from patients with COVID-19 who attended a follow-up clinic after discharge from hospital in order to describe the recovery times for these parameters, examine the factors associated with symptomatic and radiographic recovery and record unscheduled healthcare use in these patients. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 401 N/A N/A N/A Time to clinic from discharge; Time to clinic from illness onset; Abnormal chest radiograph; Symptoms; C reactive protein; Ferritine; D-dimer N/A N/A N/A N/A N/A N/A Most patients (75.1%) were symptomatic at a median 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. Almost 20% of patients (18.5%) had unscheduled healthcare visits in the 30 days post discharge.
285 March-April Mateo S et al. 10.1016/j.rehab.2021.101516 2021 France From April 20, 2020 to July 16, 2020 To assess if FES-cycling used in combination with physiotherapy early after ICU discharge in patients with critical COVID-19 is safe to favour erectus position restoration and spontaneous walking resumption more rapidly than rehabilitation without FES-cycling. Pilot controlled trial General postacute rehabilitation Micro - Interventions (efficacy/harms) Any other body structure and function-generic (s/b) Post-acute COVID-19 14 N/A functional electrical stimulation with cycling (n=8): 20 days for a total of 4 weeks, 2 sessions of physiotherapy (30 min each) and one 30-min session of cycling per day with FES cycling alone (n=6) Actimetry: Time spent in different posture/activities during daytime (min/day), manual muscle test using the MRC score , FEV1, FVC N/A N/A N/A N/A N/A N/A This study included 14 patients admitted to the rehabilitation department after hospitalisation in the ICU for a critical form of COVID-19 (Intubation duration days: 14.5 for FES-cycling group and 20.5 for controls). As compared with cycling alone, FES-cycling was associated with greater beneficial decline in the daytime spent sedentary (e.g. lying, reclining or sitting), a higher increase in time spending walking or running. All patients progressively improved across rehabilitation weeks but patients who benefitted from FES-cycling had a significantly greater daily-life physical activity recovery profile as compared with the control group. These preliminary results suggest the interest of offering rehabilitation enriched by FES- cycling to patients with critical COVID-19 as soon as they leave the ICU even though the risk of contagion requires rehabilitation under conditions of strict isolation. Nevertheless, the effect of FES-cycling on this improved physical activity recovery profile remains to be understood because it was neither explained by nor associated with an increase in muscle strength or cardiorespiratory adaptation.
286 March-April Medrinal C et al. 10.1186/s12871-021-01274-0 2021 France Between March 16 and May 15, 2020 To report the prevalence of limb and respiratory muscle weakness in COVID-19 ICU survivors and to analyse variables associated with muscle weakness. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Post-acute COVID-19 23 N/A N/A N/A MIP, MRC, IMS N/A N/A N/A N/A N/A N/A 23 patients with severe COVID-19 requiring intubation were evaluated at three timepoints: at extubation, at discharge from ICU and telephonically 30 days after discharge. All patients underwent rehabilitation in the ICU. Most patients (69%) had limb muscle weakness at extubation, and 26% of patients had both limb and respiratory muscle weakness. The number of sessions of physiotherapy was not associated with higher muscle strength. At the 30-days follow-up almost half of patients (44%) were not able to walk autonomously for 100 meters.
287 March-April Milovancev et al. 10.3390/ijerph18084059 2021 Serbia N/A To assess the effects of COVID-19 in detraining on the cardiorespiratory status of volleyball athletes after COVID-19 infection Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 16 N/A N/A N/A Body composition, FVC, FEV1, FEV1/FVC, MVV, cardiopulmonary exercise testing (CPET), cardiorespiratory fitness, WE (W), VE, VO2, VCO2 (L/min), RER, VE/VCO2, O2 pulse, HR, VE/VO2 N/A N/A N/A N/A N/A N/A Sixteen sixteen male Serbian first division volleyball players, aged 24 4.5 years, had a recent mild COVID-19 infection (symptom duration : one week on average; return to everyday sports activities: 3 weeks after symptom onset). They were assessed after 20 days of re-training. FVC, FEV1/FVC and MVV values were over 80% of predicted values [FVC(L)=5.3±2.2; FEV-1(L)=4.7±1.9; FEV1/FVC (%)=90.5±8.2; MVV=147.7±64.8(L/min)], while ECG testing revealed no cardiac abnormalities. VE, VCO2, RER and oxygen pulse increased, heart rate exceeded 90% of predicted values, and peak VO2 values were typical for this level of athlete (44.1 ± 3.4 mL/kg). VT1 (73%) and VT2 (92.5%) were above-average values.
288 March-April Monti G et al. 10.1111/aas.13812 2021 Italy February - April 2020 To assess the quality of life of invasively ventilated COVID-19 ARDS survivors at the follow-up evaluation after ICU discharge Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any Activity limitation and participation restriction (d) Post-acute COVID-19 39 N/A N/A N/A GOSe, FAC, Borg CR-10 scale, MNA-SF, EQ-5D-3L, HADS, PTSD Checklist for DSM-5, ISI, Itel-MMSE N/A N/A N/A N/A N/A N/A Thirty-nine patients were assessed at a median 61 (51-71) days after ICU discharge, reporting no difficulty in walking (82%), self-care (85%), and usual activities (78%). All patients were either malnourished (38%) or at risk for malnutrition (62%). Thus, the authors concluded that Invasively ventilated COVID-19 ARDS survivors have an overall good recovery at 2 months after discharge.
289 March-April Musheyev B 10.1186/s40560-021-00542-y 2021 USA From 15 March 2020 to 29 June 2020 To investigate the functional status of COVID-19 IMV survivors at ICU and hospital discharge, and to correlate it with some clinical variables. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 118 N/A N/A N/A The modified “Mental Status”, ICU Mobility, and Barthel Index scores at ICU and hospital discharge N/A N/A N/A N/A N/A N/A This study investigated the functional status of 118 COVID- 19 IMV survivors at ICU and hospital discharge. The major findings were (i) the majority of patients (94%) were functionally independent prior to COVID-19 illness, but not at hospital discharge (22% discharged with a cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), (ii) half of patients were discharged with supplemental oxygen equipment, (iii) the most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations (iv) Functional status improved from ICU discharge to hospital discharge (v) worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression. The data suggested that most patients were not functionally independent, and many still had significant unresolved medical issues at hospital discharge. Follow-up studies are important to ascertain long-term outcomes and anticipate healthcare needs for COVID-19 survivors
290 March-April Olezene CS 10.1371/ journal.pone.0248824 2021 USA From April 29 to May 22, 2020 To characterize the functional impairments of a cohort of patients undergoing inpatient rehabilitation after surviving severe COVID-19 illness, in order to better understand the ongoing needs of this patient population Descriptive: Historical cohort General postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 29 N/A N/A N/A BBS, 6MWT, 10MWT, FCM N/A N/A N/A N/A N/A N/A This study described the clinical characteristics of a cohort of 29 patients (mean age of 59.5) who underwent inpatient rehabilitation following hospitalization for severe COVID-19. The mean length of acute hospitalization was 32.2 days with a mean of 18.7 days intubated. Dysphagia (86.2%), weight loss (79.3%), and delirium (69%) were the most common complications. Patients spent a mean of 16.7 days in inpatient rehabilitation and 90% were discharged home. Patients demonstrated significant improvement from admission to discharge in measures of fall risk, endurance, gait speed, mobility, cognition, speech, and swallowing. At discharge, a significant portion of the population continued to deficits in cognition (attention 37%; memory 28%; problem-solving 28%), balance (55%), and gait speed (97%). These data highlight the post-acute care needs of this patient population.
291 March-April Ordinola Navarro A et al. 10.1016/j.rmed.2021.106391 2021 Mexico From April 01 to July 30, 2020. To evaluate the changes in quality-of-life and spirometric alterations in the convalescent phase of 115 patients with at least 30 days post-COVID-19. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Post-acute COVID-19 115 N/A N/A N/A Spirometry, EQ-5D-5L N/A N/A N/A N/A N/A N/A 115 patients (median age: 40 years, 57% women, 70% with mild or moderate COVID-19; 27% hospitalized for a median 10 days, IQR: 6-12) were assessed at 58±18 days of symptom onset. The persistence of symptoms was present in 63% cases, of whom 19% had at least two symptoms. There was a severe decrease in QOL up to 56%. Alterations in usual activities and anxiety/depression were present in 59% of patients with a severe decrease in QOL. The persistence of symptoms was present in 63% cases. Restrictive lung impairment was the most common spirometric alteration in 17%(20/115), of which 65%(13/20) had mild COVID-19. Spirometric alterations are present even in mild COVID-19, and more remarkably, there is a high rate of alterations in quality of life after the recovery of this disease.
292 March-April Paneroni M et al. 10.1016/j.pulmoe.2021.03.009 2021 Italy From April 1 to June 30, 2020 To investigate the safety, feasibility, and efficacy of a 1- month Telerehabilitation program in individuals discharged after recovery from COVID-19 pneumonia Analytical: Cohort study Specialized outpatient rehabilitation Micro - Interventions (efficacy/harms) Any Activity limitation and participation restriction (d) Post-acute COVID-19 25 N/A One-month telerehabilitation program consisting of aerobic reconditioning , muscle strengthening and healthy lifestyle education one hour/day. Twice a week, a physiotherapist contacted the patient-by video-call via a dedicated platform-to monitor progress. N/A 6MWT, 1 min Sit-to-Stand, and Barthel Dyspnoea Index, nd (1MSTS), Program adherence (i.e. number of performed/scheduled video-calls) N/A N/A N/A N/A N/A N/A Out of 25 consecutive patients, 24 completed the program. Patients attended 7.2±1.7 out of 8 video-calls scheduled and nurses made 13.4 ± 2.1 phone calls. Patients reported fatigue (70.8%), muscle pain (50.0%), exercise induced dyspnoea (50.0%), and sleep disorders (41.7%). After one month of TR, patients improved exercise tolerance and dyspnoea. However, approximately 20% of patients were non-responders. No adverse events were found. This preliminary report, although limited by the small sample size and absence of a control group, confirms the feasibility and safety of a dedicated telerehabilitation program for survivors of COVID-19 pneumonia.. As with chronic cardiopulmonary diseases, telerehabilitation may help to avoid a gap in service delivery following hospital discharge of COVID- 19 patients and should be integrated into their follow-up.
293 March-April Qureshi A et al. 10.1161/STROKEAHA.120.031786 2021 USA December 2019 - April 2020 To identify risk factors, comorbidities, treatment strategies, and outcomes in patients with ischemic stroke derived from a large cohort of COVID-19 patients Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 7709 (103 with stroke, 7606 without stroke) N/A N/A N/A Demographic and clinical characteristics, discharge at home, discharge to other destionations different from home, in-hospital death N/A N/A N/A N/A N/A N/A 103 out of 7709 COVID-19 patients suffered an acute ischemic stroke. Mean age in this subroup was significantly higher compared with those without stroke (68.8±15.1 vs 54.4±20.3; P<0.0001). The in-hospital mortality (19.4% vs 6.2%; P<0.0001) and discharge to destination other than home (62.1% vs 29.1%; P<0.0001) were significantly higher in COVID-19 patients with acute ischemic stroke compared with those without stroke.
294 March-April Rass V et al. 10.1111/ene.14803 2021 Austria Between April and September, 2020 To investigate the prevalence of neurological manifestations in COVID-19 patients at 3-months follow-up. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 135 N/A N/A N/A Prevalence of neurological symptoms at 3-months follow-up, 16-item Sniffin-Sticks-test, MoCA, SF-36, PCL-5, HADS. N/A N/A N/A N/A N/A N/A At 3-months follow-up after COVID-19 of various degree of intensity (from severe to mild), 125 consecutve patients were tested for prevalence of neurological and psychological symptoms. Overall, 15% of patients presented neurological symptoms who were not evident before COVID-19, including poly-neuro/myopathy (n=16, 12%), mild encephalopathy (n=2, 2%), parkinsonism (n=1, 1%), orthostatic hypotension (n=1, 1%), Guillain-Barré-Syndrome (n=1, 1%) and ischemic stroke (n=1, 1%). At the 3-months follow-up, cognitive impairment, decrease in QoL, depression, anxiety and post-traumatic stress disorders were all present in different percentage of patients, 23%, 31%, 11, 25% and 11% respectively.
295 March-April Rinaldo RF et al. 10.1183/13993003.00870-2021 2021 Italy May-August 2020 To evaluate the sequelae of COVID-19 assessing the exercise performance during incremental Cardiopulmonary exercise test Descriptive: Historical cohort Specialized outpatient rehabilitation Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Chronic COVID-19 75 N/A N/A N/A Cardiopulmonary exercise test N/A N/A N/A N/A N/A N/A Seventy-five (43, 57% males) patients were studied at 97 +/- 26 days of hospital discharge . Thirty-nine patients had a critical, 18 a severe, and 18 a mild-moderate disease. Forty- three (63%) patients showed a residual parenchymal involvement at CT. Spirometry showed normal values. Compared to subjects with normal exercise capacity (n=34), the patients with a reduced capacity (n=41) showed an early anaerobic threshold, indicating a higher degree of deconditioning; they reached lower levels of performance and earlier termination, with a lower work, a lower peak oxygen pulse, a higher Heart rate reserve, and a wider breathing reserve. Deconditioning might be related to a direct effect of the viral load on the muscle tissue, with an impaired O2 extraction and use, as well as to a prolonged hospital stay and post-hospitalization syndrome. Remarkably, parameters of ventilatory efficiency or gas exchange were still in the limit of normal and there was not a significant difference between patients with preserved and those with a reduced exercise capacity; neither pulmonary function tests nor CT imaging did help discriminate patients with a lower peak VO2. Thirty-nine (52%) patients reported dyspnea during their daily activity. Residual dyspnea origin can depend on multiple factors, and a mildly impaired exercise capacity associated with deconditioning might play a role. In conclusion, this study showed no relevant functional sequelae on ventilatory and gas exchange response to exercise
296 March-April Sakai et al. 10.2490/prm.20210013. 2021 Japan Between April 21 and August 20, 2020 To describe the characteristics and efficiency of rehabilitation for patients diagnosed with moderate-to-severe COVID-19. Descriptive: Historical cohort Rehabilitation in acute care Meso Level Any other body structure and function-generic (s/b) Acute COVID-19 161 N/A Rehabilitation delivery model, integrating in-person sessions with remote treatment by the use of technology, either in ICU, or in general COVID-19 ward. No treatment Clinical data, total number of sessions completed by patients. N/A N/A N/A N/A N/A N/A Out of 191 COVID-19 patients studied , 95 underwent rehabilitation, 78 in the general COVID-19 wards and 17 in the ICU. They completed 1035 rehabilitation sessions in total, 882 in the general ward and 153 in the ICU. Using technology such as tablet, 86 sessions of rehabilitation were remotely performed in order to reduce exposition to COVID-19 ward to clinical operators. According to the authors, rehabilitation in acute settings is feasible in COVID-19, and potentially remote rehabilitation can be used to decrease the use of protective equipment and exposure of operators.
297 March-April Shendy W et al. N/A 2021 Egypt From September 15 to December 15, 2020 To determine the prevalence of fatigue in adult people post mild and moderate COVID-19 cases and the relation between fatigue post COVID-19 and several factors. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Chronic COVID-19 81 N/A N/A N/A MFIS and Fatigue NRS. N/A N/A N/A N/A N/A N/A Adult patients with mild and moderate COVID-19 were studied after three to five months from their recovery. They showed fatigue in 64.2% cases . There was no significant association between fatigue and age, sex, BMI, smoking, hospitalization and received treatment. The association between NRS and MFIS was moderately positive and significant.
298 March-April Shi S et al. 10.1016/j.jamda.2021.04.003 2020 USA From March 15 to May 30, 2020 To compare functional recovery between older adults presenting with and without COVID-19 and post-acute recovery in SNF by baseline frailty in older adults presenting with COVID-19. Descriptive: Historical cohort Rehabilitation in social assistance Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 42 N/A N/A 31 COVID-19 negative elderly people admitted to a SNF The primary outcome was discharge to community. Secondary outcomes included change in functional status from SNF admission to discharge, based on BI. N/A N/A N/A N/A N/A N/A The study, including 42 COVID-19 positive elderly and 31 COVID-19 negative admitted to a SNF for post hospitalization care, shows that COVID-19 positive patients has community discharge rates and functional improvement comparable to a COVID-19 negative group. At baseline, patients had comparable length of hospitalization (COVID-19 negative and positive respectively 10.4 and 11.6). The results of the present study suggest that those with moderate or worse frailty at baseline improved significantly less on their occupational therapy functional score, compared with those nonfrail and mild frail at baseline. Older adults admitted to a SNF for post-acute care with COVID-19 generally had good functional recovery and were discharged back to the community; however, those who are frailer tended to have a lower function at discharge.
299 March-April Spielmanns M 10.3390/ijerph18052695 2021 Switzerland From March to December 2020 To compare the effect of pulmonary rehabilitation (PR) in post-COVID-19 patients and in patients with other lung diseases referred to PR in 2019. Analytical: Case-control study Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 99 N/A Three weeks standard inpatient PR , for a total 25–30 therapy sessions on 5–6 weekdays PR delivered to patients with pulmonary diseases in 2019 (n = 419) FIM, 6-MWT, FT N/A N/A N/A N/A N/A N/A This study compared the results of post-acute comprehensive PR delivered to severe post-COVID-19 patients with results observed in individuals with pulmonary diseases referred for PR in the preCOVID era. Improvements in physical performance, endurance, actual wellbeing during PR were significantly higher for the Post-COVID-19 patients. Consequently, healthcare facilities should develop and implement plans for providing multidisciplinary rehabilitation treatments in various settings to recover functioning and prevent the development of long-term consequences of the COVID-19 disease.
300 March-April Sryma P 10.4103/lungindia.lungindia_794_20 2021 India N/A To determine whether the early use of PP combined with noninvasive modalities of oxygen therapy can improve oxygenation and avoid the need for intubation in patients with hypoxemic respiratory failure due to COVID-19 Analytical: Cohort study Rehabilitation in acute care Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 45 N/A PP (maintained for a minimum of 2 h per session and with a target duration of 8 h/day) combined with noninvasive modalities of oxygen therapy (30 cases) Standard treatment (15 cases) Rate of intubation; ROX index at 30 min from the start of the intervention, ROX index at 12 h, days to hypoxia resolution (defined as room air SpO2 >93%), and mortality. N/A N/A N/A N/A N/A N/A 45 COVID-19 patients with hypoxic respiratory failure were included ; mean age 53.1 years. Age, comorbidities, and baseline ROX index were similar across subgroups (undergone PP or standard treatment) . The median duration of PP was 7.5 h on the 1st day. The need for MV was higher in the control group (33.3%) versus the PP group (6.7%). At 30 min, there was a statistically significant improvement in the mean ROX index of cases compared with that of the controls. No significant adverse effects related to intervention were noted. Early awake PP is associated with significant improvement in oxygenation and may reduce the need for MV in subjects with COVID‐19.
301 March-April Sun J et al. 10.21037/apm-20-2014 2021 China From January 30 to March 3, 2020 To investigate the effects of a 3-week physical rehabilitation program delivered to inpatients with severe COVID-19 in a stable phase . Analytical: Cohort study Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 31 N/A breathing exercise; respiratory muscle training; stretching training; psychotherapy; physical rehabilitaiton (2 sessions per day for 3 weeks). N/A Respiratory symptoms, exercise endurance, activities of daily living (ADL) score, SaO2%, and oxygen intake. N/A N/A N/A N/A N/A N/A The baseline prevalence for dry cough, productive cough, and dyspnea was 67.74%, 54.84%, and 51.61%, respectively, which all decreased pronouncedly over time. Already after 2-week physical rehabilitation, the prevalence rate was 6.9% in dry cough, 20.69% in productive cough,and only 31.03% of patients reported dyspnea as a remained symptom. After the completion of the 3-week physical rehabilitation, overall the patients had significant improvement of their clinical condition: none had sputum, and fewer felt fatigue or shortness breathe or palpitation, and all patients were able to wear clothes or shoes or go to the toilet by themselves.
302 March-April Sun LL et al. 10.1111/1751-2980.12983 2021 China February - March 2020 To perform an updated analysis of detailed clinical characteristics and a 3-month follow-up in hospitalized COVID-19 patients in order to disclose the symptomatic features Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 932 N/A N/A N/A Fever, cough, mMRC dyspnoea, fatigue, myalgia, and other COVID-19 symptomatic features N/A N/A N/A N/A N/A N/A Fever (60%), cough (50.8%), and fatigue (36.4%) were the most common symptoms in the 932 COVID-19 patients. Most dyspneoa occurred on the fourth day after illness onset, with a median duration of 16 days. multivariate regression analysis showed that fever lasting for more than 5 days (OR=1.9; P=0.0498), anorexia (OR=2.6; P=0.0096) and mMRC dyspnoea >2 (OR=14.2; P<0.0001) were symptomatic risk factors for severe COVID-19. At the 3-month follow-up evaluation, dyspnoea (7.2%) and cough (6.2%) were the significant remaining symptoms.
303 March-April Taboada M et al. 10.1016/j.jinf.2020.12.022 2020 Spain From March 1 to April 30, 2020 To describe functional status and the presence of persistent dyspnea six months after hospitalization. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Chronic COVID-19 242 N/A N/A N/A Clinical history, pulmonary function tests, 6-MWT, chest CT, HADS, SF-12, PCFS. N/A N/A N/A N/A N/A N/A In the present study, a decreased functional status measured with PCFS scale was reported in 87 (47.5%) patients at 6 months of COVID-19 infection. Female sex, age, length of hospital stay, mechanical ventilation, and ICU admission were associated with limitations in the functional status (grade II-IV of the PCSF). Six months after COVID-19, patients are susceptible to present reduced functional status that impact their ability to care for themselves and to perform usual activities of daily living.
304 March-April Taboada M et al. 10.1016/j.bja.2020.12.007. 2021 Spain March - April 2020 To evaluate through a structured interview HRQoL, functional status, and persistent symptoms in post-COVID-19 patients at 6 months after requiring ICU treatment Analytical: Cross-sectional study N/A Epidemiology - Prevalence Any other body structure and function-generic (s/b) Chronic COVID-19 91 N/A N/A N/A EQ-5D-3L, PCFS N/A N/A N/A N/A N/A N/A At 6 months after COVID-19, persistent symptoms correlated with COVID-19 were present in the 91 patients. A high proportion of patients reported dyspnoea on exertion (57%), asthaenia (37%), myalgia (37%), and arthralgia (29%). Only 15 (16%) patients were completely free of persistent symptoms. Moreover, they had a significantly lower HRQoL (p<0.001) compared with their pre-COVID-19 status.
305 March-April Tomar BS et al. 10.2147/IJGM.S295499. 2021 India October - November 2020 To investigate the prevalence of different symptoms in the post- acute care phase in COVID-19. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Any other body structure and function-generic (s/b) Post-acute COVID-19 50 N/A N/A N/A Clinical characteristics N/A N/A N/A N/A N/A N/A The most common symptoms at the baseline were fever (94%), cough (78%) and breathlessness (68%), showed by the 50 COVID-19 patients in the acute care facility. At the follow-up evaluation after discharge (range 15 to 50 days), 82% showed at least one persistent symptom, where fatigue was the most common one (74%), followed by breathlessness (44%), and muscle weakness (36%). Thus, authors concluded that patients discharged from the acute COVID care facility had a high prevalence of post-COVID symptoms even after 14 days.
306 March-April Townsend L 10.1371/journal. pone.0247280 2021 Republic of Ireland From August to October 2020 To investigate the presence of autonomic dysfunction following SARS-CoV-2 infection and its relationship with post-COVID fatigue. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Cardiovascular functions (Blood pressure b420) Chronic COVID-19 40 N/A N/A N/A Chalder Fatigue Scale, Ewing’s autonomic function test battery N/A N/A N/A N/A N/A N/A This study presents a comprehensive autonomic assessment of patients with post-COVID fatigue and contextualise the results with matched non-fatigued COVID survivors at a median of 166 days following infection. The authors found no objective findings of autonomic dysfunction, with no significant pathological differences noted between groups in any of the Ewing’s battery parameters. They also demonstrate a significant symptom burden, with 70% of fatigued patients reporting symptoms at the time of the active stand, but these were independent of neurocardiovascular changes. Fatigue was strongly associated with increased anxiety, with no patients having a pre-existing diagnosis of anxiety. . Finally, they demonstrate the impact of post-COVID fatigue on daily function, with 35% of the fatigued cohort not yet returned to full-time employment.
307 March-April Walle-Hansen MM et al. 10.1186/s12877-021-02140-x 2021 Norway From March 1 to July 1, 2020 To study age related change in HR-QoL, functional status and mortality among patients aged 60 years and older after hospitalisation due to COVID-19. Analytical: Cross-sectional study N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Sensory functions and pain b2) Chronic COVID-19 216 N/A N/A N/A EQ-5D-5L, MoCA, SPPB, mortality N/A N/A N/A N/A N/A N/A The study investigated hospitalized COVID-19 at a 6 months follow up. Out of 216 patients contacted, 171 were still alive (21% 6-months mortality) and 106 attended the follow-up. More than half patients (57 patients) reported a decrease in EQ-5D-5L scores after 6 months, with no difference between older (75 years old more) and younger patients (60-75 years old). Forty-six participants (43%) reported a negative change in cognitive function compared to before the COVID-19 hospitalisation.
308 March-April Wu et al. 10.1016/j.ijid.2021.04.020 2021 China January 2020 - January 2021 To evaluate the respiratory and physical functions of patients who retested positive for SARS-CoV-2 RNA during post-COVID-19 rehabilitation. Analytical: Cohort study N/A Epidemiology - Natural history/Determining and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 302 N/A N/A N/A mMRC dyspnea scale, Borg rating of perceived exertion, MMT N/A N/A N/A N/A N/A N/A The study compares mMRC, Borg, and MMT scores in re-detectable positive (23) and non re-detectable positive (279) COVID-19 patients at 2 weeks after discharge. There were no differences in the quoted scores between groups at the follow-up evaluations (at 14 days and at 6 months after discharge). The proportion of patients using antiviral drugs in the re-detectable positive group was significantly lower than those non re-detectable positive (78.3% vs 95.4%; p=0.003). The authors concluded that the prognoses of re-detectable positive and not-re-detectable positive patients are not different in terms of respiratory and physical function. at in the follow-up evaluations.
309 March-April Zampogna E et al. 10.1159/000514387. 2021 Italy April - August 2020 To evaluate the effectiveness of pulmonary rehabilitation in hospitalized patients consecutively admitted to an in-patient pulmonary rehabilitation program after COVID-19 Descriptive: Historical cohort Specialized postacute rehabilitation Epidemiology - Natural history/Determining and modifying factors Any Activity limitation and participation restriction (d) Post-acute COVID-19 140 N/A Pulmonary rehabilitation tailored to the individual patient according to age, clinical severity, length of immobilization, comorbidities, starting from a minimum of one, 20-min daily session up to two-three, 30-min daily sessions N/A BI, SPPB, 6MWT N/A N/A N/A N/A N/A N/A 140 COVID-19 patients were admitted to inpatient rehabilitation after 47 days of acute care , on average. A high proportion of patients had undergone mechanical ventilation either invasive or NIV. At admission, 6.2% of patients still had a tracheostomy, 7.1% were still under NIV, and 23.8% still used oxygen supplementation. After a mean LOS in rehabilitation of 24 days, they showed a significant improvement in SPPB (from 0.5 to 7; p<0.001) and BI (from 55 to 95; p<0.001). The proportion of patients unable at admission to stand, rise from a chair and walk was significantly reduced (p < 0.00). Pulmonary rehabilitation is feasible and effective in patients recovering from COVID-19.
310 March-April Zazzara MB 10.1093/ageing/afaa223 2021 UK March-May 2020 To assess how frailty affects presenting COVID-19 symptoms in older adults. Descriptive: Historical cohort N/A Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 857 N/A N/A N/A Frailty was classified as a binary variable: CFS ≥ 5 = frail; CFS < 5=not frail for the hospital cohort; PRISMA7 ≥ 3=frail; PRISMA7 < 3=not frail in the community-based cohort N/A N/A N/A N/A N/A N/A This study analyzed data of presenting COVID-19 symptoms from 2 cohorts of patients: hospitalized older patients (n = 322, 51% were frail) and community-dwelling older people who submitted data via the COVID Symptom Study mobile application (n = 535, 36% were frail). In the Hospital cohort, there was a significantly higher prevalence of probable delirium in the frail sample (38% of frail and 12% of non-frail patients), with no difference in fever or cough. In the Community-based cohort, there was a significantly higher prevalence of possible delirium in frailer (49%), older adults, and fatigue and shortness of breath. This study demonstrates that the prevalence of probable delirium is significantly higher in frail compared to non-frail older adults with COVID-19, highlighting both that a frailty assessment is fundamental and a systematic evaluation of change in mental status needs to be included when assessing this population.
311 March-April Zhu S et al. 10.1371/journal.pone.0243883 2020 China From February 21 to April 7, 2020. To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. Descriptive: Historical cohort N/A Epidemiology - Natural history/Determining and modifying factors Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 432 N/A N/A N/A Clinical data, IADL, BI, Zung’s self-reported anxiety scale N/A N/A N/A N/A N/A N/A At hospital discharge, COVID-19 subjects presented at least one IADL problem in 36.81%. ADL dependence was present in 16.44% and 28.70% were screened positive for clinical anxiety. A significant proportion of COVID-19 survivors had disability and anxiety at discharge from hospital. Disease severity was the only independent risk factor with consistent adverse effects on all outcomes.
312 March-April Zifko et al. 10.1016/j.jns.2021.117438 2021 Austria March - April 2020 To describe neurological symptoms occurring during a COVID-19 infection and determine the pattern of symptoms by comparing outpatients with inpatients Analytical: Cross-sectional study Specialized postacute rehabilitation Epidemiology - Prevalence Nervous system structures (s1) and related functions (Sensory functions and pain b2) Post-acute COVID-19 82 N/A N/A N/A Neurological symptoms N/A N/A N/A N/A N/A N/A Neurological symptoms were found in 32/40 inpatients (80%) and in 36/42 outpatients (86%), without differences between groups. The most common symptoms were fatigue (53% for inpatients and 55% for outpatients) and headache (33% for inpatients and 29% for outpatients), followed by loss of taste (31%), and loss of smell (27%). The onset could be clearly defined only in 41 patients with neurological symptoms (36 outpatients and 5 inpatients) and was on the first or second day of COVID-19 illness, in 63.4% of cases. A more severe course of disease was correlated with age and male sex, but age was not identified as a predictor for the occurrence of neurological symptoms. Women suffered from central and neuromuscular symptoms more often than men (p = 0,004). Pre-existing dementia was associated with increased lethality; similarly, pre-existing stroke was associated with a more severe course of Covid-19 infection. Hallucinations and confusion were related to an increased likelihood of death.