|
Supplementary Table I. Description of the articles on
rehabilitation needs due to COVID-19 included in the rapid review updated to
31st May 2020. Note that the main content of the listed articles
is available at https://rehabilitation.cochrane.org/sites/rehabilitation.cochrane.org/files/public/uploads/covid/evidmap_table.html |
|||||||
|
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 of
emerging disability after COVID-19 |
|||||||
|
1 |
Heman-Ackah SM et al., et al., Neurosurgery 2020. DOI:10.1093/neuros/nyaa198. |
To report two cases of devastating intracranial hemorrhage as a complication of veno-venous
extracorporal membrane oxygenation. |
COVID-19 patients |
Case series |
Not rehabilitation setting: ICU |
USA |
· 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. |
|
2 |
Zanin L, et al. Acta Neurochir (Wien). 2020. DOI: 10.1007/s00701-020-04374-x |
To describe the case of COVID-19 patient that developed
demyelinating lesions. |
COVID-19 patient |
Case Report |
Not rehabilitation setting: ICU |
Italy |
· 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. |
|
3 |
Su XW, et al. Muscle Nerve. 2020. DOI: 10.1002/mus.26988 |
To present the case of a quadriplegic Guillain-Barré
syndrome after a mild case of COVID-19. |
COVID-19 patient |
Case Report |
Not rehabilitation setting: acute care |
USA |
· 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. |
|
4 |
Ahmad I, Rathore FA,
J Clin Neurosci 2020. DOI: 10.1016/j.jocn.2020.05.017 |
To collect data on neurological manifestations and
complications of COVID-19 |
COVID-19 patients |
Narrative review |
Not rehabilitation setting: acute care |
Worldwide
(China, Europe, Pakistan) |
· Papers analyzed: a Retrospective Chart review of 214 Chinese
patients, an observational cohort study of 58 French patients and a few case
reports/studies · Neurological
involvement reported in 60.2% cases (36.4% and 84% respectively), with
some manifestations preceding respiratory symptoms and higher occurrence in
severely ill patients (45.5% Vs.30.2%) · Dizziness
(16.8%), headache (13.3%) followed by encephalopathy and delirium are most
common symptoms; peripheral nervous system is involved in 19% of cases with
hypogeusia present in 5.6% and hyposmia in 5.1%. · Skeletal
muscle injury occurs in 10.7% · Other
manifestations include cerebrovascular lesions, Guillain Barré syndrome,
acute transverse myelitis and acute encephalitis. |
|
5 |
Li H et al., Neurotox Res 2020. DOI:
10.1007/s12640-020-00219-8 |
To discuss the symptoms and the evidence of nervous
system involvement caused by COVID-19 infection |
COVID-19 patients |
Narrative review |
Not rehabilitation setting: ICU |
China |
· Number of
analysed studies not reported, number of total cases not known · Central and
peripheral nervous system symptoms present at COVID-19 illness onset:
headache (6.5% to 34% cases), nausea and vomiting (1% to 10.1%), dizziness,
insanity, neck stiffness, hypogeusia, hyposmia, psychiatric and psychological
involvement (mild in 35%, moderate to severe in 13% cases) · Encephalitis,
cerebrovascular diseases, consciousness impairment, anxiety, and depression
are frequent in COVID-19 patients. · CNS
involvement is associated with poor prognosis, worsened clinical condition,
and sudden death. |
|
6 |
Cipollaro et al., J Orthop Surg Res 2020.
DOI: 10.1186/s13018-020-01702-w |
To report the prevalence of muscu-
loskeletal symptoms reported worldwide in COVID-19
patients |
COVID-19 patients |
Expert opinion |
Not rehabilitation setting: ICU, acute care |
Worldwide (China, Singapore,
Europe, USA, Bolivia) |
· One
prospective and 53 retrospective studies (mostly from China) analysed, on
12,046 total patients (54% male and 46% females; mean age 52.13years). · Musculoskeletal
symptoms like myalgia, arthralgia, and fatigue, were present at onset of
COVID-19 illness up to the most severe stages. · Fatigue
occurred in 25.6%, arthralgia and/or myalgia in 15.5% |
|
Rehabilitation approaches dedicated to
COVID-19 patients |
|||||||
|
1 |
Feng F, et al. Am J Geriatr
Psychiatry. 2020. DOI: 10.1016/j.jagp.2020.05.012 |
To review literature about the application of Qigong
for prevention and treatment of infectious disease |
COVID-19 patients |
SystematicReview |
Outpatient rehabilitation, and rehabilitation
services at home |
China |
·
Qigong is a mind-body
training targeting body, breath and mind. · Qigong is easy to perform and the elderly can especially benefit from
it during COVID-19 pandemic, due to its reported capacity of preventing
respiratory infectious diseases and improve respiratory function |
|
2 |
Brugliera
L et al., Eur J Clin Nutr
2020. DOI: 10.1038/s41430-020-0664-x |
To discuss the efficacy of an interdisciplinary
management of nutrition for COVID-19 patients. |
COVID-19 patients |
Prospective uncontrolled observational study |
General post-acute rehabilitation |
Italy |
· 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%. |
|
3 |
Simonelli C et al., Monaldi Archives for Chest
Disease 2020. DOI: 10.4081/monaldi.2020.1085 |
To describe and report the clinical outcome after the re-organization
of a Cardio-Pulmonary Rehabilitation service during the COVID-19 emergency in
a Northern Italian rehabilitation hospital, focusing on the RPTs role |
COVID-19 patients |
Retrospective uncontrolled observational study |
Specialized postacute
rehabilitation |
Italy |
· 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. |
|
4 |
Zheng Z, et al. J Med Virol. 2020. DOI: 10.1002/jmv.26040 |
To report effects of ozone therapy MAH in recovery
of two severe cases with COVID-19. |
COVID-19 patients |
Case series |
Rehabilitation in acute care |
China |
Two COVID-19 patients undergone ozone therapy MAH
for seven days showed fast recovery of symptoms and normal range of
laboratory indicators. |
|
5 |
McGrath
BA et al., Anaesthesia 2020. DOI: 10.1111/anae.15120 |
To provide consensus recommendations about caring
for COVID-19 patients with tracheostomy |
COVID-19 patients |
Consensus paper |
Rehabilitation in acute care |
UK |
· The role of
the respiratory physiotherapist as part of the multidisciplinary team is
critical for patients with tracheostomy, to ensure chest clearance and early
weaning from mechanical ventilation. The early involvement of speech and language
therapists is needed, to provide creative methods of augmentative and alternative
communication to reduce patient anxiety and facilitate communication and
participation in care. |
|
6 |
Falvey
JR, Ferrante LE, Hear Lung
2020. DOI: 10.1016/j.hrtlng.2020.05.001 |
To advice how to improve outcomes in COVID-19
survivors in the current healthcare environment |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, General postacute
rehabilitation, Rehabilitation services at home |
USA |
· Increase
staffing and PPE availability within hospital and post-acute care settings · Increase use
of telerehabilitation during the hospital stay both within the ICU and
following ICU discharge. Develop rehabilitation at home models for COVID-19
survivors after discharge |
|
7 |
Klok FA, et al. Eur Respir J. 2020.
DOI: 10.1183/13993003.01494-2020 |
To develop an outcome measure to detect the several
consequences of
COVID-19. |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation, specialized outpatient rehabilitation, and rehabilitation
services at home |
Netherlands |
·
The “Post-COVID-19
Functional Status (PCFS) Scale” is an ordinal, not yet validated measure,
targeting consequences of COVID-19. ·
The author propose its use at discharge from rehabilitation setting,
4 to 8 weeks after discharge, and 6 months after discharge to follow up the
functional status of the patient over time. |
|
8 |
Liu WH, et al. World J Acupunct Moxibustion. 2020. DOI: 10.1016/j.wjam.2020.03.005 |
To present the second edition of “Guidance for
acupuncture and moxibustion intervention on COVID-19” issued by the China
Association of Acupuncture–Moxibustion |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation, specialized outpatient rehabilitation, and rehabilitation services at home |
China |
·
The authors present a practical clinical guidance
for the use of moxibustion and acupuncture on COVID-19 patients. |
|
9 |
Ronconi G et al., Minerva Med 2020. DOI:10.23736/S0026-4806.20.06629-X |
To provide advice on pathways and rehabilitation
programs for patients with COVID-19, in the acute and subacute phases |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, General postacute rehabilitation |
Italy |
Acute phase: · Include the
physiatrists in the interdisciplinary COVID 19 teams · Critical and very severe patients (ARDS): provide a
thorough functional assessment of respiratory, cardiovascular,
musculoskeletal and neurological system is needed; ensure ventilator support
and disability prevention (passive movements, posturing, prone positioning 12
hours per day, switching head and arm postures every 4-6 hours); early
respiratory rehabilitation not recommended; · Mild to severe patients: provide ventilator support,
disability prevention (active exercise, strength, weaning from lodging),
thoracic physiotherapy (cough sedation, airways clearance). Postural nursing
with passive mobilization, changing the inclination of the bed, semi-sitting
position at 45-60°. · Rehabilitation
to be started: o
For respiratory system: if FiO2 ≤ 0.6, SpO2
≥ 90%, Respiratory Rate ≤ 30 bpm and PEEP ≤ 10 cmH2O, even
with endotracheal or tracheostomy tube. o
For cardiovascular system: if systolic BP ≥
90mmHg or ≤ 180 mmHg, MAP ≥ 65mmHG or ≤ 110mmHg,
HR ≥ 40bpm or ≤ 120 bpm; exclude arrythmia, myocardial ischemia,
deep vein thrombosis and pulmonary embolism. o
For nervous system: Richmond Agitation- Sedation
Scale score –2 to +2, intracranial pressure < 20 cmH2O. · Critical
Illness Myopathy and Neuropathy (CRIMYNE): provide passive and active
exercise, bed exercise, transfer training · Transfer
patients to Rehabilitation Units if they have multiparametric stability for
at least 36-48 hours and MEWS ≤2 Subacute
phase: ensure: · Clinical
monitoring, mechanical ventilation weaning, management of post tracheostomy
complications. thoracic physiotherapy · Muscular
training and reconditioning · Psychologic
support · Physical
activity planning at discharge · Follow up
planning |
|
10 |
Valenzuela PL, et al. Ann Phys Rehabil Med. 2020. DOI:10.1016/j.rehab.2020.04.005 |
To highlight the importance of early mobilization in
hospitalized patients with COVID-19 |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care |
Spain and USA |
· Early rehabilitation (stretching, resistance and walking exercises)
might improve physical functioning, in hospitalized COVID-19 patients. |
|
11 |
Yang LL & Yang T, Chronic Dis Transl Med. 2020. DOI:10.1016/j.cdtm.2020.05.002. |
To establish a pulmonary rehabilitation model for
COVID-19 patients |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
China |
·
Pulmonary rehabilitation
should be provided to all patients in any setting (either in hospital and at
home), tailored to the individual needs. · Pulmonary rehabilitation should be integrated in daily life routine in
order to maximize the effects in the long run. |
|
12 |
Yu HP-M, et al. Physiotherapy Theory and
Practice. 2020. DOI: 10.1080/09593985.2020.1757264 |
To investigate current evidence on ultra-shortwave
diathermy to minimise pulmonary inflammation in COVID-19 patients |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation, specialized outpatient rehabilitation, and rehabilitation
services at home |
China |
·
To date there is no evidence
to support the use of ultra-shortwave diathermy in COVID-19 patients. · Investigation
of the effect of ultra-shortwave diathermy should start with carefully
constructed and conducted case series to understand also safety and
tolerability. |
|
Organization of rehabilitation services after
COVID-19 |
|||||||
|
1 |
Sheehy LM. JMIR Public Health Surveill. 2020. DOI: 10.2196/19462 |
To report rehabilitation needs due to COVID-19, based on a scientific
literature search |
COVID-19 patients |
Systematic review |
Rehabilitation in acute care, specialized postacute rehabilitation, and specialized outpatient
rehabilitation |
Canada |
· COVID-19
patients present several rehabilitation needs due to
comorbidities and complications from ICU stay and/or intubation and negative
effects of SARS-CoV-2 on multiple body systems (cardiac, neurological,
cognition, and mental health). · Inpatient
rehabilitation units for COVID-19 survivors should be properly designed,
specifying staffing issues and considerations for outpatient rehabilitation · Physiotherapy,
occupational therapy, speech-language therapy should be delivered in line
with existing guidelines developed to treat COVID-19 patients, with respect
to recovery of the respiratory system as well as mobility and function. |
|
2 |
Tenforde AS et al., PM R 2020.
DOI:10.1002/pmrj.12422. |
To describe a quality improvement initiative during
the rapid adoptive phase of telemedicine in outpatient sports medicine
practices in the COVID-19 era |
Patients with acute and chronic musculoskeletal
conditions during the pandemic |
Descriptive : cross-sectional |
Specialized outpatient rehabilitation,
Rehabilitation services at home |
USA |
· 119 patients
and 13 physicians completed an online survey at the end of a telemedicine
experience. · 70.6% were
follow-up visits of 15-29 minute duration, on
average. · Patients
rated the visit as “excellent” or “very good” across measures including
addressing concerns, communication, developing a treatment plan, convenience,
satisfaction and value in having a future telehealth visit. · 62% of
physicians had no prior experience with telemedicine visits, and 69% were
comfortable performing these visits after completing 1-4 sessions. 92% of
physicians rated their experience as very good or excellent. All physicians
reported plans to perform telemedicine visits if reimbursement continues. The main issue were technical
barriers. |
|
3 |
Middleton A, et al. Phys Ther. 2020. DOI:10.1093/ptj/pzaa089. |
To describe the process of delivering physical
therapist–guided telerehabilitation in older adults with functional
limitations |
Patients in need of rehabilitation |
Descriptive: qualitative |
Specialized outpatient rehabilitation
and rehabilitation services at home |
USA |
· There is a
need of developing strategies for preventing functional decline among at-risk
individuals during periods of social distancing and quarantine · A
telerehabilitation program including 36 sessions delivered under the
supervision of a physical therapist to a 67-year-old man is reported o
The authors provide insight into the process and
cost of developing telehealth exercise programs for older adults with
functional impairments. |
|
4 |
Prada V, et al. Int J Rehabil Res. 2020.
DOI:10.1097/MRR.0000000000000418. |
To report the case of a patient with
Charcot-Marie-Tooth that was infected by SARS-CoV-2 |
COVID-19 patient |
Case Report |
Rehabilitation in acute care |
Italy |
· 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. |
|
5 |
Bikson M ET AL., Brain Stimul
2020 DOI:
10.1016/j.brs.2020.05.010. |
To provide guidance on good practices for delivering
NIBS through the immediate and ongoing stages of COVID-19. |
Patients with clinical indications for NIBS |
Consensus paper |
Specialized outpatient rehabilitation |
Worldwide |
· A 3-phase
model (early COVID-19 impact, current practices, and future preparation) with
an 11-step checklist (spanning removing or streamlining in-person protocols,
incorporating telemedicine, and addressing COVID-19-associated adverse
events) is proposed. · Recommendations:
social distancing and sterilization of NIBS related equipment, specific
provisions for COVID-19 positive populations, for regulatory and human
resource in the era of COVID-19, and for specific clinical groups (stroke,
chronic neurological conditions, drug, alcohol or behavioral addiction,
children and older adults). |
|
6 |
Bartolo M, et al. Front Neurol. 2020.
DOI:10.3389/fneur.2020.00423. |
To describe the measures adopted by rehabilitation
structures, involved early in the COVID-19 pandemic. |
Patients with neurological disability |
Expert Opinion |
Specialized postacute
rehabilitation, specialized outpatient rehabilitation, and rehabilitation
services at home |
Italy |
· The authors
advice about the need of a balance between two fundamental needs: prevent
contagion spreading and consent the delivery of rehabilitation to
neurological patients. |
|
7 |
Bokan V, Obradovic M. Eur
J Phys Rehabil Med 2020. DOI:10.23736/S1973-9087.20.06352-2. |
To describe the impact of COVID - 19 epidemic on
rehabilitation services in Montenegro |
Patients in need of rehabilitation |
Expert opinion |
General outpatient rehabilitation |
Montenegro |
· Rehabilitation
services were reorganized as follows: o
Outpatient service delivery was restricted to urgent
conditions (in most cases, musculoskeletal trauma and peripheral nerve
lesions). o
The daily number of treated patients was reduced by
90%. o
A Call Centre was dedicated to help patients consult
a PRM specialist · COVID- 19
epidemic pointed to the necessity of: o
Organizing rehabilitation within the community (home
rehabilitation poorly developed) o
Opening PRM services at the territory of the capital
city · Strengthening
connections among associations and individuals to share information and
knowledge. |
|
8 |
Carda S, et al. Eur J Phys Rehabil
Med. 2020. DOI:10.23736/S1973-9087.20.06317-0. |
To share the clinical experience and perspective of
different International Rehabilitation Units in the management of COVID-19
patients |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Worldwide |
· Several
rehabilitation needs are expected after COVID-19, due to respiratory failure,
neurological and cognitive impairment, 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 hours with no fever
and no fever-reducing medication 3) stable respiratory rate and
oxygen saturation · 4) clinical
and/or radiological evidence of stability |
|
9 |
Chang MC & Boudier-Revéret
M. Am J Phys Med Rehabil. 2020. DOI:
10.1097/PHM.0000000000001468. |
To underline the importance of tele-rehabilitation
for stroke patients during COVID-19 pandemic. |
Stroke patients |
Expert Opinion |
Outpatient rehabilitation, and rehabilitation
services at home |
Republic of Korea |
· Telerehabilitation
is useful for stroke patients during COVID-19 pandemic as: o
Previous studies have found it as effective as
in-clinic rehabilitation o
Patients can receive psychological counselling
without the need to access the hospital o
Clinicians can check the need for COVID-19 testing,
and monitor symptom worsening while maintaining the patient at home. |
|
10 |
Dantas LO, et al. Braz J Phys Ther. 2020. DOI:10.1016/j.bjpt.2020.04.006. |
To define digital physical therapy in the COVID-19
pandemic and
describe its effects |
COVID-19 patients and patients in need of
rehabilitation |
Expert opinion |
Specialized outpatient rehabilitation, and rehabilitation
services at home |
Brazil |
· Digital
practice includes “health care services, support, and information provided
remotely via digital communication and devices”. · Digital
physical therapy is an exponentially growing field, widely adopted within the
COVID-19 pandemic, with the potential to reduce costs and increase quality of
modern health care systems. |
|
11 |
De
la Corte-Rodriguez H, et al., Haemophilia. 2020. DOI:10.1111/hae.14070. |
To provide guidance on measures to be taken to care
for patients with haemophilia requiring intra-articular injection |
Patients with haemophilia requiring intra-articular
injection |
Expert opinion |
Specialized outpatient rehabilitation |
Spain |
· Prepare
specific internal protocols and organize appropriate training for the staff
and patients involved. · Before the
procedure, minimise face-to-face contact by previously reviewing the
electronic history and through a remote consultation. · Ask the
patient to sign an informed consent form adapted to the current
epidemiological scenario. · Minimize the
time of exposure and the number of people in the room · Consider to
replace professionals who have a higher risk of complications from COVID-19
with others who are at lower risk. · Request
health care personnel to use complete PPE. · Provide the
necessary protection for patients, considering their epidemiological
situation. · Postpone
consultation for known COVID-19-positive patients whenever it is not
essential, until the infection is recovered. · Ensure that
the circuit of entry, stay, and exit of the patient are separated from the
contact with other patients and non-healthcare personnel. · Ensure that
all centers have adequate cleaning, disinfection and waste management
protocols, following official recommendations and in accordance with their
Occupational Health and Preventive Medicine departments. o
Discourage the use of steroids if possible. |
|
12 |
Feeley I et al., Ann Med Surg
2020. DOI: 10.1016/j.amsu.2020.04.023 |
To discuss the advances made by the foot and ankle
department in the COVID-19 era |
Patients with foot and ankle injuries |
Expert opinion |
Rehabilitation services at home |
Ireland |
A website (www.orthotac.ie) was created to provide educational material
(videos of exercises performed by qualified physiotherapists and information
leaflets explaining the management of common injuries). |
|
13 |
Gopaul U, et al., Physiother Res
Int 2020. DOI: 10.1002/pri.1847 |
To report on the preparedness and the role of
physiotherapy in the clinical management of COVID-19 in Africa |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care |
Africa |
· The number of
physiotherapists per 100,000 population range from 1 in Cameroon to 5 in
Mauritius to 13 in South Africa. It is unclear how many physiotherapists are
part of the team for COVID-19 patients. · The
physiotherapists should play a proactive role by increasing preparedness for
respiratory physiotherapy in intensive care for COVID-19 patients and for
early rehabilitation in the post-acute phase to minimize the impact of
COVID-19 in Africa. |
|
14 |
Gupta R et al., NEJM CAT 2020. DOI:10.1056/CAT.20.0238. |
To report a multi-disciplinary, comprehensive
treatment model for those recovering from Covid-19 critical illness |
COVID-19 patients |
Expert opinion |
Specialized postacute
rehabilitation |
USA |
· The NewYork-Presbyterian/Weill Cornell Medical Center created
a Covid-19 Recovery Unit: a 30-bed unit to deliver a multi-disciplinary and
comprehensive treatment including early rehabilitative therapy and extra
support for psychosocial complications. · The Eligibility
Criteria for the admission are: Medically stable, with ongoing medical and
rehabilitative needs; Able to tolerate >30+ min PT/OT each daily;
Anticipation of final discharge to acute or
sub-acute rehabilitation;
Anticipation
of at least one additional week of inpatient-level of care; Able to interact
well with staff & other patients; Need for peritoneal dialysis is not an
exclusion · Structured
group and individual therapy include: o
Five-times-weekly screening and sessions of PT and
OT, and speech-language pathology as appropriate o
Group therapy sessions three times weekly o
Mindfulness and meditation classes three times
weekly o
Chair yoga classes five times weekly · Goal-setting
with a therapist weekly |
|
15 |
Haines KJ & Berney S.
J Physiother. 2020. DOI: 10.1016/j.jphys.2020.03.012 |
To describe the role of physical therapists during
COVID-19 pandemic |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Australia |
· Physical
therapists need to switch to a telerehabilitation delivery model of care,
also to decrease the concerns of becoming infected during their work · Teamwork and
collaboration are now more important than ever within own profession and
inter-professionally |
|
16 |
Karri J et al., Am J Phys Med Rehabil
2020. DOI: 10.1097/PHM.0000000000001463 |
To update the existing national recommendations and
outline considerations about common rehabilitation procedures and their
infectious risk profile |
Patients in need of rehabilitation |
Expert opinion |
General outpatient rehabilitation |
USA |
· Procedures
were categorized as follows: o
Elective procedures: injections of joint, peripheral
nerve and trigger point; NCS and EMG, axial procedures including epidural
steroid injections, medial branch blocks, facet injections, radiofrequency
ablation o
Functionally driven procedures: chemodenervation
or neurolysis, axial or peripheral joint, nerve, and trigger point injections
o
Time-sensitive procedures: intrathecal pump catheter
aspiration or intrathecal pump medication refill, NCS and EMG · Prophylactic
considerations based on procedure specific risks: o
Droplet or aerosolized contagion exposure: consider
using a respirator (i.e. N95 mask) in patients with possible illness;
consider adding a face shield in case of droplet exposure o
Steroid administration: consider steroid dose
reduction or other alternative medications for vulnerable and/or
immunosuppressed populations · Reusable
equipment: following Center for Disease Control and Prevention recommended
cleaning and disinfection protocols is vital in maintaining sanitary
equipment and surfaces |
|
17 |
Leocani L, et al.
Eur J Neurol. 2020.
DOI: 10.1111/ene.14320. |
To report the rehabilitation needs of COVID-19
patients and people with physical inactivity during the lockdown |
COVID-19 patients and home-restricted subjects |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Italy |
· Rehabilitation
needs are triggered by prolonged immobilization and acute neurological
complications due to COVID-19, but also by the restriction of physical
activity due to government decrees · Rehabilitation
for COVID-19 patients should begin in the ICU, to foster functional recovery
and ventilator weaning · Telerehabilitation
should be offered for physical, language and cognitive training, considering
that exergaming could allow remote supervision and collection of
patient-reported outcomes |
|
18 |
Lew HL, et al. Am J Phys Med Rehabil.
2020. DOI: 10.1097/PHM.0000000000001460 |
To highlight the role of rehabilitation during the
current pandemic. |
COVID-19 patients |
Expert Opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
USA |
· Interdisciplinary
rehabilitation is needed to care for all the impairment developed by COVID-19
patients. · Education of
patients and care-givers is fundamental to permit a safe discharge to home. · Ensuring a continuity of care even after discharge,
through face to face consultation or by telerehabilitation could be
beneficial on long-term outcomes. |
|
19 |
Meythaler JM, Arch Phys Med Rehabil.
2020. DOI: 10.1016/j.apmr.2020.05.001 |
To comment on the proposed changes to the inpatient
rehabilitation facilities in the US. |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation |
USA |
· The Centers
for Medicare and Medicaid Services (CMS) proposed a change in regulations and
guidance for inpatient rehabilitation facilities in the USA. The author
argument that the timing for the proposal is poor and it should be revised
after more careful consideration. |
|
20 |
Pinto TF & Carvalho CRF, Braz
J Phys Ther. 2020. DOI: 10.1016/j.bjpt.2020.04.004 |
To describe the lessons learnt from the experience
of Brazilian Physical Therapists with COVID-19 |
COVID-19 patients |
Expert Opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Brazil |
· Four lessons
should be learnt from the Brazilian physical therapists
experience: o
Every professional should be trained in infection
control strategies, such as washing hands or using PPE. o
Primary care during a pandemic is of the utmost
importance for reducing mortality rate by correctly treating comorbidities. o
Cardiorespiratory and Intensive care Physical
Therapists are at the center of the rehabilitation programs during the
pandemic. · Physical
therapists should remain scientifically updated. |
|
21 |
Prvu Bettger J, et al. BMJ
Glob Health. 2020. DOI: 10.1136/bmjgh-2020-002670 |
To describe adjustments to the continuum of
International Rehabilitation Services in the context of national COVID-19 preparedness
responses |
Patients in need of rehabilitation |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Worldwide |
· Rehabilitation service providers mobilised quickly
to provide the best and safest care possible to those in greatest need, to
optimize physical and cognitive functioning. · A core set of outcome measures should be adopted to
monitor functioning for COVID-19 and other patients at risk for functional
decline. · Safe and
effective home-based rehabilitation strategies should be provided to mitigate
the consequences of COVID-19 and reduced service capacity. |
|
22 |
Smith et al. PM R. 2020. DOI:10.1002/pmrj.12405. |
To present a model for field rehabilitation. |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation |
USA |
· Given the
intense stress on the health care systems due to COVID-19, rehabilitation
services should be optimized to cope with it. The authors stress the need to
identify patients with most severe disability and barriers to discharge in
order to prioritize them during postacute inpatient
rehabilitation. |
|
23 |
Stein J, et al. Am J Phys Med Rehabil.
2020. DOI:10.1097/PHM.0000000000001470. |
To report the experience of a New York City academic
medical center preparing for the pandemic,
confronting it and the plans for post-peak recovery |
COVID-19 patients |
Expert Opinion |
Specialized postacute
rehabilitation |
USA |
· Rehabilitation
is a crucial aspect of our health care, but is particularly vulnerable during
a pandemic. · The
experience reported could provide guidelines for similar cases in the future. · Preparing for
future pandemics is a critical long-term response. |
|
24 |
Thornton J. BMJ. 2020. DOI: 10.1136/bmj.m1787 |
To describe the UK National Health Service plan for
rehabilitation of COVID-19 patients on ICU discharge |
COVID-19 patients |
Expert opinion |
Specialized postacute
rehabilitation |
UK |
· The “tsunami
of rehabilitation needs” after ICU makes necessary to develop
soon-to-be-released COVID-19 rehabilitation plans in UK · The UK
government predicts that 45% of patients will need low level medical or
social input for recovery and that 4% will require focused intensive
rehabilitation. · COVID-19
patients will need an adequate psychological support after ICU discharge,
because of higher levels of “survivors’ guilt” and post-traumatic stress disorder. |
|
25 |
·
Wainwright
TW & Low M. J Rehabil Med. 2020. DOI: 10.2340/16501977-2685 |
To propose the inclusion of collaborative
self-management in the new models of post-acute care for COVID-19 to
optimise outcomes |
COVID-19 patients |
Expert opinion |
Specialized postacute
rehabilitation |
UK |
· Self-management
is a complex intervention, consisting of encouraging and coaching patients to
manage medical or emotional elements of their condition. · Rehabilitation
services should include collaborative self-management in the new models of
post-acute care for COVID-19 to optimise patient outcomes. · COVID-19
patients need specific advice on activity pacing, to cope with fatigue in the
recovery phase from acute viral illness, and the potential associated
complications. |
|
Impact of COVID-19 on
diseases of rehabilitative interest |
|||||||
|
1 |
NICE guideline
www.nice.org.uk/guidance/ng167 |
To update the recommendations for the management of
people with rheumatological autoimmune, inflammatory and metabolic bone
disorders in the COVID-19 era |
People with rheumatologica
l autoimmune, inflammatory and metabolic bone disorders |
Rapid guideline |
Specialized outpatient rehabilitation |
UK |
· On 21 May
2020, the authors highlighted factors to take into account when considering
temporarily stopping some drugs for children and young people · The authors
aligned recommendation 1.4 (Communicating with patients and minimising risk)
with current government advice on social distancing. |
|
2 |
NICE guideline www.nice.org.uk/guidance/ng177 |
To provide recommendations for the management of
people with interstitial lung disease, including idiopathic pulmonary
fibrosis and pulmonary sarcoidosis in the COVID-19 era, to protect staff from
infection and enable services to make the best use of NHS resources. |
People with interstitial lung disease |
Rapid guideline |
Specialized outpatient rehabilitation,
rehabilitation services at home |
UK |
· This
guideline provides 50 different recommendations for the management of people
with interstitial lung disease. · A small
section concerns pulmonary rehabilitation, as indicated here:
o
Continue to offer pulmonary rehabilitation services
to patients if available, including local services offering remote individualised education and exercise advice. o
If remote pulmonary rehabilitation services are not
available locally, use online pulmonary rehabilitation resources · When
face-to-face pulmonary rehabilitation services become available, discuss the
risks and benefits of attending with the patient, taking into account the
current prevalence of COVID-19. |
|
3 |
Negrini S, et al. Eur J Phys Rehabil Med. 2020. DOI: 10.23736/S1973-9087.20.06361-3. |
To describe the impact of COVID-19 on people
experiencing disability. |
Patients in need of rehabilitation |
Descriptive : cross-sectional |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation. |
Italy |
· A survey
about rehabilitation services in Europe in the COVID-19 era has been answered
by 109 delegates of ESPRM from 35 countries. · Up to 2
million patients, in Europe, do not have access to rehabilitation services,
due to stop of admissions to rehabilitation, early discharge and reduction of
activities, during the pandemic. · Future
increase of rehabilitation demand is expected, after the emergency, due to
the return wave of these not well treated patients, and of post-Covid-19
patients' needs |
|
4 |
Goodman-Casanova JM, et al. J Med Internet Res. 2020. DOI: 10.2196/19434. |
To study the impact of quarantine in older patients
with mild cognitive impairment. |
Older people with mild cognitive impairment. |
Descriptive : cross-sectional |
Rehabilitation services at home |
Spain |
· A
telephone-base survey was administered to 93 patients participating in a
study involving a television-based assistive integrated technology · Psychological
well-being was optimal for the majority of the studied population. · Those living
alone at home had the worst psychological outcomes. · Television
was the preferred device to access to COVID-19 information. |
|
5 |
Korupolu R, et al. Spinal Cord Ser Cases. 2020.
DOI:10.1038/s41394-020-0284-7 |
To outline important differences in presentation
along with COVID-19 cases co-morbid with SCI. |
People with SCI |
Case series |
Rehabilitation in assistive service for specific
disabled population groups |
USA |
· SCI patients
could not present with typical symptoms of COVID-19 due to altered
physiology, posing challenges with their surveillance and management · A
paradigmatic case with traumatic SCI (C5 motor level) presented fever,
attributed to an UTI and treated with antibiotics, developed loose stools,
attributed to neurogenic bowel; a few days later fever relapsed with
intermittent cough. The patient underwent chest CT scan and was tested
positive for SARS-CoV-2 only at 2 weeks from the initial onset of fever |
|
6 |
Boldrini P et al., Eur J Phys Rehabil Med
2020. DOI: 10.23736/S1973-9087.20.06373-X. |
To report the contents of the 6th SIMFER Covinar on the impact of the pandemic on people living
with disability. |
Persons with disability |
Descriptive: qualitative |
Rehabilitation services |
Italy |
· 7
representatives of Italian Patient Associations described the difficulties
they are facing during the pandemic, the initiatives undertaken and their
future perspectives and expectations. · The huge
impact of the COVID-19 pandemic on rehabilitation services was confirmed · Associations
made great efforts to assist their members offering information, advice and
individual support (e.g. providing online videos with exercises) · Associations
unanimously expressed a plea for rapid reactivation of rehabilitation services,
the need for some changes in their organization and delivery, and the request
to maintain tele-rehabilitation services. |
|
7 |
Manto M et al., Cerebellum 2020. DOI:
10.1007/s12311-020-01139-1. |
To provide guidance about how to care for patients
with cerebellar ataxia
in the COVID-19 era |
CA patients |
Consensus paper |
Rehabilitation services at home |
Worldwide |
· CA patients
are at higher risk of developing complications due to COVID-19: o
they are mostly older patients; o
ataxic respiration, maintenance of airway
protection, and the presence of aspiration pneumonia are a constant threat; o
immune ataxia subjects are treated with
immune-modulating agents o
many genetic ataxias are complicated by cardiac
disorders and other comorbidities as diabetes. · Discontinuation
of rehabilitation services including speech therapy may exacerbate symptoms
and worsen functional impairment (increasing balance loss, muscle spasms,
speech and swallow disorders) · Novel practice
patterns need to emerge, including the use of telerehabilitation for balance
and speech training and for psychological support |
|
8 |
De Marchi F, et al. Neurol Sci. 2020. DOI: 10.1007/s10072-020-04457-8 |
To describe a novel approach using telemedicine for
patients suffering from ALS |
Patients with ALS |
Expert opinion |
Rehabilitation services at home |
Italy |
· Quarantine
due to COVID-19 pandemic creates huge difficulties in the care of patients
with ALS, with the risk of speeding up functional decline. · The authors describe an integrated system for
telemedicine, telehealth, tele-coaching and telecare supported by an
internet-based app and education material that they will be testing in the
near future. |
|
9 |
Longo E et al., Phys Occup
Ther Pediatr. 2020. DOI:
10.1080/01942638.2020.1759947 |
To describe the implementation of home-based
rehabilitation for children in low- and middle-income countries |
Children with disabilities |
Expert opinion |
Rehabilitation services at home |
Brazil |
· Home-based
rehabilitation programs could be effective in improving motor function of
children with cerebral palsy. · A
collaborative partnership with parents is warranted, to know the child’s
needs and the home environment features. · Home-based
rehabilitation programs should match the child and family goals. · Regular
support and coaching to the family should be ensured to identify the child’s
improvements and adjust the complexity of the program as needed. · It is crucial
to promote telehealth for follow-up and continuity of care in children with
disabilities during COVID-19 pandemic. |
|
10 |
Sell NM et al., Ann Surg
2020. DOI: 10.1097/SLA.0000000000004002. |
To report an adaptive response to pandemic-related prehabilitation barriers using a virtual platform. |
Oncology patients who are receiving neo-adjuvant
therapy prior to anticipated surgery |
Expert opinion |
Rehabilitation services at home |
USA, CANADA |
· The authors
suggest a multimodal, home-based, virtual prehabilitation
program that include: standardized fitness program, nutrition
supplementation, smoking cessation, and mindfulness practice. · Before
commencing exercise sessions, instruct the patients to be mindful of any
significant changes in symptoms or the presence of new symptoms. Common
side-effects: muscular fatigue and soreness, transient increases in
treatment-related symptoms. Rare risks: the possibility of injury due to
unknown bone metastases or acute cardiac events in conjunction with cytotoxic
therapy. Intensity and acute changes in symptoms should be closely monitored
and reported. |
|
11 |
Sylaja PN, et al. Ann N Y .Acad Sci. 2020. DOI: 10.1111/nyas.14379 |
To report the issues in stroke care due to COVID-19
pandemic in India. |
Stroke patients |
Expert Opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
India |
· In India,
COVID-19 pandemic caused a significant reduction in stroke cases reported and
treated. · Stroke
rehabilitation facilities were hugely affected because of lower availability
of personnel, fear of contagion between patients and staff and poor access to
rehabilitation. · The authors
propose possible solutions for handling stroke patients from acute phase to
home-based rehabilitation, guaranteeing continuity of care. · Telemedicine
could be an opportunity for stroke patients during the current pandemic. |
|
12 |
Turolla
A et al., Phys Ther 2020. DOI: 10.1093/ptj/pzaa093 |
To report clinical evidence on telerehabilitation
(1), describe its feasibility and acceptability (2), explain opportunities
and challenges for MSK physical therapists (3), and suggest clinical
implications, calling to action the community of physical therapists (4). |
Patients with MSK dysfunction |
Expert opinion |
Rehabilitation services at home |
Italy |
· Telerehabilitation
unveils itself as a promising and timely model of care for patients who have
MSK dysfunction during COVID-19 · Consultation
for MSK pain is feasible and has a good acceptability · There are
benefits for patients (eg the reduction of
hospitalization rates and the prevention of readmissions, improvements in
health outcomes, quality of life and an early return to work), for physical
therapists (eg maintaining continuity of care,
monitoring patients’ progress), for health care services (eg
increase care efficiency while containing costs, reduce waiting lists,
guarantee adequate and continued services to both acute and chronic
condition) · Telerehabilitation
should be enriched with contextual factors (eg
elements of verbal communication and nonverbal communication) · Establish in
time the needed tools for exercise so that they can be rented and delivered
to the patient’s home. · Time for
consultation and reimbursements for telerehabilitation services differ widely
across countries. · Medicolegal
aspects need to be considered while using the telerehabilitation (Protection
of health care data and patient privacy) |
|
13 |
Yarimkaia E & Esentürk
OK. International Journal of Developmental Disabilities. 2020.
DOI:10.1080/20473869.2020.1756115. |
To describe the benefit of physical activity for
children suffering from Autism Spectrum Disorders during COVID-19 quarantine. |
Children suffering from Autism Spectrum Disorders |
Expert Opinion |
Rehabilitation services at home |
Turkey |
· Quarantine
can be an acute form of stress for children suffering from Autism Spectrum
Disorders, and lead to mental health issues. o
Parents should engage in physical activity with
their children during the quarantine to increase well-being and calm at home,
increasing quality of life of both children and care givers. |
|
Late complications due to COVID-19 that may be of
rehabilitative interest |
|||||||
|
1 |
Wang X, et al. QJM. 2020. DOI:10.1093/qjmed/hcaa178. |
To study the evolution of clinical outcomes after
discharge from hospital in COVID-19 patients. |
COVID-19 patient |
Prospective uncontrolled observational study |
Rehabilitation in acute care |
China |
· 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. |
|
2 |
Candan SA, et al. Physiother
Theory Pract. 2020. DOI:
10.1080/09593985.2020.1766181 |
To outline potential long-term secondary effects of COVID-19 infection on the musculoskeletal system |
COVID-19 patients |
Expert opinion |
Rehabilitation in acute care, specialized postacute rehabilitation, specialized outpatient
rehabilitation, and rehabilitation services at home |
Turkey and Nigeria |
· ICU stay
might be the most important determinant of disability in the long term, considering
the physical domains of PICS. · Rehabilitation
program for the post-hospital period should involve strengthening,
flexibility exercises, aerobic exercises, and balance and gait exercises. · Rehabilitation
should be focused
on reducing contributors to impaired long-term function to prevent or treat
ICU-acquired weakness, deconditioning, and myopathies and neuropathies, in
conjunction with respiratory care. |
Abbreviations: ALS= Amyotrophic
lateral sclerosis; ARDS= acute respiratory distress syndrome; BMI= Body Max
Index; BP= Blood pressure; bpm= beats per minute; CA= Cerebellar ataxia;
COVID-19= COronaVIrus Disease 19; Covinar=
COVID-19 webinar; CNS= Central nervous system; CPAP= continuous positive
airways pressure; CT= computed tomography; ECMO= extracorporal
membrane oxygenation; EMG= electromyography; FIM= Functional Independence
Measure; HR= heart rate; ICU= intensive care unit; MAH= major autohemotherapy; MAP=
mean arterial pressure; MSK= musculoskeletal; MEWS= Modified Early Warning
Scale; MRI= Magnetic Resonance Imaging; NCS= nerve conduction study; NIBS=
non-invasive brain stimulation; OT= Occupational Therapy; PEEP= Positive
end-expiratory pressure; PICS= post-intensive care syndrome; PPE= Personal
Protective Equipment; PRM= Physical and Rehabilitation Medicine; PT= Physical
Therapy; RPTs= Respiratory Physiotherapists; SARS-CoV-2= Severe Acute
Respiratory Syndrome - Coronavirus–2; SCI= spinal cord injury; SIMFER= Italian Society of Physical Medicine
and Rehabilitation; UK= United Kingdom; USA = United States of America; UTI=
urinary tract infection.