Supplementary Table I: Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of September 30th, 2020
Author DOI Year Country Experimental Dates Aim of the study Study Design Type of rehabilitation service Research Question LFRI Covid Phases Population N° of participants Clinical presentation Intervention Comparator Outcomes Adverse events Diagnostic test Sensitivity Specificity Types of validity Attributes of reliability Main findings
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.
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
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
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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
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.
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.
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)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
Zito A10.3389/fneur.2020.009092020ItalyN/ATo 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 infectionDescriptive: Case ReportGeneral postacute rehabilitationEpidemiology - Natural history/Determining and modifying factorsNervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)Post-acuteCOVID-19 patient with GBS1Weakness in dorsiflexion of the foot, extension of the toes, extension of hand and fingers, and gait ataxia at the baselineIVIG cycle at 0.4 g/kg/day over 5 days; at the discharge, the patient underwent rehabilitationN/AN/AN/AN/AN/AN/AN/AN/AAfter 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.

Abbreviations:6-MWT= 6-minutes walk test; ADL= activities of daily living; AIS= acute ischemic stroke; ARDS= acute respiratory distress syndrome; ASMI= Appendicular skeletal muscle mass index; ASMM= appendicular skeletal muscle mass; BAI= Beck Anxiety Inventory; BCRSS= Brescia-COVID Respiratory Severity Scale; BDI= Beck Depression Inventory; BIA= bioelectrical impedance analysis; BMI= Body mass index; CDS= Care Dependency Scale; CN= cranial berve; COVID-19= Coronavirus Disease 2019; CPAP= continuous positive airway pressure therapy; CSII= continuous subcutaneous insulin infusion; DORSCON=Disease Outbreak Response System Condition; DOSS= Dysphagia Outcome and Severity Scale for functional severity of dysphagia; ED=emergency department; EORTC-QLQ= European Organization for Research and Treatment of Cancer quality of life questionnaire; EVT= endovascular thrombectomy; FAC= functional ambulation category; FEV1= forced expiratory volume in one second measured in liters; FIM= Functional Independent Measure; FOIS= Functional Oral Intake Scale for documenting change in the functional eating abilities; FVC= Forced Vital Capacity; GBS= guillain-barré syndrome; HDU= high-dependency unit; HFNC= high-flow nasal cannula; HFNO= high-flow nasal oxygen; HGS= hand grip strength test; IADL= Instrumental Activities of Daily Living; ICU= Intensive Care Unit; ICUAW= intensive care unit acquired weakness; IMT= inspiratory muscle training; IMV= invasive mechanical ventilation; IOPI= Iowa Oral Performance Instrument for tongue strength evaluation; LOS= Length of Stay; MBS= Modified Borg Scale; MDI= multiple daily injections of insulin; MOCA= Montreal Cognitive Assessment; MFS= Miller-Fisher Syndrome; MIP= Maximal Inspiratory Pressure; MMSE= mini mental status exam; MRC= Medical Research Council; mRS= mdofied Rankin scale; MS= Multiple Sclerosis; MSQOL-54= Multiple Sclerosis Quality of Life-54; NCD= neurocognitive disorder; NIHSS= National Institute of Health Stroke Scale; NIV= bilevel non-invasive ventilation; NYU- PRT= New York University Paragraph Immediate and Delayed Recall Test; PASE= physical activity scale of the elderly; PD= Parkinson disease; PEF= Peak Expiratory Flow; PHQ-9= Patient Health Questionnaire-9; PMR= Physical Medicine and Rehabilitation; POMA= Performance-Oriented Mobility Assessment; PPE= Personal protective equipment; PSQI= Pittsburgh Sleep Quality Index; QoL= Quality of Life; QoL-AD= Quality of Life in Alzheimer’s Disease; RCSES= Revised Caregiving Self-Efficacy Scale; RMBPC= Revised Memory and Behavior Problem Checklist; SARS-COV-2= severe acute respiratory syndrome coronavirus 2; SE-ADL= Schwab and England activities of daily living scale; SF-36v2= The Short Form 36 version 2; SMIP= Sustained Maximal Inspiratory Pressure; SPPB= Short Physical Performance Battery; STS= sit-to-stand; TBR= time below range; TIR= time in range; UPDRS= Unified Parkinson’s Disease Rating Scale; USD= Utrecht Symptom Diary; VR= virtual reality; VRF= vascular risk factor; ZBI= Zarit Burden Interview Scale. 

Reference: Andrenelli E, Negrini F, De Sire A, Patrini M, Lazzarini SG, Ceravolo MG; The International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020. Eur J Phys Rehabil Med 2020 Oct 29.
DOI: 10.23736/S1973-9087.20.06672-1