Supplementary Table I: Rehabilitation and COVID-19: the Cochrane Rehabilitation rapid living systematic review.Update as of April 30th, 2021
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
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).
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
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.
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.
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.
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.
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.
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.
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.
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.
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%).
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.
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.
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.
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.
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
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%).
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.
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).
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

Abbreviations: 1STST= 1-minute sit-to-stand test; 4MGS= 4-meter gait speed; 6-MWT= 6-Minute Walking Test; 30SSTS= 30-seconds-sit-to-stand; 2MST= 2 Minutes step test; AM-PAC 6= 6-clicks Activity Measure for Post-Acute Care; ARDS= Acute respiratory distress syndrome; ATS= American Thoracic Society; BI=Barthel Index; B-PAP=Biphasic Positive Airway Pressure; BRASS= Blaylock Risk Assessment Screening Score; CFS= Clinical Frailty Scale; CIRS= Cumulative Illness Rating Scale; COPD= chronic obstructive pulmonary disease; CPAx= Chelsea Critical Care Physical Assessment Tool; CR-10= Category-ratio 10; CT= Computed Tomography; DLCO= diffusing capacity of the lungs for carbon monoxide; ED=emergency department; EQ-5D-3L= EuroQol five-dimension three-level; EQ-5D-5L= EuroQol five-dimension five-level; EQ-VAS= EuroQol Visual Analogue Scale; FAC= Functional Ambulation Classificatio; FES= functional electrical stimulation; FEV1= forced vital capacity in one second ; FILS= Food Intake Level Scale; FIM= Functional Independence Measure; FCM= Functional Communication Measures; FSS= Fatigue severity scale; FT= Feeling Thermometer; FVC= forced vital capacity; GOSe= Glasgow Outcome Scale extended; HADS= Hospital Anxiety and Depression Scale; HR=Heart Rate beats per minute; HRQoL= Health-related quality of life; IADLs= Instrumental Activities of Daily Living; ICU= Intensive Care Unit; IES-R= Impact of Event Scale-Revised; IMS= ICU Mobility Scale; IMT= Inspiratory Muscle Training; ISI= Insomnia Severity Index; Itel-MMSE= Italian Telephonic version of the Mini-Mental State Examination; MIP= maximum inspiratory pressure; mMRC= modified Medical Research Council; MMSE= Mini Mental State Evaluation; MNA-SF= Mini Nutritional Assessment –Short Form; MoCA= Montreal Cognitive Assessment; MRC= Medical Research Council; MV=Mechanical ventilation; NRS= Numeric Rating Scale; O2 pulse=Oxygen uptake milliliters per heartbeat; pCO2= pression of carbon dioxide; PCFS= Post COVID-19 Functional Status; PCL-5= Post-traumatic Stress Disorder Checklist-5; PICS= Post intensive care syndrome; pO2= pression of oxygen; PP= prone positioning; QoL= Quality of Life; ROM= Range of Motion; RER=Respiratory exchange ratio; RPE= Borg Rating of Perceived Exertion scale; RV= total lung capacity; SaO2%=blood oxygen saturation; SF-12= Short Form Health Survey 12; SF-36= Short Form Health Survey 36; SNF= Skilled Nursing Facility; SPPB= Short Physical Performance Battery; TLC= total lung capacity; VAS= Visual Analogue Scale; VE=Respiratory ventilation; VE/VCO2=Ventilatory equivalent for carbon dioxide production; VE/VO2=Ventilatory equivalent for oxygen uptake; VCO2 (L/min)=Carbon dioxide production liters per minute; VO2=Oxygen uptake milliliters per kilogram per minute