Table III: Rehabilitation and Covid-19: the Cochrane Rehabilitation 2020 rapid living systematic review

Record ID 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 Specifity Types of validity Attributes of reliability Main findings
1 Aoyagi Y 10.1007/s00455-020-10140-z 2020 Japan N/R To report the first case of a patient with oropharyngeal dysphagia associated with COVID-19 and discuss the potential underlying cause. Descriptive Study - Case Report Rehabilitation in acute care Epidemiology - Clinical presentation Digestive functions (b510) Acute COVID-19 patient with dysphagia 1 At admission: - sore throat, cough, and high fever 20 day from admission: - dysphagia - persistent taste impairment - aspiration pneumonia antibiotics, mechanical ventilation dysphagia rehabilitation program including tongue-hold swallow, tongue base exercise, Shaker exercise, and transcutaneous electrical sensory stimulation using interferential current N/A - NRRSv - NRRSp - mesopharyngeal peak pressure - mesopharyngeal contractile integral - SRI N/A N/A N/A N/A N/A N/A
  • The authors report the case of a 70-year-old male who developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19
  • Glossopharyngeal and vagal neuropathy is suggested as possibile cause of dysphagia on the basis of the concomitan disgeusia, mesopharyngeal contraction disfuncion and silent aspiration
  • The patient followed a dysphagia rehabilitation program including tongue-hold swallow, tongue base exercise, Shaker exercise, and transcutaneous electrical sensory stimulation using interferential current
  • At follow-up
    1. the normalized residue ratio scale for valleculae and for piriform sinuses were slightly decresed
    2. mesopharyngeal contractile ability and swallow risk index were improved
  • The authors stress the importance of presuming neurologic involvement and concurrent dysphagia and alert that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.
2 Assini A 10.1007/s10072-020-04484-5 2020 Italy N/R To report two different clinical manifestations of COVID-19 related GBS; one is a GBS/MF overlap syndrome, the other one an Acute Motor Sensory Axonal Neuropathy (AMSAN) with massive vegetative impairment, both highly responsive to intravenous immunoglobulins. Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients 2 > Case 1: - at admission: severe respiratory syndrome preceded by anosmia and ageusia, fever, and cough - 20 day from admission: bilateral eyelid ptosis, dysphagia, and dysphonia, bilateral masseter weakness, tongue protrusion deficit, and hyporeflexia of upper and lower limbs (without muscle weakness) and deficit of elevation of the soft palate. > Case 2: - at admission: fever and cough - during hospitalization: acute weakness in lower limbs with distal distribution and foot drop on the right side associated with massive gastroplegia, paralytic ileus, and loss of blood pressure control hydroxychloroquine, antiretroviral therapy, and tocilizumab, intravenous immunoglobulins N/A case 1: swallowing, speech, and tongue motility and strength, as well as on eyelid ptosis case 2: vegetative symptomatology, osteotendinous hyporeflexia, right foot drop N/A N/A N/A N/A N/A N/A The first patient was a 55-year-old man hospitalized for severe respiratory syndrome due to COVID-19
  • 20 days after admission he rapidly developed impairment of several cranial nerves, a demyelinating peripheral neuropathy
  • The clinical presentation, CSF exam results and four limb electroneurography suggested an overlap of Miller-Fisher and Guillain-Barré syndrome
The second patient was a 60-year-old man hospitalized for severe respiratory syndrome due to COVID-19
  • At day three his respiratory functions worsened and he needed tracheostomy and assisted ventilation
  • 20 days after he presented acute massive impairment of the vegetative nervous system with Acute Motor Sensory Axonal Neuropathy (AMSAN), confirmed by electrophysiological studies
Both patients showed an excellent response to immunoglobulin treatment, that coupled with the absence of COVID in CSF suggested an immuno-mediated inflammatory nature of neuropathy
3 Bao Y 10.1007/s42399-020-00315-y 2020 China February-March 2020 To report a case of COVID-19 complicated with cerebral hemorrhage and summarize the relevant treatment experience. Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 Sudden disturbance of consciousness - Craniotomy - Antiviral treatment and COVID-19 convalved patient plasma infusion N/A Symptoms, dyspnea, body temperature N/A N/A N/A N/A N/A N/A
  • Case report of a 38-year-old man whose first symptom was cerebral hemorrhage.
  • After craniotomy, the patient had a high fever, chest CT showed pulmonary interstitial inflammation and he was tested for COVID-19: firstly, the results were negative, but a second test showed positive results and COVID-19 infection could be confirmed.
  • Antiviral treatment and COVID-19 convalved patient plasma were used: the symptoms improved, the body temperature decreased, and the dyspnea decreased. Two COVID-19 nucleic acid test (24h interval) were negative. Days after, the patients developed hyperthermia again
  • SARS-CoV-2 can damage the neurovascular system and cause bleeding, and it can be followed by multiple system failure.
4 Bracaglia M 10.1007/s00415-020-10014-2 2020 Italy March 15th, 2020 To describe a case of COVID-19 presenting with acute demyelinating polyneuritis in absence of respiratory symptoms common to SARS-CoV-2 infection Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 The patient reported hyposthenia in the four limbs (MRC scale of 1/5 in distal and 2/5 in proximal lower extremities and 3/5 in distal and 4/5 in proximal upper extremities), distal tingling sensation, pronounced lumbar pain for about eight days, tendon reflexes abolished, inability to walk, difficulty in swallowing and speeching. N/A N/A N/A N/A N/A N/A N/A N/A N/A The case highlights the chance that COVID-19 manifests with neurological symptoms in absence of any usual infectious manifestations (fever....) probably as part of a dysimmune process.
5 Brugliera L 10.1038/s41430-020-0664-x 2020 Italy March - April 2020 To discuss the efficacy of an interdisciplinary management of nutrition for COVID-19 patients. Analytical study - Cohort study (prospective uncontrolled) NA Micro - Interventions (efficacy/harms) Digestive functions (b510) Acute COVID-19 patients 32 Dependence for motor or respiratory functions at FIM assessment and risk of malnutrition Three-step nutritional protocol N/A Malnutrition Universal Screen Tool (MUST), Body Mass Index (BMI) N/A N/A N/A N/A N/A N/A Cohort study assessing the efficacy of a three-step nutritional protocol:
  1. Nutritional assessment and malnutrition screening in all patients;
  2. Nutritional treatment plan;
  3. Continuous monitoring of body weight, nutrition intake, blood tests, and clinical condition with variable frequency.
In 32 out of 50 hospitalized patients (FIM 76.6; 90% with dysphagia; 45% at high risk and 26% at moderate risk of malnutrition), malnutrition improved in 15.3%, BMI improved in 43.7%.
6 de Lima MS 10.6061/clinics/2020/e2021 2020 Brasil N/R To investigate the incidence of dysphagia, its time course, and its association with clinically relevant outcomes in extubated critically ill patients with COVID-19, compared to data of non-COVID-19 patients who were also subjected to prolonged orotracheal intubation. Analytical study - Case-control study (retrospective controlled) NA Epidemiology - Clinical presentation Digestive functions (b510) Acute COVID-19 patients referred for a bedside swallowing assessment 101 COVID-19 vs 150 controls COVID-19 patients subjected to orotracheal intubation, Glasgow Come Scale ≥ 14, stable medical respiratory condition Exposure to COVID-19 Not exposure to COVID-19 - American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing level scale [Level 1 – the individual is not able to swallow safely orally. Nutrition and hydration are received through non-oral means; Level 7 – an individual’s ability to eat independently is not limited by the swallow function. Swallowing would be safe and efficient for all consistencies. Compensatory strategies are effectively used when needed], within 24 hours after extubation and at ICU discharge. - Days of intubation - Sessions for dysphagia resolution N/A N/A N/A N/A N/A N/A
  • 101 ICU patients diagnosed with COVID-19 and subjected to orotracheal intubation (median age 53.4±15.9 yr) were assessed for dysphagia and compared with a confirmatory cohort of 150 critical (not COVID-19) ICU patients subjected to prolonged orotracheal intubation (≥ 48 hours) (median age 54.0±18.6 yr).
  • Patients with COVID-19 remained intubated for more days and had higher incidences of neurological disorders, diabetes and hypertension than critical ICU patients, who presented with more pulmonary disorders
  • Groups differed in terms of functional level of swallowing 24 hours after extubation (COVID-19 vs ICU patients: 19.8 % vs 40.0 % ASHA levels 1-3; 53.5 % vs 26.0 % ASHA level 4-5), dysphagia resolution at ICU discharge (70.3 % vs 52.0 % ASHA levels 6-7) and number of swallowing rehabilitation sessions until dysphagia resolution (2.9±1.7 vs 10.5±9.3 sessions) in favour of COVID-19 patients.
  • Patients with COVID-19 remained intubated longer and needed fewer swallowing rehabilitation sessions to return to safe oral feeding.
7 Decavel P 10.1212/WNL.0000000000010011. 2020 France March 20, 2020 To describe a case of Tapia syndrome after prolonged intubation due to severe COVID-19 Descriptive Study - Case Report NA Epidemiology - Clinical presentation Any other body structure and function-generic (s/b) Post-acute COVID-19 patient 1 The patient presented dysphonia and swallowing difficulties after removal of orotracheal intubation. N/A N/A N/A N/A N/A N/A N/A N/A N/A The paper describe a case of a 62-year-old patient that required ventilatory assistance for 16 days. After removal of orotracheal intubation, the patient presented dysphonia and swallowing difficulties. Neurological evaluation and nasofybroscopy revelead a paralysis of left hypoglossal and vagus nerve. One month later the clinical status of the patient still was not improved.
8 Efe IE 10.1016/j.wneu.2020.05.194 2020 Turkey N/R To present a patient with COVID-19-associated encephalitis mimicking a glial tumor Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 Headache, nausea, dizziness and drug-refractory seizures Left anterior temporal lobectomy N/A Neurologic symptoms N/A N/A N/A N/A N/A N/A
  • Case report of a 35-year-old woman with COVID-19-associated encephalitis mimicking a glial tumor.
  • Left anterior temporal lobectomy was performed due to unsatisfactory seizure control and clinical and radiological findings.
  • After surgery, the patient was tested positive for COVID-19 and referred to a designated infectious diseases clinic.
  • This case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors.
9 Garg A 10.7759/cureus.8847 2020 USA N/R To describe a case of COVID-19 infection with delayed thromboembolic complication on Warfarin Descriptive Study - Case Report NA Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 1 One month after recovering from COVID-19 pneumonia he referred worsening shortness of breath and cough N/A N/A N/A N/A N/A N/A N/A N/A N/A This case highlights the risk of delayed thromboembolic complications (a month after recovering from pneumonia) in patients with COVID-19 and the need to identify and monitor the patients with a higher risk of thromboembolism ( those with underlying comorbid conditions that may require anticoagulation for a longer duration)
10 Grimaud M 10.1186/s13613-020-00690-8 2020 France April 15th - 27th, 2020 To describe the characteristics, management and time course of 20 critically ill children admitted to the PICU with cardiogenic shock secondary to acute myocarditis and suspected SARS-CoV-2 infection. Descriptive Study - Retrospective uncontrolled cohort NA Epidemiology - Natural history/Determing and modifying factors Cardiovascular functions (Heart b410) Acute Critically ill children patients with suspected COVID-19 infection 20 Hypotensive shock, abdominal pain, vomiting, fever, acute myocarditis and arterial hypotension with mainly vasoplegic clinical presentation Exposure to COVID-19 N/A Clinical, biological and hemodynamic characteristics N/A N/A N/A N/A N/A N/A
  • 20 critically ill children admitted with hypotensive shock and fever to 4 academic tertiary care centers in Paris.
  • All the children were hypotensive and presented with a major systemic inflammation and an acute myocarditis.
  • Nineteen of the 20 patients had identified SARS-CoV-2 infection on PCR (n= 12) and/or by serology (n= 15).
  • All children but one needed an inotropic/vasoactive drug support and 8 were intubated.
  • All children survived and were discharged from the PICU with full left ventricular systolic function recovery and a substantial decrease of inflammatory biomarkers.
  • Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease is an emerging severe pediatric disease following SARS-CoV-2 infection
11 Gutierrez-Ortiz C 10.1212/WNL.0000000000009619 2020 Spain N/R To report two COVID-19 patients presenting with Miller Fisher syndrome and polyneuritis cranialis, respectively. Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 patients 2 Patient 1: 50-year-old man presenting with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation and positive testing for GD1b-IgG antibodies. Patient 2: 39-year-old man presenting with ageusia, bilateral abducens palsy, areflexia and albuminocytologic dissociation. Patient 1: treated with intravenous immunoglobulin. Patient 2: treated with acetaminophen. N/A N/A N/A N/A N/A N/A N/A N/A These 2 cases highlight the occurrence of Miller Fisher syndrome and polyneuritis cranialis in COVID-19 patients. Neurological manifestations might occur because of an aberrant immune response to COVID-19
12 Heman-Ackah SM 10.1093/neuros/nyaa198 2020 USA N/R To describe 2 patients who required ECMO for refractory hypoxia secondary to COVID-19 and developed neurologically devastating intraparenchymal hemorrhage (IPH) despite lacking the classical risk factors. Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 2 - Case 1: at admission: cough, fever, and shortness of breath acute event: nonreactive right pupil - Case 2: at admission: cough, fever, and shortness of breath acute event: fixed and dilated left pupil Case 1: intubation, ECMO, prone positioning, heparine Case2: intubation, ECMO, heparine N/A NA N/A N/A N/A N/A N/A N/A
  • 2 patients who required ECMO for refractory hypoxia secondary to COVID-19 developed devastating intraparenchymal hemorrhage despite lacking the classical risk factors.
  • It is suggested that the microvascular thrombosis observed as a precipitator of COVID-19 respiratory pathology may underlie ischemia and subsequent hemorrhage in these patients. Moreover, the COVID-19 might cause cytokine storm resulting in platelet dysfunction.
  • The authors propose the use of head CT to identify neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.
13 Iaccarino MA 10.1097/PHM.0000000000001502 2020 USA N/R To report the neurological symptoms associated with COVID-19 in hospitalized patients Descriptive Study - Retrospective uncontrolled cohort NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 214 Approximately one-third (36.4%) of patients had neurological manifestation of the disease. Of those with neurological manifestations, 67.9% had central nervous system symptoms, most commonly dizziness (46.2%) and headache (35.8%), and 24.4% had peripheral nervous system manifestations including impaired taste (15.4%) and smell (14.1%). Other notable manifestations included stroke (n=6) and altered mental status (n=16). Reporting prevalence of neurological clinical manifestations N/A N/A N/A N/A N/A N/A N/A N/A Approximately one-third of hospitalized patients with COVID-19 displayed neurological signs or symptoms, including a small subset of patients for which stroke-like symptoms were the primary presentation of infection.
14 Iannaccone S 10.2340/16501977-2704. 2020 Italy 2 months of 2020 To describe the organizational needs and operational costs of COVID-19 rehabilitation units, by comparing its activity, organization, and costs with 2 other functional rehabilitation units (Cardiologic and the Motor Rehabilitation) Analytical study - Case-control study (retrospective controlled) Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A The COVID-19 Rehabilitation Unit had the same number of care beds as the Cardiac and Motor Rehabilitation Units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs.
15 Kishfy L 10.1016/j.jns.2020.116943 2020 USA April 2020 To present the first case series of posterior reversible encephalopathy syndrome (PRES) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 2 Patients diagnosed with COVID-19 requiring mechanical ventilation due to acute hypoxic respiratory failure N/A N/A N/A N/A N/A N/A N/A N/A N/A
  • This report describes a case series of two patients with SARS-CoV-2 infection associated with posterior reversible encephalopathy syndrome (PRES), providing further evidence of the diverse neurological complications potentially associated with COVID-19
  • The authors advocate for tight blood pressure control in all COVID-19 patients as they may be at more risk for sequelae of hypertensive encephalopathy, which may be an unrealized contributory factor to the prolonged ventilation times observed in severe COVID-19
16 Landes SD 10.1016/j.dhjo.2020.100969 2020 USA (New York State) Beginning of the pandemic through May 28, 2020 To describe COVID-19 outcomes among people with intellectual and developmental disabilities (IDD) living in residential groups homes in the state of New York and the general population of New York State. Analytical study - Cross-sectional study NA Epidemiology - Prevalence Nervous system structures (s1) and related functions (Mental functions b1) NA COVID 19 patients with or without intellectual and developmental disabilities 1,602 people with IDD living in residential group homes versus 371,559 people without IDD N/A N/A N/A COVID-19 incidence COVID-19 case fatality N/A N/A N/A N/A N/A N/A COVID-19 case rate per 100000 is 7,841 for people with IDD compared to 1,910 for people without IDD; case fatality is 15.0% for people with IDD compared to 7.9% for people without IDD; mortality rate per 100,000 is 1,175 for people with IDD compared to 151 for people without IDD. COVID-19 appears to present a greater risk to people with IDD, especially those living in congregate settings.
17 Liu K 10.1016/j.ctcp.2020.101166 2020 China Patient enrolment: January 1st to February 6th, 2020 To investigate the effects of respiratory rehabilitation on respiratory function, ADL, QoL, and psychological status in elderly patients with COVID-19 who were discharged from the hospital with satisfying results. Randomised controlled trial Specialized postacute rehabilitation Micro - Interventions (efficacy/harms) Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute Elderly patients with COVID-19 76 N/A (1) respiratory muscle training; (2) cough exercise; (3) diaphragmatic training; (4) stretching exercise; and (5) home exercise NR Primary: Respiratory function Secondary: Exercise endurance (6-min walk distance), ADL and QoL, psychological status assessment (anxiety, depression scores). N/A N/A N/A N/A N/A N/A
  • RCT of respiratory rehabilitation (36 cases) vs no treatment (36 cases)
  • Intervention:
    1. respiratory muscle training;
    2. cough exercise;
    3. diaphragmatic training;
    4. stretching exercise; and
    5. home exercise.
  • Respiratory training included 2 sessions/week for 6 weeks, each session lasting 10 min.
  • Significant increase in pulmonary function tests, 6 MWT, SF36 score and anxiety score, in the intervention group compared to controls
18 Mo X 10.1183/13993003.01217-2020 2020 China Patient enrolment: February 5th to March 17th To describe the characteristics of pulmonary function in COVID-19 survivors after discharge from hospital Descriptive Study - Retrospective uncontrolled cohort NA Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 110 - mild illness: mild symptoms without radiographic appearance of pneumonia - pneumonia: having symptoms and the radiographic evidence of pneumonia, with no requirement for supplemental oxygen - severe pneumonia: having pneumonia, including one of the following: respiratory rate > 30 breaths/minute; severe respiratory distress; or SpO2 ≤ 93% on room air at rest COVID-19 N/A - SpO2% on room air - Spirometry:TLC%, FVC%, FEV1, FEV1/FVC - DLCO% - DLCO/VA N/A N/A N/A N/A N/A N/A
  • The first and second most common abnormalities of lung function in patient dischargerd after hospitalization for COVID-19 are:
    1. diffusion capacity
    2. restrictive ventilatory defect
  • both are linked to the severity of the disease
  • Follow-up of selected survivors - parcticularly those recovered from a severe form - should comprehend pulmonary function test (spirometry and diffusion capacity)
  • Pulmonary rehabilitation might be considered as an optional strategy
19 Mukaino M 10.1097/PHM.0000000000001441 2020 Japan N/R To describe a preliminary attempt to use a telerehabilitation system to deliver exercise opportunities to individuals isolated because of SARS-CoV-2 infection. Descriptive Study - Case Series Rehabilitation in acute care Meso Level Products and technology (Products for communication e125) Acute Patients in need of rehabilitation 4 NR telerehabilitation N/A - satisfaction, - whether the patients felt it meaningful for their health to participate in the program - whether they would recommend this exercise to others No adverse events N/A N/A N/A N/A N/A
  • 4 patients underwent telerehabilitation using a tablet while in communication with the physical therapy and being monitored with a pulse oximeter.
  • Patients were overall satisfied with the exercise program (NRS ranged from 8 to 10 with a median of 10), felt meaningful for their health to participate in the program (range 7 to 10, median 10), and they would recommend this exercise to others (range 8 to 10, median 10).
20 Novi G 10.1212/NXI.0000000000000797 2020 Italy N/R To report on a COVID-19 case presenting with ADEM, preceded by an influenza-like syndrome Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Sensory functions and pain b2) Acute COVID-19 patient 1 Before admission: influenza-like syndrome, anosmia and ageusia At admission: - mild behavioral abnormalities (irritability) - headache - bilateral relative afferent pupillary defect - ageusia and anosmia - severe visual loss - right abdominal sensory level - left-sided lower limb hyper-reflexia with positive Babinski sign - high-dose steroids (IV methylprednisolone 1 g/d for 5 days tapered with oral prednisone 75mg/d) associated with - IV immunoglobulins (2 g/kg in 5 T8days) N/A - Vision - Visual-evoked potential - MRI Gd-enhancing lesions. N/A N/A N/A N/A N/A N/A
  • The patient was a 64-year-old woman with a history of vitiligo, hypertension, and monoclonal gammopathy of undetermined significance who developed an influenza-like syndrome in mid- March 2020, 2 weeks before she reached emergency department due to worsening visual symptoms
  • She underwent a brain and spine MRI scan and a lumbar puncure
  • PCR for COVID-19 tested negative on nasal swab and positive on CSF, her serum was positive for anti-SARS-CoV-2 IgG
  • ADEM disease was suspected on these findings, high-dose of steroids were administered and the patient reported significant improvements in visual symptoms
  • The authors stress the importance of being aware of the possible autoimmune neurologic complications in COVID-19, whose prompt recognition and treatment is needed to reduce permanent neurological disability
21 Pancera S 10.1097/HCR.0000000000000529 2020 Italy March 27th - April 21st, 2020 To describe the respiratory rehabilitation program in a patient with severe COVID-19, referred to a tertiary subacute rehabilitation center Descriptive Study - Case Report Specialized postacute rehabilitation Epidemiology - Natural history/Determing and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 1 Barthel index based on dyspnea: 61/100; EuroQol questionnaire—5 dimensions, 3 levels: 12/15; Short Physical Performance Battery= 0/12 COVID-19 ward: Early mobilization; Leg/arm cranking; neuromuscular electrical stimulation; seat-to-stand training; Walking training; Weaning from mechanical ventilation. COVID-19 free ward: Aerobic training (cycle ergometer); Resistance training (elastic bands/free weights); Stair climbing. N/A BI, Barthel index; BID, Barthel index based on dyspnea; EQ-5D-3L, EuroQol questionnaire—5 dimensions, 3 levels; MRC sum score, Medical Research Council sum score; Q girth, quadriceps size (taken 10 cm above patella); SPPB, Short Physical Performance Battery; N/A N/A N/A N/A N/A N/A A 51-year-old man with acute respiratory distress syndrome (ARDS) related to coronavirus disease-2019 (COVID-19) infection. The patient achieved autonomous walking within 1 week from intensive care unit (ICU) discharge. After 38 days of hospitalization , the patient recovered muscle function and increased quadriceps size (13%). Maximal inspiratory pressure and maximal expiratory pressure results showed a 7% improvement.
22 Patelli G 10.1016/j.ejrad.2020.109121 2020 Italy April 15th-30th, 2020 To review lung CT findings and report the preliminary results in relation to lung perfusion conditions more than one month after remission of the symptoms Analytical study - Case-control study (retrospective controlled) NA Epidemiology - Natural history/Determing and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 20 + 4 controls Patients observed 40 +/- 13 days after fever resolution, in the phase where they were asymptomatic or slightly dyspnoic and with negative swab Exposure to COVID-19 Not exposure to COVID-19 Volume of low perfusion tissue at chest CT N/A N/A N/A N/A N/A N/A
  • Out of 20 COVID-19 patients, with negative swab, only 8 reported residual dyspnea, 3 of whom with minimal effort.
  • Persistent dyspnea was not associated with signs of interstitial pneumonia.
  • Five patients underwent angioCT with contrast media whose findings were compared with those of 4 patients not affected by COVID-19: hypoperfused lung volume ranged from 21.0% % to 48.4 %, in COVID-19 patients with dyspnea, compared to 8.5 % in patients not affected by COVID-19
  • In COVID-19 patients who are still dyspnoic one month after remission from fever, extended hypoperfused areas of lung parenchyma are still present, despite the absence of residual pulmonary fibrous stripes. CT should be used to quantify the presence of lung perfusion dysfunction during the recovery phase of COVID-19
23 Pattanakuhar S 10.1097/phm.0000000000001485 2020 Thailand N/R To present a patient with cervical traumatic SCI who developed COVID-19 in the acute phase and to describe the consequences at the individual and service level Descriptive Study - Case Report Specialized postacute rehabilitation Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute SCI patient developing COVID-19 1 At admission: - weakness and numbness of upper and lower extremities bilaterally - grade 5 of biceps brachialis and grade 0 of all muscles below the C5 myotome of both sides - absent deep anal pressure and voluntary anal contraction - absent anal and bulbocavernosus reflexes At day 4: - 39°C fever, with mild dyspnea - anterior cervical discectomy, and fusion with plates and screws and iliac bone grafting - Daily subcutaneous injection of 0.6 ml (60 mg) of enoxaparin - rehabilitation program: range of motion and isometric strengthening exercises of bilateral elbow flexors - hydroxychloroquine and azithromycin - lopinavir/ritonavir - oxygen therapy N/A - SaO2 - body temperature - heart rate - blood pressure N/A N/A N/A N/A N/A N/A
  • The patient was a 28-year-old admitted after a motorcycle accident and diagnosed with C5-6 burst fracture with SCI resulting in complete C5 tetraplegia AIS A
  • COVID-19 screening consisted in history of exposure and symptoms and ruled out the suspicion of infection
  • On day 4 he was found positive to SARS-CoV-2, on day 6 he was diagnosed with a mild degree of COVID-19 pneumonia, the patient died on day 10 and cause of death remains uncertain
  • 104 hospital personnel were quarantined after close contact with the patient
    • The authors present four issues related to the case and suggest that:
    1. patients with SCI and concomitant COVID-19 might be at a higher risk of developing venous thromboembolism, including pulmonary embolism
    2. COVID-19 patients with cervical cord injury might develop dyspnea and respiratory failure earlier than those without SCI
    3. all SCI patients eligible for surgical and rehabilitation therapy should be screened for COVID-19 and rehabilitative personnel should use PPE
    4. rehabilitation management should be reorganized during the epidemic, social distancing policies should be implemented for in-person rehabilitation and alternative methods, such as telerehabilitation, should be adopted whenever possible
24 Poussardin C 10.1016/j.accpm.2020.06.002 2020 France February 24th - April 15th, 2020 To provide an immediate feedback on a specialised ICU, allowing to increase knowledge and understanding of follow-up care requirements Analytical study - Cross-sectional study NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patients 51 48/51 (94%) patients reported severe respiratory symptoms: 39/51 (76%) required orotracheal intubation and 9/51 (18%) tracheotomy. 13/51 patients (26%) exhibited neurologic disorders. Reporting prevalence of clinical manifestations in COVID-19 patients admitted to the ICU N/A N/A N/A N/A N/A N/A N/A N/A The authors estimated that among the 51 patients, 5 (11%) patients will die within the ICU. If the 46 remaining patients should be weaned from ICU life support, 5 patients will need active post-resuscitation care (APRC) and 45 follow-up care. From the hospital perspective, it was estimated that 14 patients will need APRC and 205 follow-up care. From a population-based perspective, it was estimated that the need for APRC and follow-up care were respectively four and 40 per 100 000 inhabitants. Therefore, this study provides immediate patients’ characteristics and a first rough estimation of requirements for COVID-19 post-resuscitation care.
25 Prada V 10.1097/MRR.0000000000000418 2020 Italy March 2020 To describe the case of a patient with Charcot-Marie -Tooth who developed COVID-19 during the rehabilitation following tendon transfer surgery and was managed postoperatively by telemedicine. Descriptive Study - Case Report Rehabilitation services at home Meso Level Products and technology (Products for communication e125) Post-acute Charcot-Marie-Tooth patient developing COVID-19 1 Headache, constant leg pain, and fever Eight telerehabilitation sessions N/A Thumb Opposition Test, ad-hoc developed dexterity tests N/A N/A N/A N/A N/A N/A
  • A 28-year old male with Charcot-Marie-Tooth underwent a tendon transfer surgery in the left hand.
  • He developed COVID-19 during the rehabilitation period, 3 months after surgery.
  • To accomplish rehabilitation goals, the patient underwent 8 telerehabilitation sessions in the following month.
  • Thanks to telerehabilitation, the recovery process did not cause any appreciable setback.
26 Righi G 10.1038/s41394-020-0274-9 2020 Italy N/A To present the clinical manifestation of COVID-19 in a person affected by tetraplegia. Descriptive Study - Case Report NA Epidemiology - Clinical presentation Respiratory structures (s430) and related functions (Respiration b440-455) Acute Tetraplegia patient developing COVID-19 1 - AIS A C4 tetraplegia since 2013 - Fever - mild dyspnea - home therapy: oxybutynin, rivaroxaban, gabapentin, tramadol - before admission: trimethoprim/sulfamethoxazole - during hospital stay: various broad spectrum antibiotics, Furosemide, manually assisted cough, low-dose oxygen therapy Lopinavir/Ritonavir, hydroxychloroquine N/A - fever - arterial blood gas - nasopharyngeal swabs for the detection of SARS-CoV-2 N/A N/A N/A N/A N/A N/A
  • Case report of a 56-year-old tetraplegic male developing COVID-19.
  • The patient never exhibited coughing, and did not develop severe symptomatology, in spite of its disability
27 Simonelli C 10.4081/monaldi.2020.1085 2020 Italy March 14th - April 14th 2020 To describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) Service during the COVID-19 emergency in an Italian rehabilitation hospital, with focus on the Respiratory Physiotherapist Therapists’ (RPTs) role Descriptive Study - Retrospective uncontrolled cohort Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients 170 Moderate/severe impairment of motor functional capacity with a SPPB 3 (0-7) points out of 12 Organizational plan: general new hospital organization, role of RPTs, the number of all tasks performed by the RPTs during a typical working day, as well as the percentage of patients who needed a specific performance N/A N/A N/A N/A N/A N/A N/A N/A
  • COVID-19 care team developed based on a multidisciplinary panel of physicians, nurses, and RPTs to manage 90 beds for post acute patients with COVID-19
  • >RPTs tasks are: oxygen therapy daily monitoring, non invasive ventilation and CPAP delivery, pronation and postural changes, reconditioning exercises, functional assessments.
  • Three “what-to-do” algorithms guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity.
  • 170 patients treated in 1 month, with RPTs managing oxygen therapy (in a third of cases), reconditioning (60% of the cases), and initial and final functional motor capacity assessment in all subjects.
28 Su XW 10.1002/mus.26988 2020 USA NR To describe a patient who developed quadriplegic GBS with dysautonomia preceded by mild COVID-19–induced diarrhea. Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patient 1 - 7 days before admission: mild diarrhea, anorexia, and chills, without fever or respiratory symptoms - at admission: Quadriplegic Guillain-Barré syndrome with dysautonomia and syndrome of inappropriate antidiuretic hormone secretion - mechanical ventilation - sulfamethoxazole-trimethoprim N/A - strength and extremities strength - nerve conduction studies - blood electrolytes N/A N/A N/A N/A N/A N/A
  • The patient was a 72-year-old male that suffered from mild COVID-19-induced diarrhea.
  • He rapidly evolved in quadriplegic Guillain-Barré syndrome with dysautonomia and syndrome of inappropriate antidiuretic hormone secretion.
  • Patient with Guillain-Barré syndrome should be tested for COVID-19
29 Tatu L 10.1007/s00415-020-10005-3 2020 France - Switzerland From March to April 2020 To report an unusually high number of cases with diagnosis of Guillain–Barré syndrome during COVID-19 pandemic Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) NA Patients with diagnosis of Guillain–Barré syndrome with negative findings on SARS-CoV-2 nasopharyngeal swab and SARSCoV-2 serology 6 All 6 patients reported paresthesia. 4 patients reported paraparesis. 2 patients reported tetraparesis. 4 patients reported ataxia. 1 reported facial paralisis. Reporting clinical manifestations of 6 patients with diagnosis of Guillain–Barré syndrome during COVID-19 pandemic in a Neurologic Unit N/A N/A N/A N/A N/A N/A N/A N/A Patient 3 had an acute motor-sensory axonal neuropathy; acute inflammatory demyelinating polyneuropathy (AIDP) was found in the other 5 patients. The neurological progression was favorable in 5 cases. Two patients (patients 1 and 2) relapsed, one of whom died from a severe acute respiratory syndrome.
30 Tunç A 10.1016/j.jocn.2020.05.018. 2020 Turkey Up to April 14th, 2020 To describe a series of simultanously diagnosed COVID-19 and acute ischemic stroke Descriptive Study - Case Series NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) Acute COVID-19 patients 4 Case 1 presented left facial paresis, dysarthria, left hemiparesis (NIHSS: 16), high fever, and cough. Case 2 suffered from dysarthria and right hemiparesis (NIHSS: 5), intermittent fever, and upper respiratory tract symptoms. Case 3 reported loss of consciousness, dysarthria, right hemiparesis ( NIHSS: 10), and mild cough. Case 4 left hemi-hypoesthesia with mild ataxia ( NIHSS: 2), fever, cough and shortness of breath. N/A N/A N/A N/A N/A N/A N/A N/A N/A Ischemic stroke may simultaneously develop in the course of Covid-19 independently of the critical disease process. In this study the average of time from Covid-19 onset to the diagnosis of ischemic stroke was 2 days (no cardioembolic type)
31 Vitale JA 10.1080/07420528.2020.1775241 2020 Italy April 27th - May 12th, 2020 To describe the quality of sleep of four COVID-19 recovered patients during the sub-acute stage of the disease Descriptive Study - Case Series Rehabilitation in acute care Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Post-acute COVID-19 patients 4 Patient 1: able to walk autonomously without aid; Patient 2: able to walk autonomously without aid; Patient 3: able to walk autonomously using a single crutch; Patient 4: not able to stand up or walk autonomously. Wearing an actigraph around the clock and completing a daily sleep diary to record bedtime, get-up time, and the spans of the day and night when the actigraph was not worn. Furthermore, the 4 patients underwent functional evaluation tests N/A Sleep parameters (time in bed, total sleep time, sleep efficiency, sleep latency, wake after sleep onset, immobility time, fragmentation index), assessed through an actigraph on the wrist of the non-dominant hand; the Pittsburgh Sleep Quality Index (PSQI); 30 s Sit-To-Stand Test (STST) and Timed Up and Go Test (TUG) N/A N/A N/A N/A N/A N/A The mean sleep duration was 6.3 hours, indicating an insufficient sleep duration that could be partially attributed to the forced early awakening. Three out of four subjects were able to perform functional tests. These preliminary data suggest that functional recovery could not be considered as directly linked to sleep quality
32 Wang X 10.1093/qjmed/hcaa178 2020 China February 3rd - 21st, 2020 To track the course of clinical outcomes of COVID-19 patients after discharge, and the transmission risk during the observation period, therefore to make improvement on post-discharge management if necessary. Analytical study - Cohort study (prospective uncontrolled) NA Epidemiology - Natural history/Determing and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patients 131 On discharge, 78 of the 131 (59.54%) patients had no symptoms. However, 38 (29.01%) patients had cough, 10 (7.63%) had fatigue, 8 (6.11%) had expectoration, 8 (6.11%) had chest tightness, 5 (3.82%) had dyspnea, 4 (3.05%) had chest pain, 2 (1.53%) had dizziness and 2 (1.53%) had palpitation. Other rare symptoms, including pharyngeal pain, nausea, inappetence and vomiting were presented in 1 (0.76%) patient, respectively Exposure to COVID-19 N/A Information regarding symptoms and treatment post hospitalization (detailed treatment of oxygen therapy and medicines), reexamined outcomes, distribution of quarantine locations and close contact history after discharge N/A N/A N/A N/A N/A N/A
  • Out of 131 patients, 40.05% cases still had symptomatology at discharge, with the most represented symptom being cough (29.01%), followed by fatigue (7.63%), expectoration (6.11%), chest tightness (6.11%), dyspnea (3.82%), chest pain (3.05%), and palpitation (1.53%).
  • In the third and fourth weeks only 18 patients had one or more symptoms.
  • 8 patients still tested positive for SARS-CoV-2 after discharge.
    • Considerate self-quarantine and close follow-up of patients are required after discharge.
33 You J 10.1016/j.jinf.2020.06.003 2020 China March 26th - May 1st, 2020 To report the pulmonary function and chest CT changes in COVID-19 patients after discharge Descriptive Study - Retrospective uncontrolled cohort NA Epidemiology - Prevalence Respiratory structures (s430) and related functions (Respiration b440-455) Post-acute COVID-19 patient 18 N/A Spirometry Lung CT at 40 +/- 11 days of hospital discharge N/A All spirometry parameters of ventilation function Lung CT features N/A N/A N/A N/A N/A N/A COVID-19 survivors after discharge may report persistent restrictive ventilatory defect and small airway function impairment, regardless of their disease severity. So a long-term follow-up of lung function after discharge should be performed in clinical practice to provide a guideline for pulmonary rehabilitation.
34 Zanin L 10.1007/s00701-020-04374-x 2020 Italy N/R To describe the case of a COVID-19 patient presenting with neurological symptoms associated with demyelinating brain lesions. Descriptive Study - Case Report NA Epidemiology - Clinical presentation Nervous system structures (s1) and related functions (Mental functions b1) Acute COVID-19 patient 1 - at admission: GCS of 12 (E3 M6 V3), anosmia and ageusia, interstitial pneumonia - during hospital stay: seizures - Antiretroviral, hydroxychloroquine - lacosamide, levetiracetam, phenytoin - mechanical ventilation - High-dose steroid treatment N/A - pulmonary impairment - sensorimotor deficits N/A N/A N/A N/A N/A N/A
  • The authors describe the case of a 54-year-old female, who complained of anosmia and ageusia for several days before severe COVID-19 onset.
  • She needed mechanical ventilation and during intubation presented two episodes of seizures.
  • While head CT scan was negative, MRI showed demyelinating lesions of the periventricular white matter, at the bulbo-medullary junction and at the cervical and dorsal spinal cord.
  • The authors conclude that neurological impairment during COVID-19 acute phase and seizures could be attributed to demyelinating lesions.
35 Zheng Z 10.1002/jmv.26040 2020 China February 2020 To introduce the authors' experience in treating two COVID-19 cases by ozone therapy Descriptive Study - Case Series Rehabilitation in acute care Epidemiology - Natural history/Determing and modifying factors Respiratory structures (s430) and related functions (Respiration b440-455) Acute COVID-19 patients 4 Fever, dyspnea, headache, runny nose, fatigue, loss of appetite, cough, sore throat, altered laboratory and imaging findings Ozone therapy - Major Autohemotherapy (MAH) for seven consecutive days N/A Symptoms, laboratory indicators, chest imaging N/A N/A N/A N/A N/A N/A Two COVID-19 patients who underwent ozone therapy MAH for seven days showed fast recovery of symptoms and normal range of laboratory indicators.
36 Zheng QN 10.1017/dmp.2020.214 2020 China January -February 2020 To develop a model able to predict the length of rehabilitation from the analysis of clinical risk factors Descriptive Study - Retrospective uncontrolled cohort Specialized postacute rehabilitation Meso Level Health services, systems and policies (e580) Post-acute COVID-19 patients 90 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A The authors developed, through multivariate stepwise linear regression, a model to predict lenght of stay of post-acute mild COVID-19 patients in an inpatient rehabilitation setting. The five parameters included in the model were white blood count, partial pressure of carbon dioxide, serum potassium, total bilirubin and aspartate aminotransaminase.
Abbreviations: 6MWT= Six Minutes Walking Test; BI= Barthel Index; COVID-19= COronaVIrus Disease 19; CSF=cerebrospinal fluid; DASS-21=Depression, Anxiety, and Stress Scale–21; DLCO= Diffusing Capacity of the Lung for Carbon Monoxide; ECMO=ExtraCorporeal Membrane Oxygenation; FEV1= Forced expiratory volume in one second; FIO2=fraction of inspired oxygen; FM%= Percentage of Fat Mass; FVC= forced vital capacity; GBS= Guillain Barré Syndrome; HASD-A, HASD-D= Hospital Anxiety and Depression Scale; HRCT= high resolution computed tomography; ICU= Intensive Care Unit; IPAQ-SF= International Physical Activity Questionnaire Short-Form; IV= intra-venous; IVIG= intra-venous immunoglobulins; LOC= level of consciusness; MET= Metabolic equivalent of task; mMRC= modified Medical Research Council; MOF= multisystem organ failure; MuSK= Muscle Specific Kinase; MV= mechanical ventilation; N/A= not applicable; N/R= not reported; NMD= Neuromuscular Diseases; PA= Physical Activity;  PaO2=partial pressure of oxygen; PD=Parkinson's Disease; PDQ39= PD questionnaire; PT= Physical Therapy; SARS-CoV-2= Severe Acute Respiratory Syndrome; SCI/D= spinal cord injuries and disorders; SF-12= Short-Form Health Survey; Intravenous, IV; t-PA= Tissue plasminogen activator; UK= United Kingdom; SSEP= Somatosensory evoked potential

Reference: Ceravolo MG, Arienti C, De Sire A, Andrenelli E, Negrini F, Lazzarini S et al; The International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and Covid-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Eur J Phys Rehabil Med 2020 Jul 24.
DOI: 10.23736/S1973-9087.20.06501-6