Table I. Description of the articles on rehabilitation needs
due to COVID-19 included in the rapid review updated to 30th April
2020. |
|||||||
N. |
Authors, Journal, Year |
Aim of the study |
Study population or target
population |
Study design |
Study setting or target
setting |
Nation or geographical Area
involved |
Main results and conclusions |
Prevalence
and /or the characteristics emerging disability after COVID-19 |
|||||||
1 |
Herman C, et al. Neurology 2020 |
To assess the potential
impact of pre-existing neurological comorbidities and new neurological events
in patients hospitalized with COVID-19. |
COVID-19 patients |
Scoping review |
ICU, acute wards |
China |
· 32 retrospective studies selected out of 643
retrieved · Prevalence of pre-existing neurological
illness: 8.0 % (322 cases out of a
total 4014 patients hospitalized for Covid-19) · Incidence and risk of secondary neurologic events
ranges from 6%, to 67%. Most frequent complications in people admitted to the
ICU are: corticospinal signs, followed by confusion, neuromuscular injury,
hypoxic encephalopathy and stroke. In people discharged home, 33% showed a
dysexecutive syndrome. |
Rehabilitation
approaches dedicated to COVID-19 patients |
|||||||
1 |
Brugliera
L, et al. J Rehabil Med. 2020 |
To provide information on
the rehabilitation needs of COVID-19 patients in different settings |
COVID-19 patients |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
Italy |
· Acute phase: early respiratory rehabilitation highly
recommended (non-invasive ventilation, changes of posture, and passive
mobilization) · Post-acute phase: neuromotor rehabilitation for
immobilization syndrome (passive/active mobilization, muscle strength
exercises, and articular recovery) · Need of speech therapists and neuropsychologists to
treat dysphagia and cognitive impairment · Few and minor sequelae might benefit from outpatient
or home-based rehabilitation (aerobic exercises, strength training, static
and dynamic balance training, bronchial clearance techniques, exercises for activities
of daily living, and neuropsychological support) |
2 |
Kiekens C, et al. Eur J Phys Rehabil Med. 2020 |
To share the early
experiences from the clinical field in Northern Italy about respiratory
management in the acute and immediate post-acute phases. |
COVID-19 patients |
Descriptive:
qualitative |
ICU, acute wards,
rehabilitation wards |
Italy |
Rehabilitation services
reorganization: · no visitors · reduction or suspension of activities and admissions
of “classical” patients · support of therapists to nurses in other tasks · restriction of contacts between personnel and
Covid-19 patients · use of web based electronic patient records Advice: · accurate monitoring in the weaning phase from
ventilatory support · early rehabilitation in ICU patients with several
complications seems not well tolerated (rapid desaturation) · in case of lung fibrosis as a sequel of pneumonia
use respiratory rehabilitation or NIV · in case of tough secretions, provide specific
physiotherapy techniques or technical removal |
3 |
Li J. Eur J Phys Rehabil Med. 2020 |
To describe rehabilitation
management of patients with COVID-19. |
COVID-19 patients |
Expert opinion |
Home, ICU, rehabilitation
hospitals |
China |
Acute phase management: · Mild patients: o
Respiratory
training and mild aerobic training and Chinese traditional exercises (Tai-ji,
Ba-duan-jin), as well as
square dance, in mobile cabin hospitals. · Severe and critical
patients: o
Breath training
at prone and/or semi recumbent bed position, moderate head elevation, limb
mobilization, bed and bedside sitting and standing, as well as bedside
walking. o
Respiratory
training (timing and program remain should be clarified). o
Patients with
chronic diseases or complications require appropriate rehabilitation plans. o
Psychological
rehabilitation Post-acute phase management · Telerehabilitation
(wearable devices, mobile phone APPs, virtual reality) · Inpatient rehabilitation
for some severe cases |
4 |
Liu K et al., Complementary Therapies in Clinical
Practice. 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. |
Elderly patients with
COVID-19 at ≥6 months of onset. |
RCT |
Hospital |
China |
· RCT of respiratory rehabilitation (36 cases) vs no
treatment (36 cases) · Intervention: (1) respiratory muscle training; (2)
cough exercise; (3) diaphragmatic training; (4) stretching exercise; and (5)
home exercise. Respiratory training included 2 sessions/week for 6 weeks, each
session lasting 10 min. · Significant increase in pulmonary function tests, 6
MWT, SF36 score and anxiety score, in the intervention group compared to
controls |
5 |
Mattei A et al., Eur
Ann Otorhinolaryngol Head Neck Dis. 2020 |
To provide
recommendations for the management of swallowing disorders and the assessment
of acute dysphonia in the context of the COVID-19 |
Patients with
swallowing disorders or recent dysphonia following ORL surgery. |
Practice guideline |
Hospital |
France |
· Assess patients suffering from swallowing disorders
only in cases of emergencies and in a hospital environment. · Postpone voice rehabilitation and provide tele-rehabilitation
whenever it is technically possible and allowed by the current regulations · Apply same precautions to all patients (even asymptomatic) · Advice for caregivers: o
be aware of the
high risk of contamination from droplets emitted by the patient o
Procedures at
very high risk of contamination: clinical and flexible endoscopic swallowing
assessments, flexible endoscopies, insertions of nasogastric tubes and video
fluoroscopic swallowing exams. o
Personal
protective equipment (PPE) recommended: protective glasses, FFP2 (N95) mask,
cap, gloves and gown. o
Learn the
appropriate dressing and undressing technique. |
6 |
Rahmati-Ahmadabad S et al, Obes
Med. 2020 |
To review literature about
the effect of exercise intensity on inflammation in obesity patients in the
COVID-19 era |
Patients suffering from
obesity |
Expert opinion |
Outpatient, home-based settings |
Iran |
· Light and moderate intensity exercise can reduce
inflammation in obese patients, thus having an indirect protective effect
against the virus. · On the other hand, high intensity exercise,
especially in obese people, can cause the production of oxidants and
transient suppression of immune system that could exacerbate COVID-19
symptoms. |
7 |
Severin R et al, Am J Med. 2020 |
To investigate the potential
role of respiratory muscle performance. |
COVID-19 patients |
Expert opinion |
ICU, acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
U.S.A. |
· Respiratory muscle performance can be reduced
because of several factors, such as aging, obesity, physical inactivity,
smoking and chronic disease. · People with pre-existent reduced respiratory muscle
performance have major difficulties in weaning from mechanical ventilation
and is reported an elevated number of complications during the process,
especially in obese patients. · The authors propose to screen respiratory muscle
performance, annually, in patients at risk. If reduced performance is
detected a home-based training approach would be prescribed, remotely
monitored using telemedicine. |
8 |
Silver JK et al, Am J Phys Med Rehabil. 2020 |
To propose prehabilitation
for patients awaiting surgery. |
Patients awaiting surgery |
Expert opinion |
Inpatient rehabilitation,
outpatient rehabilitation, and home-based settings |
U.S.A. |
· Prehabilitation should be considered to reduce
surgical risk in post-pandemic elective surgery. · Clinical prehabilitation programmes should: o
Focus on
modalities that could prevent or reduce incidence of known surgical
complications, o
Measure the
outcome by both surgical and rehabilitation metrics, o
Be practically
feasible in order to increase adherence, o
Be discernible
from general lifestyle recommendations. |
9 |
Simpson R et al, Am J Phys Med Rehabil. 2020 |
To describe impairment
patterns in critically ill patients with acute respiratory distress and
related service organization in the ICU. |
COVID-19 patients |
Expert opinion |
ICU, acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
Canada |
· Physical and cognitive functions and psychosocial
wellbeing can be severely impacted in COVID-19 patients admitted to the ICU. · Multimodal interventions for acute care and
inpatient rehabilitation are warranted optimize outcome. · Innovative approaches are used, like tele-
rehabilitation to avoid face-to-face interaction between the patient and the
healthcare provider,
and prehabilitation to prevent possible complications of
COVID-19. |
10 |
Smith JM et al, Phys Ther.
2020 |
To describe characteristics
and prevalence of PICS, discuss the possibilities for optimizing outcomes for
PICS patients and suggest future directions for research and practice. |
PICS patients |
Expert opinion |
ICU, Inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
U.S.A. |
· Critical illness often leads to PICS, defined as
“new or worsening impairments in physical, cognitive, or mental health status
arising after critical illness and persisting beyond acute care
hospitalization”. · The syndrome impacts on functional capabilities and
psychological and neuropsychological aspects of patients. · Given the
increasing number of survivors to critical illness, a routine screening of
people referred to physical therapists is advised, with ICU stay being
considered a yellow flag. · A comprehensive evaluation for PICS patients and
interventions applicable in ICU, inpatients, outpatients and home-based
settings are reported. |
11 |
Thomas P, et al J Physiother.
2020 |
To provide recommendations for use by physiotherapists and other relevant stakeholders in the acute care setting
caring for adult patients with confirmed or suspected COVID-19. |
COVID-19 patients. |
Practice guideline |
Acute care inpatients |
Australia |
· 17 recommendations for physiotherapy workforce planning
and preparation, including criteria for assigning staff to acute care of COVID19 patients · 7 criteria to determine the indication for
physiotherapy intervention in the acute hospital setting and a screening tool
to match patient’s clinical features with the need for physiotherapy referral · 27 recommendations concerning the delivery of
respiratory, mobilization, exercise and other rehabilitation interventions by
physiotherapists · 15 recommendations about the use of personal
protective equipment during physiotherapy care |
12 |
Wainwright TW,et al J Rehabil Med.
2020 |
To assert the necessity for
the development, co-ordination, and delivery of
inter-disciplinary rehabilitation to patients with COVID-19 and propose that
collaborative self-management strategies be considered as a key component
within the interdisciplinary rehabilitation pathways dedicated to these
patients |
COVID-19 patients |
Expert opinion |
Outpatient rehabilitation,
and home-based settings in a long-term care perspective |
UK |
· Challenges are expected to threaten the healthcare
system over the longer term due to the current epidemics, like: handling the
rehabilitation burden of COVID-19 patients post-acute care; managing
emergency non-COVID conditions within restricted resources and managing the
interrupted care of patients with long-term chronic conditions. · Rehabilitation services are not currently resourced
to assist with the operational management of the cited challenges. · The new models of post-acute care for COVID-19 must
include collaborative self-management to encourage and coach patients to
actively manage medical, lifestyle, or emotional elements of their condition.
This can be done through online-guidance, live streaming and
video-consultations. |
13 |
Zhu C, et al. Heart Lung. 2020. |
To support the
need for early pulmonary rehabilitation program
in severe SARS-CoV-2 pneumonia. |
COVID-19 patients |
Expert opinion |
ICU |
China |
· This is a case report of a 41-year-old man with
severe SARS-CoV-2 pneumonia admitted to the ICU and treated with an individualized
rehabilitation program for 9 days, during weaning from
mechanical ventilation in the ICU. · Treatment included: a) Postural change and prone
position, b) Respiratory training to restore respiratory muscle strength and
lung volume, c) Early mobilization and physical exercises and d)
Psychological intervention and sleep promotion. |
Organization of
rehabilitation services after COVID-19 |
|||||||
1 |
Alpalhão V & Alpalhão M. Phys Ther. 2020 |
To provide information on
clinical practices to reduce the risk of infection for both physical
therapists and patients in COVID-19 era |
COVID-19 patients, patients
in need of rehabilitation and physical therapists |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
Portugal |
Recommendations for physical
therapists to ensure that they can be delivered also in the COVID-19 era,
adopting precautions to reduce the risk of infection spread: · Wear disposable PPE, changing it between patients · Reduce the number of patients and therapists in the
same physical space · Propose digital physical therapist practice, making
use of technology for communicating with and guiding patients |
2 |
Babu AS, et al. Can J Cardiol.
2020 |
To present alternative CR
delivery models, implementing the HBCR options |
Patients needing CR |
Expert opinion |
Home-based setting |
India and USA |
· HBCR prescription should be modified due to stay at
home orders. · Other types of physical activity should be explored,
as: calisthenics, chair-based exercises, resistance and balance exercises,
and the use of yoga. · TDCR, a non-supervised delivery of CR with the
assistance of technology might be useful in COVID-19 era |
3 |
Boldrini P, et al. Eur J Phys Rehabil Med. 2020 |
To provide notes for the
preparation of PRM services worldwide starting from the 1st Covinar by SIMFER |
COVID-19 patients, patients
in need of rehabilitation |
Descriptive: qualitative |
Acute care, inpatient and
outpatient rehabilitation, home-based
settings |
Italy |
· The first “Covinar”,
organized by SIMFER (March 18th, 2020) involved the webinar had
230 live viewers (4.5%) out of 5,000 PRM specialists, and more than 8,900
individual visualizations of the recorded version · The participants report an overall difficulty in
acting proactively and in defining a stable framework for organization and
delivery of rehabilitation interventions |
4 |
Carda S, et al. Ann
Phys Rehabil Med. 2020 |
To report the main clinical
manifestations due to COVID-19 and to propose criteria for admission of
COVID-19 patients to Rehabilitation Units |
COVID-19 patients |
Expert opinion |
Inpatient rehabilitation, outpatient
rehabilitation, and home-based settings |
World |
· Main repercussions due to COVID-19 are: respiratory,
central nervous system and cognitive, deconditioning,
critical-illness–related myopathy and neuropathy, dysphagia, joint stiffness
and pain, and psychiatric problems. · Admission to a Rehabilitation Unit should be
performed based on 4 criteria: 1) ≥7 days from diagnosis of COVID-19 2) at least 72 hr with no fever and no fever-reducing medication 3) stable respiratory rate and oxygen saturation 4) clinical and/or radiological evidence of stability |
5 |
Chaler J, et al. Eur J Phys Rehabil Med. 2020 |
To provide the point of-view
by the SERMEF on the impact of COVID-19 outbreak on Rehabilitation Services
and PRM specialists activity |
COVID-19 patients, patients
in need of rehabilitation |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
Spain |
The SERMEF proposes to: 1) reinforce the academic
and training contents of PRM physicians in the area of Internal Medicine 2) to provide resources to
launch research projects on the COVID-19 impact on rehabilitation 3) to strengthen the
Rehabilitation Services during COVID-19 outbreak |
6 |
Dalal H, et al. Eur J Prev Cardiol. 2020 |
To clarify that there is
need of caution in introducing innovative CR techniques |
Patients needing CR and
respiratory rehabilitation |
Expert opinion |
Outpatient rehabilitation,
and home-based settings |
UK |
· Self-managed, home-based interventions are being
encouraged · Research on the implementation of novel CR
approaches is urgently needed |
7 |
Escalon MX, et al. Am J Phys Med Rehabil. 2020 |
To share the experience on
COVID-19 pandemic from the PRM Department of Mount Sinai Hospital, New York.
U.S.A. |
COVID-19 patients, patients
in need of rehabilitation |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
U.S.A. |
· COVID-19 patients should be treated like people with
ARDS · A home monitoring program started for persons with
true or suspected COVID-19 · Their PRM Department provided only essential
consultations, as for people in need of intrathecal baclofen pump refill |
8 |
Falvey JR, et al. Phys Ther.
2020 |
To outline how physical
therapists can help offload emergency department volume and of meet
post-discharge rehabilitation demand for COVID-19 survivors |
COVID-19 patients, patients
in need of rehabilitation |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
U.S.A. |
· Home- or community-based rehabilitation should be
guaranteed to the subset of patients at highest risk for avoidable
hospitalization · Physical therapists might bring added value to
Emergency Department practice for musculoskeletal injuries · Physical therapists might have a key role in
rehabilitation of post-acute patients |
9 |
Khan F & Amatya B. J
Rehabil Med. 2020 |
To underline the role of
medical rehabilitation as an integral component of the comprehensive
management of the COVID-19 emergency and provide recommendations for
rehabilitation approach of the COVID-19 patient. |
COVID-19 patients |
Expert opinion |
Acute care, inpatient
rehabilitation |
Australia |
· The rehabilitation needs for COVID-19 survivors vary
in various settings and over time, yet rehabilitation is essential in all
phases of pandemic management. · Early rehabilitation is fundamental to promote
respiratory function recovery, reduce complications, improve function and,
eventually, mitigate cognitive impairment and increase quality of life. · Residual disability is expected to affect up to
one-third of COVID-19 patients, due to neurologic manifestations occurring in
the acute phase, including stroke, impaired consciousness and skeletal muscle
injury. · Recommendations are provided about organizational
(n. 10) and operational issues (n.13) to be considered when planning
rehabilitation services in the COVID-19 era. |
10 |
Lee A. Phys Ther. 2020 |
To identify recommendations
on digital physical therapist practice and offer future directions in
advancing digital practice and telehealth in the physical therapy profession
in the wake of COVID-19. |
|
Expert opinion |
Home |
World |
· COVID-19 presents
digital practice opportunities for improved access, high quality, and safety
in physical therapy services for both service user and provider. · Possible
limitations concern: specific federal and state payer guidelines, regulatory
hurdles, patient privacy barriers, inadequate technology training, limited
knowledge translation, regulatory barriers;
telerehabilitation may require more provider time for consultations,
and it is unclear whether it improves access to beneficial services. · The guiding
principles require strong provider-patient relationship, valid and reliable
evidence, and the conduct of research to show whether telerehabilitation
gives more benefits than risks for digital physical therapist practice |
11 |
Levy J et al., Ann Phys Rehabil
Med. 2020 |
To describe a model for a
ventilator-weaning early rehabilitation unit to deal with post-ICU
impairments |
COVID-19
ventilator-dependent patients with stable disease and no other organ failure
but respiratory or neurological features |
Expert opinion |
Tertiary care university
hospital, post-ICU rehabilitation unit |
France |
The main features of an
organization model representing a possible intermediary stage between ICU and
either home discharge or inward rehabilitation are described: · Beds and rooms
dedicated to post-ICU ventilator-dependent COVID-19 patients: each bed
equipped with a ventilator and non-invasive continuous monitoring; each room
equipped with a lift and harness for transfers. · Staff: senior and
junior physicians with ICU or ventilator training and expertise. Paramedic
staff including rotations of nurses and caregivers per 24 hr. Paramedic staff
undergoing a full-day teaching program with the medical staff and a
ventilation-specialized nurse before the opening of the unit.
Physiotherapists dedicated to motor and cardiorespiratory rehabilitation of
patients, and part-time occupational, speech therapists and psychologists. · Criteria for
admission: Ventilator-dependent patients tracheotomized at least 24 hr before
admittance, weaned from vasopressors for 48 hr and without any other organ
failure needing invasive support. Before ICU discharge, patients are switched
from an ICU ventilator to the weaning unit ventilator with clinical
assessment and arterial blood gas analysis after 2 hr. |
12 |
Mukaino M, Am J Phys Med
Rehabil, 2020. |
To present a preliminary
attempt to use a telerehabilitation system to deliver exercise to isolated
individuals. |
Patients in need of
rehabilitation |
Case series |
Inpatients acute setting |
Japan |
· 4 patients underwent telerehabilitation using a
tablet while in communication with the physical therapy and being monitored
with a pulse oximeter. · Patients were overall satisfied with the exercise
program (NRS ranged from 8 to 10 with a median of 10), felt meaningful for
their health to participate in the program (range 7 to 10, median 10),
and they would recommend this exercise
to others (range 8 to 10, median 10). |
13 |
Negrini S, Eur J Phys Rehabil Med., 2020. |
To report the contents of
the third SIMFER Covinar about the application of
telemedicine in rehabilitation. |
COVID-19 and rehabilitative
outpatients. |
Descriptive:
qualitative |
Outpatient setting |
Italy |
· The experience with telemedicine applied on
rehabilitative outpatients of 6 clinicians is presented. · All the clinicians interviewed underlined that it
was feasible and cost-effective. · They also clarified that it is not a substitute of
the human interaction between patients and doctor. Furthermore, the
clinicians presented the many problems related to organization, such as
privacy and payment issues. · Overall, the consensus was that telemedicine could
and must be an integrative solution to common practice. |
14 |
NICE guideline www.nice.org.uk/guidance/ng159 |
To provide recommendations
about critical care in adults in the COVID-19 era |
Adults needing critical care
in the COVID-19 era |
Practice guideline |
ICU |
UK |
· An algorithm supporting decision making for the
admission of COVID-19 patients to critical care is described, it links
admission of individual adults to critical care on the likelihood of their
recovery to an acceptable outcome · The following recommendations about how to provide
functional prognosis are given: · assess all adults for frailty, irrespective of
COVID-19 status, using an individualized assessment of frailty for any
patient aged under 65, or patient of any age with stable long-term
disabilities (for example, cerebral palsy), learning disabilities or autism. · adopt a standard assessment (the CFS score), as part
of a holistic assessment, for people >65 without stable long-term
disabilities. · involve relevant specialists if needed. · record the frailty assessment in the patient's
medical record. |
15 |
Pedersini P et al, Phys Ther. 2020 |
To share insights useful to
optimize physical therapy reaction and organization in response to COVID-19 |
Physical therapists |
Expert opinion |
Acute care, inpatient,
outpatient and home-based rehabilitation setting. |
Italy |
· The Italian physical therapists respond to the
emergency is reported. · Due to the measures of social distancing undertaken
by the government, activity had to be re-organized. Every non-urgent physical
therapy treatment had to be suspended and reorganized, eventually, using
telemedicine. All urgent treatments had to be performed using appropriate
protective equipment because of the impossibility to maintain a safe
distance. · Many therapists provided care in acute care setting
in response of the increasing demand due to COVID-19. |
16 |
Stam HJ et al J Rehabil Med. 2020 |
To launch a call for action
to acknowledge the need for a coordinated response to the cohort of post-ICU
patients . |
COVID-19 patients |
Expert opinion |
Acute care and inpatient rehabilitation
setting. |
Netherlands and Switzerland |
· Several disabling consequences of severe respiratory
illness and intensive care treatments are expected to affect COVID-19
survivors, in the frame of a PICS. · Major risk factors for PICS are cognitive
impairments, acute brain dysfunction, hypoxia, hypotension, and glucose
dysregulation. · Cognitive impairments may occur in 30% to 80% of
post-ICU patients, depending on pre-existing cognitive deficits and age. · Early rehabilitation combining mobilization with
physiotherapy is reported to be an important strategy to facilitate and
improve long-term recovery and functional independence of patients with PICS,
also shortening the duration of ventilation and hospitalization. · Resources should be allocated to facilitate in– and
outpatients’ rehabilitation interventions for ICU survivors, by promoting an
early transfer of patients from ICU to rehabilitation facilities. |
17 |
Thomas E et al.
Eur J Prev Cardiol. 2020 |
To provide evidence summary
and advice on telehealth as an efficacious and safe solution for patients,
family and staff in the domain of cardiac rehabilitation (CR) |
People in need of cardiac
rehabilitation in countries hit by the COVID-19
outbreak |
Expert opinion |
Home-based setting. |
Australia |
· Telehealth is both efficacious and safe. Considering
more than 30 unique telehealth trials conducted internationally within CR
settings, a metanalysis confirms that tele-CR is significantly associated
with reduced Hospitalizations and cardiac events. · Practical advices concern the content of messages to
be conveyed by tele-CR, the media to be used (email, text messages, Mobile
health). Videoconferencing is especially valued as a means to develop a
therapeutic rapport, supervise exercise remotely, provide feedback and
support, share screens and files for educational and counseling
purposes, enhancing efficiency and providing the opportunity for participants
to share experience if groups are allowed. Web-based resources, like Cardiac
College, can also help. |
18 |
Torres-Castro R
et al. Spinal Cord. 2020 |
To alert rehabilitation
professionals against the risks of performing aerosol-generating procedures
in SCI subjects in the COVID-19 era. |
People with cervical SCI in
need of rehabilitation in countries hit by the COVID-19
outbreak |
Expert opinion |
Spine unit or rehabilitation
setting for SCI patients |
Spain and Chile |
· People with cervical SCI frequently need
aerosol-generating procedures, like NIV and mechanical cough assist. · To ensure staff safety in the COVID-19 era,
physiotherapists should wear a waterproof long-sleeved gown, double
non-sterile gloves, eye protection (with lateral protection), and a
respirator that ensures a level of protection equal to or greater than N95/FFP2. · Physiotherapists should also be aware that exhaled
air-jet spreads through the mask’s holes up to 91.6 cm, in the case of NIV
via a full-face mask in a bi-level setting with a single limb circuit. |
19 |
Treger I et al. Eur J Phys Rehabil Med. 2020 |
To describe changes in the
organization of rehabilitation services in a Israeli rehabilitation
department |
People in need of post-acute
rehabilitation in countries hit by the COVID-19 outbreak |
Expert opinion |
Acute and rehabilitation
settings |
Israel |
Changes to the organization of rehabilitation services have challenged
the transfer of acute patients to the appropriate rehabilitation setting. In
fact, day rehabilitation services are closed, people prefer to be discharged
home than prolong hospitalization in inpatient rehab facilities, home
rehabilitation is severely compromised by staff loss and lockdown policies. |
20 |
Yeo TJ et al. Eur J Prev Cardiol. 2020 |
To provide a range of
options for Cardiac rehabilitation delivery during the COVID-19 crisis and beyond. |
People in need of cardiac
rehabilitation in countries hit by the COVID-19
outbreak |
Expert opinion |
Home-based setting. |
Singapore |
· CR is currently underutilised in most countries in
spite of its proven efficacy. · The ongoing outbreak has amplified traditional
barriers to CR · In this scenario, the authors list a range of CR
methods and related barriers to their successful delivery, concluding with a
call for enhancing the role of technology to boost CR programs. |
Impact of COVID-19 on diseases of rehabilitative interest |
|||||||
1 |
Helmich RC & Bloem BR. J Parkinsons Dis.
2020 |
To describe the impact of
the COVID-19 pandemic on Parkinson’s Disease |
People with Parkinson’ s
Disease |
Expert opinion |
Home |
Netherlands |
· Individuals with PD are at risk of experiencing the
sequelae of both stress and reduced physical exercise, with a worsening of
their motor and non-motor symptoms.
The following is recommended: · Apply self-management strategies to reduce
stress (e.g., mindfulness), increase
coping (e.g., cognitive behavioural therapy) or enhance physical activity
(e.g., home-based training programs, online singing, exercise or dancing classes). |
2 |
Jalali M, et al.
Disability & Society. 2020 |
To describe the different
challenges people with disabilities are facing during the COVID emergency in
Iran, and provide advice for the management |
People with disabilities |
Expert opinion |
Community |
Iran |
Advices for the management of people with disabilities in the COVID-19
era · Use tele-rehabilitation for therapy, assessment and
follow-up · Provide valid and usable informative materials for
people with hearing and visual disability (sign language translator, Braille,
audio, and electronic formats) regarding the disease and infection control · Provide educational materials for specific types of
disabilities and their families/caregivers · In case of caregivers’ illness or quarantine: a
substitute caregiver needs to be put in place. A written history of the
person with medical and rehabilitation needs should be provided in case of
emergency. · In addition to political attempts, humanitarian and
charity donations may be necessary to face the poverty of disabled people and
the weakness of the health care system to respond to normal daily demands let
alone those arising through the COVID-19 emergencies. |
3 |
Ku PK et al., Head Neck. 2020 |
To provide a strategic plan
to facilitate safe practice in dysphagia management for health care personnel
and patients with dysphagia, without jeopardizing the standard of care. |
Patients with dysphagia
following surgery for Head and Neck Cancer |
Expert opinion |
Home setting, hospital |
Hong Kong |
· Defer any non-urgent instrumental swallowing · Screening of TOCC in last 14 days and/or fever,
acute respiratory symptoms and/or smell and/or taste disturbances (anosmia,
hyposmia, taste loss) · Use telehealth to: o
screen and
assess swallowing function, o
implement
swallowing training, o
monitor and
review progress, o
engage home
caregivers and plan future services. · Advice for clinical evaluation through telehealth: o
advanced
preparation is necessary to ensure the patient has appropriate food and
liquid boluses available, o
use clear
feeding instruments to allow the clinician to best gauge the size of bolus
presented, o
food coloring in boluses to increase visibility, and
application of colored tape at the level of the
thyroid cartilage to aid in visualization of laryngeal elevation during
swallow o
use also
quantitative swallowing measures. · If instrumental assessment is necessary, adopt
conservative, high level PPE. VFSS is preferable to FEES. |
4 |
López-Dolado E & Gil-Agudo A. Spinal Cord. 2020 |
To describe the experience
of a monographic center for SCI |
People with SCI |
Expert opinion |
National SCI monographic
hospital |
Spain |
· Isolate and treat adequately SCI patients with
COVID-19 · Design and apply the infrastructure to perform
face–to–face and remote ongoing rehabilitation treatment using telemedicine
support · Continue admission of new patients with acute SCI
using enhanced hygiene protection conditions: quarantine them for 7 days in
single-use rooms in a dedicated ward. RT-PCR in suspect of COVID-19 infection
and, if confirmed, send the patient to the SCI COVID-19 inpatient area. |
5 |
Mesa Vieira C,
et al. Maturitas, 2020. |
To analyse the impact of
COVID-19 and its prevention measures on the wellbeing of vulnerable
populations. |
People experiencing
disability. Homeless, indigenous, migrant and imprisoned populations. |
Expert opinion |
Outpatient and homebased
settings. |
Switzerland |
· The authors focused on the most vulnerable
populations, including people experiencing disability. During a pandemic, the
barriers that impair their access to health care could worsen, and this could
put them to an increased sanitary risk. · The author formulated a call for action for
policymakers to promote strategies to protect the well-being of the whole
population, especially the most vulnerable communities. |
6 |
Mobasheri A. Case Rep Womens Health. 2020. |
To stress the need for
exercise for women suffering from osteoarthritis. |
Women suffering from
osteoarthritis |
Expert opinion |
Homebased setting. |
Finland. |
· Women with osteoarthritis should be advised about
the risks of immobility during social distancing due to COVID-19 and the
importance of exercising even during the current crisis, · They should evaluate which kind of exercise are
feasible in their house and perform regular physical activity. |
7 |
NICE guideline www.nice.org.uk/guidance/ng168 |
To provide recommendations
about the community-based care of patients with COPD in the COVID-19 era |
People with COPD |
Practice guideline |
Home-based setting |
UK |
The guideline provides 43
different recommendations for the management of people with COPD. A few of
them may be relevant for the rehabilitation care, as indicated here: · Use online pulmonary rehabilitation resources. This
covers self-management, home exercise and educational materials · Advise patients currently using airway clearance
techniques to continue to do so, adopting precautions to reduce the risk of
nebulization when inducing sputum.or using
non-invasive ventilation at home |
8 |
NICE guideline www.nice.org.uk/guidance/ng170 |
To provide recommendations
about the management of people with cystic fibrosis in the COVID-19 era |
People with cystic fibrosis |
Practice guideline |
Hospital and home care
setting |
UK |
The guideline provides 36
different recommendations for the management of people with cystic fibrosis
Many of them are relevant for rehabilitation care, as indicated here: Patients without COVID-19 infection · Communicate with patients, their families and carers,
and support their mental health and wellbeing to help alleviate any anxiety
and fear they may have about COVID-19. · Minimise face-to-face contact to reduce the risk of
infection by video-consultation or any other remote communication aid · Tell patients, their families and carers to continue
with all their usual self-care arrangements including. · Monitor patients with cystic fibrosis closely,
because they may be at greater risk of rapid deterioration if they contract
COVID-19. · Specialist cystic fibrosis centres should maintain
sufficient inpatient beds and facilities for those patients for whom a
hospital admission is essential Patients with suspect COVID-19 · Ensure that relevant members of the cystic fibrosis
team are involved in decisions about the care of patients with suspected
COVID-19, including escalation of treatment · Alert patients and family members against the risks
of infectious aerosol generating procedures |
9 |
NICE guideline www.nice.org.uk/guidance/ng167 |
To provide recommendations
for the management of people with rheumatological autoimmune, inflammatory
and metabolic bone disorders in the COVID-19 era |
People with rheumatological
autoimmune, inflammatory and metabolic bone disorders |
Practice guideline |
Hospital and home care
setting |
UK |
The guideline provides 42
different recommendations for the management of people with rheumatological
autoimmune, inflammatory and metabolic bone disorders. A few of them are
relevant for rehabilitation care, as indicated here: Patients without COVID-19 infection · Communicate with patients and support their mental
wellbeing, to help alleviate any anxiety and fear they may have about
COVID-19. · Minimise face-to-face contact · In musculoskeletal services, prioritise
rehabilitation for patients who have had recent elective surgery or a
fracture, and for those with acute or complex needs (including carers). Patients with known or suspect COVID-19 · Continue hydroxychloroquine and sulfasalazine · Do not suddenly stop prednisolone · Only give corticosteroid injections if the patient
has significant disease activity and there are no alternatives · Temporarily stop other disease-modifying
antirheumatic drugs, JAK inhibitors and biological therapies, and contact
their specialists for advice on when to restart treatment. |
10 |
Righi G, et al. Spinal Cord Ser Cases. 2020 |
To report the first case of
COVID-19 in a tetraplegic person in Italy. |
Tetraplegic COVID-19 patient |
Case report |
Outpatient, inpatient
settings |
Italy |
· Case report of a 56-year-old tetraplegic male
developing COVID-19. · The patient never exhibited coughing, and did not
develop severe symptomatology, in spite of its disability |
11 |
Singh R, et al. Eur J Phys Rehabil Med. 2020 |
To share early experience
with COVID-19 in the UK. |
Patients in need of
rehabilitation |
Expert opinion |
Inpatient rehabilitation,
outpatient rehabilitation, and home-based settings |
UK |
· The following measures taken in UK to limit the
spread of COVID-19 infection are expected to impact on patients in need of
rehabilitation: · Many inpatients wards, especially rehabilitative
wards, have been cleared. · Most face-to-face appointments have been switched to
telephone appointments with mixed review. · The pandemic has interfered even with medical learning,
as it is impossible for students to get access to the patients. · Eventually, the number of disabled people is
expected to increase as most COVID-19 survivors will exhibit functional
impairment. |
12 |
Solé G, et al. Revue Neurologique. 2020. |
To provide a practice
guideline to homogenize the management of NMD patients within the
French territory, in the COVID-19 era |
People with NMD in countries
hit by the COVID-19
outbreak |
Practice guideline |
Hospital and home care
setting |
France |
The FILNEMUS advises the following strategies for the management of
NMD: 1) reserve hospitalization for emergencies, urgent diagnostic
approaches (as in case of Guillain–Barre´ syndrome, or myasthenia gravis) 2) offer hospital care for treatments, check-ups and cardiorespiratory
assessments for which the delay may result in a loss of survival chance; 3) ensure teleconsultations be conducted by a doctor, a resident, or a
coordinator nurse, to verify that the cancelation of the hospitalization will
not harm the patient. 4) make support
systems available (e.g., illustrated
sheets with links to online videos) for self-rehabilitation and exercises, to
cope with the cessation of regular in-house or office care by the
rehabilitation team; 5) continue nusinersen intrathecal
injections in patients with type 1 SMA and among young children with type 2
SMA. 6) do not stop immunosuppressants in patients with a dysimmune pathology in the absence of any manifestations
suggestive of COVID-19; 7) clearly identify patients with a good prognosis, who may be
eligible for resuscitation admission in ICU; 8) adopt measures to adapt the circuit and the use of NIV to limit
nebulization and continue using NIV in ventilator-dependent patients. |
13 |
Stillman MD, et al. Spinal Cord Ser Cases. 2020 |
To investigate COVID-19
screening practices and availability of screening kits among rehabilitation
professionals caring for people living with SCI. |
People with SCI in countries
hit by the COVID-19
outbreak |
Descriptive |
Spine units |
World |
· This worldwide survey collected 783 responses,
highlighting substantial variability in the rehabilitation medicine community
in COVID-19 screening practices and availability of screening kits. · Only 5.8% respondents had tested their outpatients
with SCI for COVID-19, and 4.4% reported having a patient with SCI with the
virus. Screening of inpatients was performed only for symptomatic individuals
in 53.3% cases or never in 29.9% cases. · Patients with SCI are worried for their
vulnerability to infection (76.9%) and fragility of caretaker supply (42%). |
14 |
Veerapandiyan A, et al. Muscle Nerve. 2020
|
To provide recommendations
pertaining to care of patients with DBMD in the COVID-19 era. |
People with DBMD in
countries hit by the COVID-19 outbreak |
Expert
opinion |
Hospital and home care
setting |
USA |
The following main
recommendations are provided, concerning the care of patients with DBMD: · Continue treatment with corticosteroids, Exon
skipping medications, and Angiotensin converting enzyme inhibitors and/or
angiotensin receptor blockers (for prophylaxis or treatment of
cardiomyopathy). · Do not prescribe Hydroxychloroquine. · Treat patients with chronic respiratory
insufficiency in collaboration with pulmonary and/or anaesthesiology
specialists, avoiding the use of supplemental oxygen without ventilatory
support. · Continue multidisciplinary care for these patients
using telehealth. |
15 |
Vigorito C, et al Monaldi Arch Chest Dis.
2020 |
To describe the barriers to
Cardiac rehabilitation delivery and provide strategies to overcome them in
the COVID-19 era and beyond |
People in need of cardiac
rehabilitation in countries hit by the COVID-19 outbreak |
Expert opinion |
Hospital and home care
setting |
Italy |
· The results of an Italian survey among CR units
demonstrate that: · Referral to residential CR from the traditional
source (cardiac surgery, PTCA, etc.)
is drastically reduced due to postponement of all elective activities.
Conversely, the proportion of STEMI vs NSTEMI has increased, as only patients
with worse symptoms are hospitalized, while those with mild symptoms or chronic
conditions (see heart failure) prefer to stay at home. The CR section of EAPC
recommends setting priorities for referral to CR, increase patients turnover,
adopt precautions during training, shorten the programs, keep track of
discharged patients and follow them with remote assessment. In the near
future, CR units should be prepared to face the needs of patients with ACS or
with worsening HF whose features could be similar to that of pre-PTCA era,
with more frequent STEMI, left ventricular systolic dysfunction, poorer
physical function for longer inactivity and poorer prognosis. |
Late
complications due to COVID-19 that may be of rehabilitative interest |
|||||||
1 |
Coraci D, et al. J Med Virol. 2020 |
To provide information on
the support that rehabilitation might provide for COVID-19 patients, taking
into account the possible relationship between respiratory failure and neuroinvasion of SARS‐CoV‐2. |
COVID-19 patients, patients
in need of rehabilitation |
Expert opinion |
Acute care, inpatient
rehabilitation, outpatient rehabilitation, and home-based settings |
Italy |
· Rehabilitation could play a relevant role for the
management of post-acute COVID‐19
patients preventing secondary impairments, due to immobilization syndrome,
and critical illness of neuropathy and myopathy |
Abbreviations: ARDS: acute respiratory distress syndrome; COPD =
chronic obstructive pulmonary disease; COVID-19= COronaVIrus
Disease 19; Covinar= COVID-19 webinar; CFS= Clinical Frailty Scale; CR= cardiac rehabilitation; DBMD=Duchenne Becker Muscular Dystrophies; DBS=
deep brain stimulation; FEES= Fiberoptic Endoscopic
Evaluation of Swallowing; HBCR= home-based cardiac rehabilitation; IVU= intensive care unit; NIV = non-invasive
ventilation; ORL= Otorhinolaryngology; PICS= Post-Intensive Care Syndrome; PPE= personal protective equipment; PRM=
Physical and Rehabilitation Medicine; QoL= quality of life; SARS-CoV-2= Severe Acute Respiratory Syndrome
- Coronavirus – 2; SCI= Spinal Cord Injury; SIMFER= Italian Society of Physical
Medicine and Rehabilitation; SERMEF= Spanish Society of Physical Medicine and Rehabilitation;
SMA= Spinal muscular atrophy; TDCR= technology driven cardiac rehabilitation; TOCC=
Travel, Occupation, Contact and Clustering; UK= United Kingdom; U.S.A. = United
States of America; VFSS= Videofluoroscopic Swallowing
Study.
Reference:
de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo MG. Systematic rapid living review on rehabilitation needs due to COVID-19: update as of April 30th, 2020.
Eur J Phys Rehabil Med 2020 May 15.
DOI: 10.23736/S1973-9087.20.06378-9