COVID-19 and Rehabilitation July 2020

Author

DOI

Year

Country

Dates

Aim of the study

Study Design

Type of rehabilitation service

Research Question

LFRI

COVID-19 Phases

Population

N° of participants

Clinical presentation

Intervention

Comparator

Outcomes

Adverse events

Diagnostic test

Sensitivity

Specifity

Types of validity

Attributes of reliability

Main findings

Burns SP

10.1038/s41393-020-0529-0

2020

USA

March 9th - June 30th, 2020

To describe case fatality of COVID-19 infection in Veterans with SCI/D

Analytical: Cohort study

Specialized postacute rehabilitation

Epidemiology - Prevalence

N/A

Acute, post-acute, late-onset, or permanent on a pre-existing health condition

Veterans with SCI/D with diagnosis of COVID-19

140

N/R

N/A

Veterans with SCI/D without diagnosis fo COVID-19

Case fatality rate

N/A

The SCI/D Veteran case fatality rate with COVID-19 was 19%; it was 2.4 times the rate observed in the non-SCI/D Veteran population with an absolute rate that is 11% greater (95% CI: 5–19%; Z score = 4.8; p < 0.0002).

Curci C

10.23736/S1973-9087.20.06339-X

2020

Italy

March 10th - April 15th, 2020

To characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to a Rehabilitation Unit.

Analytical: Cross-sectional study

Specialized postacute rehabilitation

Epidemiology - Clinical presentation

Respiratory structures (s430) and related functions (Respiration b440-455)

Post-acute

COVID-19 patients

Most patients needed respiratory supports (mainly nasal cannula and Venturi Mask) with a sustained FiO2 to maintain a good peripheral oxygen saturation. Moreover, the majority was bedridden and suffered from dyspnoea and shortness of breath even for minimal activities

N/A

Pulmonary function: 13 of them had FiO2 ≥ 40% <60% (mean 51.7 ± 14.0 %), 19 FiO2 ≥ 21% <40% (mean 26.7±4.5 %). Patients with lower FiO2 showed lower PaO2 values and a lower PaO2/FIO2 ratio.
Disability status: BI was 45.2±27.6, the patients with higher FIO2 showed lower values: 39.6 ± 25.7 vs 53.3 ± 29.3. All patients had grade 4 or 5 on the mMRC Dyspnoea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
Post-acute COVID-19 patients suffered from dyspnoea and shortness of breath even for minimal activities, with a resulting severe disability.
An early rehabilitation protocol was adapted to the two subgroups according to the baseline conditions of the patients.

Di Stefano V

10.1007/s00415-020-10064-6

2020

Italy

April 20th - May 4th, 2020

To quantify the reduction of PA in patients with NMD due to lockdown, and its impact on quality of life

Analytical: Cross-sectional study

N/A

Epidemiology - Prevalence

N/A

Patients with pre-existing NMD and healthy age-matched controls

NMD group= 149; healthy controls= 119

N/A

Levels of PA measured by IPAQ-SF as energy expenditure (MET–minutes/week), both before and in the last 7 days of the quarantine. The distribution of MET was calculated for different levels of PA intensity (vigorous-intensity PA; moderate-intensity PA; moderate-to-vigorous PA; walking activity) in all subjects. SF-12 was also administered by telephone to NMD group .

N/A

In healthy controls, a significant reduction of PA was reported during quarantine compared to before quarantine for vigorous-intensity, moderate-intensity and moderate-to-vigorous intensity and total PA levels, and for walking activity. In NMD, a significant reduction of PA was reported for walking activity, moderate-to-vigorous and total PA levels, while no difference was found for vigorous-intensity and moderate-intensity PA. Furthermore, NMD showed reduced scores for SF12.

Diaz-Segarra N

10.1097/PHM.0000000000001532

2020

USA

N/R

To report clinical findings of four COVID-19 patients that developed acute ischemic stroke

Descriptive: Case Series

Rehabilitation in acute care

Epidemiology - Clinical presentation

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 patients

Patient 1: Dysarthria; left hemiparesis, and reduced LOC + cough, fever, chills; deceased on day 3; Patient 2: Aphasia, facial droop; right hemiparesis, sensory deficit, complete hemianopsia + None symptoms of COVID-19; discharged home on day 9; Patient 3: Reduced LOC + Shortness of breath, fevers; ARDS; sepsis, MOF, deceased on day 42; Patient 4: Reduced LOC + Cough, SOB, diarrhea; ARDS, sepsis, MOF, discharged to rehabilitation on day 29.

Patient 1: Mechanical thrombectomy, aspirin; Patient 2: IV t-PA, mechanical thrombectomy, aspirin; Patient 3: Aspirin; Patient 4: Aspirin

N/A

This case series highlights that COVID-19 ischemic strokes had a heterogeneuos clinical presentation with an unknown duration of the COVID-19 related prothrombotic state. Therefore, the authors concluded that the physiatric awareness of this prothrombotic state is mandatory, taking into account the increased incidence of ischemic strokes in COVID-19 patients referred to rehabilitation units.

Gualtieri P

10.3390/ijms21134670

2020

Italy

March 19th - April 27th, 2020

To evaluate the differences in body composition during a ICU hospitalization in overall, lean, and obese COVID-19 patients.

Analytical: Cohort study

N/A

Epidemiology - Natural history/Determining and modifying factors

Any other body structure and function-generic (s/b)

Acute

COVID19 patients

30 (13 lean and 17 obese patients)

N/R

Chest CT within 24 hours and about 20 days later

N/A

Differences in body composition and liver composition during ICU hospitalization (assessed by chest CT)

N/A

Subscapular thickness, suprailiac thickness, sum thickness, body density, FM%, and waist circumference were statically increased in the obese group compared to the lean group. Liver attenuation and liver/spleen ratio were statistically reduced in the obese group compared to the lean group. These findings could be co-caused by COVID-19, prolonged bed rest, and a low-grade inflammation typical of obesity.

Halpin SJ

10.1002/jmv.26368

2020

May-June 2020

To describe the symptoms and rehabilitation needs of COVID-19 patients after discharge

Analytical: Cross-sectional study

Rehabilitation services at home

Epidemiology - Prevalence

Respiratory structures (s430) and related functions (Respiration b440-455)

Post-acute

COVID-19 patients 4 weeks after hospital discharge

100

N/A

Telephonic survey

N/A

Prevalence of post-discharge symptoms

N/A

The most common symptom reported was fatigue (72% of post ICU patients; 60.3 % of hospitalized patients), followed by breathlessness (65.6% in ICU group; 42.6% in hospitalized group) and psychological distress (46.9% in ICU group; 23.5% in hospitalized group). There was a clinically significant drop in EQ5D in 68.8% participants in the ICU group and in 45.6% of participants in the ward group. The authors recommend planning rehabilitation services to manage these symptoms appropriately and maximise the functional return of COVID-19 survivors.

Huang Y

10.1186/s12931-020-01429-6

2020

China

N/R

To investigate the influence of COVID-19 on lung function in early convalescence phase (at 30 days after discharged)

Descriptive: Historical cohort

N/A

Epidemiology - Natural history/Determining and modifying factors

Respiratory structures (s430) and related functions (Respiration b440-455)

Post-acute

COVID-19

N/A

Lung volumes (TLC), spirometry (FVC, FEV1), DLCO, ,respiratory muscle strength, 6-MWT and high resolution CT

N/A

Out of 57 COVID-19 patients, 40 were non-severe and 17 were severe ones. Impaired diffusing-capacity, respiratory muscle strength decrease, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in the early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment (75.6% vs 42.5%) and encountered more TLC decrease and 6MWT decline. Tha authors showed that most of the COVID-19 patients had a pulmonary function impairment in early convalescence phase, concluding that there is a need of longer follow-up studies in COVID-19 patients to better investigate clinical outcomes (i.e. tendency of lung function and exercise tolerance) in recovered COVID-19 patients.

Khalifa M

10.1093/jpids/piaa086

2020

Saudi Arabia

From 10th of April, 2020

To report one of the first descriptions of GBS and COVID-19 association in a child

Descriptive: Case Report

N/A

Epidemiology - Clinical presentation

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 child developing GBS

After three weeks with mild febrile illness with mild respiratory manifestations and a persistent cough, a eleven-year-old boy presented with typical features of GBS and after five days a morbilliform skin rash over the palms of both hands.

-intravenous immunoglobulin (IVIG) infusions at a dose of 1 gram/kg/day for two days. -paracetamol when needed (10mg/kg/dose) - hydroxychloroquine twice daily (6.5 MG/KG) for one day, and then (3.25 MG/KG) twice daily for seven days. -as thromboprophylaxis low molecular weight heparin (R/ Enoxaparin) was given s.c.20 IU once daily.

N/A

Neurological assessment

N/A

This report describes an eleven-year-old boy, who presented with acute GBS, three weeks after a mild symptomatic respiratory illness (positive infection via nasopharyngeal RT-PCR). -Awareness of neuromuscular presentations also in children may have a guiding significance for the early detection of the combined or preceding infection with SARS-CoV-2

Kirshblum SC

10.1002/pmrj.12454

2020

USA

April 4th - 27th, 2020

To determine the prevalence of COVID-19 in asymptomatic individuals referred for admission to an inpatient rehabilitation facility in a high prevalence community setting

Descriptive: Historical cohort

General postacute rehabilitation

Epidemiology - Clinical presentation

N/A

Post-acute

Patients admitted to an inpatient rehabilitation facility and presumed to be COVID-19 free

103

N/A

Positivity at the reverse transcriptase-polymerase chain reaction SARS-COV-2 testing withing the first two weeks of admission

N/A

Seven patients resulted positive at SARS-COV-2 testing at admission (6.8%). Two positive patients stayed asymptomatic while five developed symptoms in the next 5.2 days. Nine patients who tested negative were subsequently re-tested for developing symptoms compatible with COVID-19 infection, and five of them resulted positive. Overall, 12 patients (13.6%) resulted positive in the first 14 days of hospitalization. Screening for SARS-CoV-2 at the time of admission to an inpatient rehabilitation facility can identify pre-symptomatic or asymptomatic individuals, to determine their appropriate placement within a facility and using appropriate infection control practices. However, negative results do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.

Krett JD

10.1016/j.jneuroim.2020.577326

2020

Canada

N/R

To report a critically ill man with a COVID-19-associated hemorrhagic encephalopathy

Descriptive: Case Report

N/A

Epidemiology - Clinical presentation

Nervous system structures (s1) and related functions (Mental functions b1)

Acute

COVID-19 patient

Cough and fatigue and after 2 days increasing confusion. -At Hospital admission, the patient was disoriented, agitated, without lateralizing neurological deficits. -13 days later, the patient was unresponsive and diffusely paretic. -2 months following admission, the patient gradually recovered.

Mechanical ventilation, minimal vasopressor support, oral hydroxychloroquine, and neurorehabilitation

N/A

Neurological assessment, CSF analyses, brain MRI

N/A

This case reports encephalopathy with multifocal cerebral hemorrhages in a COVID-19 patient with severe, otherwise unexplained cortical dysfunction.
SARS-CoV-2 RNA was not detected in cerebrospinal fluid (CSF) or blood. CSF analyses suggested a cytokine release syndrome. Two months following hospital admission, the patient gradually recovered. He was transferred to a neurorehabilitation unit with mild residual physical and cognitive impairments.
Awareness of this clinical entity may facilitate the identification of patients with a potentially remediable cause of encephalopathy in COVID-19.

Kushlaf H

10.1002/mus.27020

2020

USA

N/R

To report the clinical course of a patient with myasthenia gravis who developed COVID-19

Descriptive: Case Report

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute, post-acute, late-onset, or permanent on a pre-existing health condition

Patient with myasthenia gravis developing COVID-19

The patient presented with fever and SOB

Hydroxychloroquine for 5 days, tocilizumab, and IVIG 1 g/kg daily for two consecutive days.

N/A

A 66-year-old woman, who was diagnosed with myastenia gravis at age 44, was intubated for hypoxemic respiratory failure and she also presented with hypotension and acute renal failure for which she was placed on continuous renal replacement therapy followed by intermittent emodialysis. After the COVID-19 treatament, she slowly improved and was extubated after 17 days then discharged to inpatient rehabilitation.

Li Z

10.23736/S1973-9087.20.06298-X

2020

China

February 29th - March 2nd, 2020

To collect the basic information, dysfunctions, and rehabilitation needs of hospitalized COVID-19 patients.

Analytical: Cross-sectional study

N/A

Epidemiology - Prevalence

Respiratory structures (s430) and related functions (Respiration b440-455)

Post-acute

Post-acute hospitalized COVID-19 patients

280

N/A

A questionnaire that included demographic and clinical history of the patients, the awareness about rehabilitation and the willingness to do it, current dysfunctions they suffer from, and the specific needs for rehabilitation, was administered to all the patients included.

N/A

Awareness and willingness of rehabilitation; common dysfunctions; current rehabilitation needs

N/A

The average Content Validity Index of the questionnaire was 0.958. Cronbach’s alpha was used to assess the internal consistency reliability, which was found to be 0.944 .

N/A

Patients were 51.8% male and 48.2% females. 64.2% of the patients were over 51 years of age, and only 9.3 % below 30 years of age. The most common physical dysfunctions reported by the patients were sleep disorders (63.6%), decreased activity endurance (61.4%), respiratory dysfunction (57.9%), loss of appetite (55.4%), and pain disorder (47.5%). Meanwhile, the most reported psychological dysfunctions were anxiety (62.1%), fear (50.0%), apathy (41.8%), depression (40.7%), and despair (32.5%). The patients felt a high demand for rehabilitation: the sum of the high need and need response with regard to exercise guidance, dietary instruction, and traditional Chinese medicine therapy, were 45.0%, 40.4%, and 39.6%, respectively

Manganotti P

10.1002/jmv.26289

2020

Italy

March-April 2020

To report a case series of 5 COVID-19 patients who developed GBS

Descriptive: Case Series

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 patients developing GBS

Fever and cough, and a significant impairment of taste and smell in 4/5 patients. The patients developed progressive weakness of the upper and lower limbs, in a disto-proximal fashion with a latency ranging from 14 to 30 days.

IVIG therapy was initiated in 4/5 patients at a dose of 0.4 gr/kg for 5 days.

N/A

Four out 5 COVID-19 patients with GBS presented with a mild facial nerve involvement limited to the muscles of the lower face; in one patient, taste assessment showed right-sided ageusia of the tongue, ipsilateral to the mild facial palsy. The Authors report that peripheral nervous system involvement after COVID-19 might be successfully treated with IVIG, as showed in 4/5 patients, whose neurological symptoms partially resolved without any side effect.

Ng JA

10.1093/ptj/pzaa124

2020

USA

April - May, 2020

To describe the establishment, operation and evolution of a rehabilitation therapist staffed prone team.

Descriptive: Historical cohort

Rehabilitation in acute care

Meso Level

Respiratory structures (s430) and related functions (Respiration b440-455)

Acute

COVID-19 patients in need of prone positioning

934

N/A

Position change by a prone team.

N/A

Number of position changes in a 7 weeks period, time spent for each position change, number of members of the team needed for each position change.

N/A

With the surge of ARDS cases due to COVID-19, the request for proning position increased exponentially. Given the possible side effect of prone positioning, and the complexity of the procedure, a team of rehabilitation therapists expert of mobilisation is needed to improve the outcome of patients. The team achieved during the pandemic the following numbers and goals. Total volume of requests to the prone team for position changes was 934. 70% of position changes involved 3 prone team members, 26% involved 2, 13% involved only 1 and 11% involved 4. The mean (SD) number of minutes for each position change was 20 (9.15) with a range of 5 to 80 minutes.

Pfefferkorn T

10.1007/s00415-020-09897-y

2020

Germany

April 2020

To report the case of a COVID-19 patient presenting with acute polyradiculoneuritis.

Descriptive: Case Report

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 patient

Fever, cough, tetraparesis and acral paresthesias.

Mechanical ventilation, tracheostomy, intravenous immunoglobulins, plasma exchange therapy.

N/A

The authors report the case of a 52 years old man who presented with tetraparesis after 14 days of fever and respiratory symptoms and was found positive on COVID-19 testing. The patient underwent mechanical ventilation and tracheostomy, and IVIG and plasma exchange therapy were administred. Thirty-one days after admission the patient showed signs of motor improvement with regressive facial and hypoglossal paresis but still needed mechanical ventilation, and was referred to a specialized rehabilitation clinic.

Piscitelli D

10.1007/s10072-020-04593-1

2020

Italy

March 5th - May 13th,2020

To report the case of a 39-year-old woman, in- home nurse, of normal social well-being with no history of somatoform or other psychiatric disorder or traumas, who developed, with SARS-CoV-2 infection, functional tremors.

Descriptive: Case Report

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Mental functions b1)

Acute

COVID-19 patient

After 7 days with mild COVID-19 symptoms the patient developed a lower limb tremor with variable frequency and amplitude. She presented abnormal movements while sitting (e.g., lower limb twisted movements), walking (e.g., ataxic gait), or at rest (e.g., jerky movements in supine position)

N/A

Case report of a patient without any history of psychiatric/neurologic events.

After 7 days with COVID-19 symptoms requiring quarantine, she developed a lower limb tremor and abnormal movements.
In the Emergency Department, she was treated with benzodiazepines without significant improvement. She was admitted to the Neurological Department, where she was found free from any neurological impairment and discharged after 10 days.
One week later, abnormal movements increased, she underwent instrumental examinations that found no abnormalities.
Two months after the onset, she tested negative twice for SARS-CoV-2 and tremor decreased.
This case represents the development of psychiatric comorbidity (a functional movement disorder) subsequent to an event threatening body integrity and autonomy of the subject, by means of the COVID-19 condition itself or of the isolation due to lockdown.

Rosen K

10.1007/s11420-020-09774-4

2020

USA

April 8th - May 12th, 2020

To investigate if an inpatient telerehabilitation program was viable for COVID-19 patients.

Descriptive: Historical cohort

Rehabilitation in acute care

Meso Level

Respiratory structures (s430) and related functions (Respiration b440-455)

Post-acute

COVID-19 patients

33 (12 of whom received only telerehabilitation PT services)

N/A

Telerehabilitation

In person PT or Telerehabilitation PT + in person PT

Percentage of patient that met their PT goals and were discharged.

N/A

The Hospital for Special Surgery in New York city, due to COVID-19 outbreak, introduced a telerehabilitation service for COVID-19 patients, based on a COVID-19 rehabilitation response algorithm. This latter could identify 3 groups:

patients who required in-person PT only;
patients who required telerehabilitation PT only;
patients who required a combination of in-person and telerehabilitation PT.

All the 12 patients treated with telerehabilitation PT only met their PT goals and were discharged home safely. Therefore, inpatient telerehabilitation might be considered as a viable option for selected COVID-19 inpatients in order to reduce their LOS.

Saggese CE

10.1159/000509453

2020

Italy

March - April, 2020

To present the case of a COVID-19 patient presenting with stroke and thromboses in different locations

Descriptive: Case Report

N/A

Epidemiology - Clinical presentation

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 patient presenting with stroke

Expressive aphasia, right hemiplegia, right neglect occurring after ten days of fever and cough.

rTPA therapy, oxygen, clopidogrel, atorvastatin, hydroxychloroquine, azithromycin, enoxaparin, amlodipine and ramipril.

N/A

The paper describe the case of an acute ischemic stroke patient who was suffering from fever and cough since ten days and was found positive for COVID-19 on admission. Afterwards he developed right dorsalis pedis and distal lateral plantar artery occlusion that were recanalized with balloon catheter, and left forearm superficial thrombophlebitis. The authors underline that although this was not a severe case of COVID-19, the ischemic vascular complications may have been linked to the COVID-19 infection.

Shalash A

10.1002/mds.28134

2020

Egypt

N/R

To investigate the impact of the COVID-19 pandemic on the mental health, physical activities, and QoL of PD patients.

Analytical: Cross-sectional study

N/A

Epidemiology - Prevalence

N/A

PD patients

58 (38 PD, 20 no PD)

N/A

telephone interview

Age- and sex-matched controls without PD

perception of impact of COVID-19, DASS-21, IPAQ, PDQ39

N/A

Compared with controls, PD patients showed significantly worse stress, depression, anxiety, total DASS, moderate physical activity, walking, total IPAQ, total and most of the PDQ39 dimensions, which were correlated with current mental health and pre- lockdown characteristics (i.e. motor severity).

Most PD patients reported a negative impact on their mental health, physical activity, and health care, and interest in virtual visits.
PD patients showed a significant decline in physical activity compared with their pre-lockdown state.
The current findings highlight the importance of managing these issues and continuing care of PD patients, particularly by adopting telemedicine

Tankisi H

10.1016/j.clinph.2020.06.003

2020

Denmark

March - April, 2020

To describe the case of a COVID-19 patient who developed critical illness myopathy

Descriptive: Case Report

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Acute

COVID-19 patient

Severe symmetrical proximal and distal weakness, diffuse muscle wasting, and absent deep tendon reflexes occurring 10 days after COVID-19 infection onset with fever, cough, dyspnea

Piperacillin/tazobactam, oxygen, mechanical ventilation

N/A

The authors describe the case of a severe COVID-19 patient that needed mechanical ventilation and ICU stay. After 65 days of hospitalization the patient presented severe muscle weakness. Electromyography analysis revealed critical illness myopathy. This is the first case of CIM in a patient surviving from severe COVID-19. While clinical and electrophysiological findings resembled CIM of other causes, this case deserves special attention in the context of a growing awareness of long-term complications of COVID-19.

Tay SS

N/A

2020

Singapore

March - April, 2020

To describe the case of a COVID-19 patients who benefitted from the use of a robotic patient-guided suspension system for mobilisation.

Descriptive: Case Report

Specialized postacute rehabilitation

Micro - Interventions (efficacy/harms)

Any Activity limitation and participation restriction (d)

Post-acute

COVID-19 patient

The patient presented, cough, dyspnea and respiratory failure on admission to acute care

Conventional physiotherapy and occupational therapy, gait training with the Andago V2.0 robot (Hocoma) which is a dynamic patient-guided suspension system for overground walking.

N/A

HADS-A, HADS-D, 6MWT

N/A

A severe COVID-19 patient after ICU discharge presented depression and anxiety and severe impairment in gait autonomy and endurance. After conventional physical therapy and training with robotic patient-guided suspension system the patient was able to walk significantly longer in the 6MWT and had lower score in HADS-A and D. The robotic system seemed safe and efficient for recovering gait autonomy in the patient presented.

Tiet MY

10.1136/bcr-2020-236536

2020

N/R

To report a case of GBS associated with COVID-19

Descriptive: Case Report

N/A

Epidemiology - Natural history/Determining and modifying factors

Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7)

Post-acute

COVID-19 patient developing GBS

He reported a 3-week history of shortness of breath, headache and cough. -Then, he showed worsening cough and distal lower limb paraesthesia, resulting in difficulty mobilising. -3 days after being discharged home there was worsening lower limb paraesthesia and ascending lower limb weakness. -4 days later, he developed facial diplegia, limbs weakness (MRC: 1/5 in lower limbs, 3/5 proximal upper limbs and 2/5 distal upper limbs), distal reduced sensation to pinprick and vibration sense, dysaesthesia in lower limbs, and he was areflexic.

Monitoring in intensive care -nasogastric tube for feeding due to swallowing difficulties -intravenous immunoglobulin 0.4 g/kg daily for 5 days -neurorehabilitation

N/A

Neurological assessment, SARS-CoV-2 PCR in cerebrospinal fluid and from oropharyngeal swabs

N/A

The patient developed GBS as a likely postinfectious complication 3 weeks after the onset of mild COVID-19 related symptoms.

He was highly responsive to immunoglobulin therapy, emphasising the importance of early recognition and treatment.
Despite neurological sequelae, RNA was not detected in CSF, but SARS-CoV-2 PCR from oropharyngeal swabs remained positive for 7 weeks after initial COVID-19 symptoms.
Eleven weeks later, after receiving neurorehabilitation and optimisation of neuropathic medications, the patient was able to mobilise unassisted.

Zhao Y-M

10.1016/j.eclinm.2020.100463

2020

China

January 20th - February 24th, 2020

To study the pulmonary function, HRCT scan of the thorax and SARS-CoV-2 IgG in serum in COVID-19 patients 3 months after their hospital discharged and to investigate the relationship between the clinical characteristics and the pulmonary function or CT scores.

Descriptive: Historical cohort

N/A

Epidemiology - Natural history/Determining and modifying factors

Respiratory structures (s430) and related functions (Respiration b440-455)

Chronic

COVID-19 survivors

Of 55 patients, including 4 mild (7.27%), 47 moderate (85.45%) and 4 severe (7.27%) cases, 35 presented COVID-19 related symptoms including gastrointestinal symptoms (30.91%), headache (18.18%), fatigue (16.36%), exertional dyspnea (14.55%), as well as cough and sputum (1.81%). Of the 55 patients, 6 experienced olfactory and gustatory dysfunctions during infection period and 2 female still experienced a decrease sense of taste during follow-up period.

pulmonary function test

Clinical assessment, HRCT of the thorax, lung function and serum levels of SARS-CoV-2 IgG antibody tests 3 months after discharge

N/A

3 months after discharge COVID-19 symptoms were detected in 35/55 patients and different degrees of radiological abnormalities were detected in 39 patients.

Urea nitrogen concentration at admission was associated with the presence of CT abnormalities.
Lung function abnormalities were detected in 14 patients
The level of D-dimer was an important prognostic factor for abnormal DLCO.
47 of 55 patients showed SARS-CoV-2 IgG in serum, among which the generation of IgG antibody in female patients was stronger than male patients in the infection rehabilitation phase.
It is necessary to follow up the COVID-19 patients to appropriately manage any persistent or emerging long-term sequelae. Thus, for patients who have markable raised D-dimer, pulmonary rehabilitation would be needed subsequently even in the absence of other severe respiratory symptoms.

Abbreviations: 6MWT= Six Minutes Walking Test; ARDS= Acute Respiratory Distress Syndrome; 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; LOS= length of stay; 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; 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; USA= United States of America; SSEP= Somatosensory evoked potential.

Reference: Negrini F, De Sire A, Andrenelli E, Lazzarini SG, Patrini M, Ceravolo MG; The International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of July 31st, 2020. Eur J Phys Rehabil Med 2020 Sep 01.
DOI: 10.23736/S1973-9087.20.06539-9