| Author | DOI | Year | Country | Experimental Dates | Aim of the study | Study Design | Type of rehabilitation service | Research Question | LFRI | Covid Phases | Population | N° of participants | Clinical presentation | Intervention | Comparator | Outcomes | Adverse events | Diagnostic test | Sensitivity | Specificity | Types of validity | Attributes of reliability | Main findings |
| Fisher et al. | 10.1111/irv.12832 | 2020 | USA | July 2020 | To compare symptom prevalence and recovery among adults with and without COVID-19 who were tested at outpatient health facilities for SARS-CoV-2 infection during July 2020. | Analytical: Case-control study | N/A | Epidemiology - Natural history/Determining and modifying factors | Any other body structure and function-generic (s/b) | Acute | COVID-19 | 157 | N/A | N/A | 163 healthy controls | Frequency and duration of reported symptoms | N/A | N/A | N/A | N/A | N/A | N/A | COVID-19 patients were more likely than controls to have experienced fever, body aches, weakness, or fatigue during illness, and to report ≥1 persistent symptom more than 14 days after symptom onset (50% vs 32%, P<0.001). Cases reported significantly more days of poor physical health during the past 14 days than controls (P<0.01). |
| Huang C et al. | 10.1016/S0140-6736(20)32656-8 | 2021 | China | January 2020 - May 2020 | To describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. | Analytical: Cohort study | N/A | Epidemiology - Natural history/Determining and modifying factors | Any other body structure and function-generic (s/b) | Chronic | COVID-19 | 1733 | N/A | N/A | N/A | Disease severity scale, mMRC dyspnoea scale, EQ-5D-5L, EQ-VAS, symptom questionnaire, 6MWT | N/A | N/A | N/A | N/A | N/A | N/A | At 6 months after COVID-19 onset, fatigue or muscle weakness (63%) and sleep difficulties (26%) were the most common symptoms. The proportions of median distance AT 6MWT less than the lower limit of the normal range were: 24% for Those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The authors concluded that patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and might be considered as the main target population for intervention of long-term recovery. |
| Puchner B et al. | 10.23736/S1973-9087.21.06549-7 | 2021 | Austria | April - July | To explore the dysfunctions and outcome of COVID-19 survivors after early post-acute rehabilitation. | Analytical: Cohort study | Specialized postacute rehabilitation | Micro - Outcome Measures | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Post-acute | COVID-19 | 23 | N/A | An individualized, multi-professional treatment plan lasting at least 3 weeks, which focused on respiratory function, mobilization, and psychosocial management | N/A | FVC, FEV1, FEV1/FVC, TLC, RV, DLCO, blood gas analysis (pH, pO2, and pCO2), 6MWT, MIP, and BI | N/A | N/A | N/A | N/A | N/A | N/A | Rehabilitative intervention resulted in a significant improvement in lung function, as reflected by an increase of FVC (p=0.007) and FEV1 (p=0.014), TLC (p=0.003), and diffusion capacity for carbon monoxide (p=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of 6MWT distance by 176±137 meters. However, the 83% of patients still had limited diffusion capacity. |
| Tuzun S et al. | 10.23736/S1973-9087.20.06563-6 | 2021 | Turkey | May - June 2020 | To reveal musculoskeletal symptoms in COVID-19 patients, to evaluate myalgia, arthralgia, fatigue, muscle strength, and to examine the relationship of these parameters with the severity and laboratory findings of the disease | Analytical: Cross-sectional study | General postacute rehabilitation | Epidemiology - Clinical presentation | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Post-acute | COVID-19 | 150 | 103 patients (68.7%) were non-severe, and 47 (31.3%) were severe according to ATS guidelines. | N/A | N/A | Myalgia severity, assessed by a NRS scale; fatigue severity, assessed by Chalder Fatigue Scale were used for fatigue severity; muscle strength, assessed by HGS | N/A | N/A | N/A | N/A | N/A | N/A | The mean value of NRS for myalgia was 7.20 (6.76–7.64), 120 patients (80%) showed fatigue at the Chalder Fatigue Scale. There was a muscle weakness in both female (HGS: 21.83 kg) and male (HGS: 36.93 kg). The authors concluded that muscle involvement in COVID-19 seemed to be related to hypoxia leading to ischemic myalgia and physical fatigue. Although there is muscle weakness in all patients, the loss of muscle function is related to the disease activity, especially in women. |
| Cerillo AG et al. | 10.1111/jocs.15326 | 2021 | Italy | From March 23 to April 14, 2020, | To describe the benign course of the COVID‐19 in cardiac surgical patients | Descriptive: Historical cohort | General postacute rehabilitation | Epidemiology - Natural history/Determining and modifying factors | Any other body structure and function-generic (s/b) | Post-acute | COVID-19 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | This study described a cohort of 18 patients who contracted the SARS‐CoV2 infection in a rehabilitation clinic (after a median period of 9 days) while recovering from cardiac surgery. This was a group of critically ill, elderly patients (mean age was 70 years) with multiple severe comorbidities and high surgical risk scores. Seven patients had a fever and were hospitalized, and only one patient needed admission to the COVID‐19 ICU for dyspnea and mild hypoxemia, which was treated by continuous positive airway pressure. The remaining 11 asymptomatic or mildly symptomatic patients ( 6 and 5, respectively) were discharged home or to a COVID‐19 hotel. At the latest follow‐up (after 6 months), all patients had been discharged home. The patients, despite having all the risk factors for the development of severe symptoms and death (older age, obesity, arterial hypertension, chronic obstructive pulmonary disease, and cardiovascular diseases), had a benign course. The hypothesis is 1) the low rate of symptoms and complications was simply due to chance; 2)all patients received low‐ molecular‐weight heparin during the perioperative period, and all except one were discharged on oral anticoagulants that might have exerted a protective effect; 3) the cardiac surgery promoting a strong systemic inflammatory response caused a secondary immunodeficiency in these patients, resulting in a blunted immune response to the SARS‐CoV2 infection. Further studies are needed to investigate the relationship between the surgery‐induced inflammatory response, some potentially protective therapies (e.g., anticoagulants), and severity of COVID‐19. |
| Spielmanns M et al. | 10.1097/PHM.0000000000001686 | 2021 | Switzerland | From March to May 2020 | To analyzed a cohort of nosocomial infected COVID-19 patients in a single center inpatient rehabilitation clinic and describe performance and outcome. | Descriptive: Historical cohort | General postacute rehabilitation | Epidemiology - Natural history/Determining and modifying factors | Any other body structure and function-generic (s/b) | Post-acute | COVID-19 | 27 | N/A | N/A | 786 Neuro-musculoskeletal rehabilitation inpatients of 2019 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | COVID-19 patients were mostly male (66.7%) with an age of 71.5 ±12.3 years. Age, sex, and cumulated comorbidities were not different between groups (COVID-19 vs non-COVID-19). 92.6% of COVID-19 patients had a mild or moderate course and two patients had to be referred to acute hospital due to respiratory failure and one of these patients died in the acute hospital. The rehabilitation duration was significantly longer in the COVID-19 group, 54.2±23.6 days versus 32.1±17.7 days. Daily therapy duration was lower during COVID-19. However, after discontinuation of isolation measures, therapy duration increased significantly. The baseline FIM score was higher in the COVID-19 group and FIM improvements were lower in COVID-19 patients than in the 2019 comparison group. In conclusion, COVID-19 infection itself had a strong negative impact on FIM change reducing the FIM at discharge by 8.9 points after correction for FIM at admission, age, sex, and morbidity index at admission. |
| Loerinc LB et al. | 10.1016/j.hjdsi.2020.100512 | 2021 | USA | From March 26 to April 21, 2020 | To describe the demographics, baseline comorbidities, hospital course, and post-discharge care plans of patients with COVID- 19 discharged from hospitals within an academic healthcare system | Descriptive: Historical cohort | N/A | Epidemiology - Natural history/Determining and modifying factors | Any other body structure and function-generic (s/b) | Post-acute | COVID-19 | 310 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A total of 310 patients were included (median age 58, range: 23–99; 51.0% female; 69.0% African American) with a median length of hospitalization was 5 days (range: 0–33). The analysis was stratified into four groups: (1) all patients who survived to discharge (N=310), (2) patients with no ED visit or readmission after discharge (N=284), (3) patients with ED treat and release after discharge (N=10), and (4) patients who were readmitted (N=16). The most common complications recorded in discharge documentation for all patients were electrolyte abnormalities, acute kidney injury, and sepsis. 31 of 310 patients had a neurological complication: delirium (N=27), cerebral vascular accident (N=3), and seizure (N=1). Patients who were readmitted had overall similar hospital course in duration, treatments received, intensive care requirements, and complications recorded compared to the overall population. The majority of patients (281, 90.6%) were discharged directly home. Twenty-five patients (8.1%) were discharged to a skilled nursing facility (SNF) and four patients (1.3%) were discharged to a quarantine facility. Seventy-five patients (24.2%) required any home service at discharge, including physical or occupational therapy (42, 13.5%), nursing (16, 5.2%), and new home oxygen therapy (41, 13.2%). Only 162 patients (52.3%) had a caregiver or family support identified in the medical record. Two hundred thirteen patients (68.7%) were documented to have at least one ongoing symptom at discharge with the most common being cough (44.5%) and shortness of breath (44.2%). The post-discharge ED visit rate was 7.7% with 54.2% of these attributable to COVID-19. The post- discharge readmission rate was 5.2% with 68.8% of these attributable to COVID-19. The most common COVID-19 related reason for readmission was worsening pneumonia or bacterial superinfection, noted in four patients (1.3%). Only one patient (0.3%) was suspected to have a pulmonary embolism. Two patients (0.6%) died during rehospitalization, and both had sepsis present on readmission. One patient (0.3%) was placed on hospice after discharge. The patients have significant recommended post- discharge care in the outpatient setting. There are specific transitions of care that must be anticipated and addressed by healthcare systems and the primary care community including post-hospital visits, home health supervision, monitoring of medications, discontinuation of isolation, and follow-up laboratory and radiology needs. |
| Li X et al. | 10.1148/radiol.2021203998 | 2021 | China | From May to September 2020 | To evaluate cardiac involvement in participants recovered from COVID-19 without clinical evidence of cardiac involvement using cardiac MRI | Analytical: Cohort study | N/A | Epidemiology - Natural history/Determining and modifying factors | Cardiovascular functions (Heart b410) | Chronic | COVID-19 | 40 | N/A | N/A | 25 healthy controls matched for age and sex | Cardiac MRI | N/A | N/A | N/A | N/A | N/A | N/A | Forty participants (54±12 years; 24 men) who recovered from COVID- 19 with moderate(n=24) or severe(n=16) pneumonia and without clinical evidence of cardiac involvement, were enrolled with a mean time between admission and cardiac MRI of 158 ±18 days and discharge and examination of 124 ±17 days. Cardiac MRI revealed extracellular volume fraction (ECV) was elevated in 24 of 40 participants (60%) recovered from COVID-19 compared to healthy controls. Moreover, 28 of 40 participants (70%) had subclinical changes of myocardial dysfunction demonstrated by a reduction in left ventricle 2D-global longitudinal strain compared with healthy controls, regardless of the severity of pneumonia. Long-term cardiovascular consequences of COVID-19 need to be investigated, and cardiac MRI can be a sensitive imaging tool. The clinical significance of these results is unknown, and this work highlights the need for longitudinal follow-up to understand the importance and progression of subclinical myocardial findings in COVID-19 participants. |
| Curci C et al. | 10.23736/S1973-9087.20.06660-5 | 2021 | Italy | From March 10th to April 30th, 2020 | To describe the role of a patient-tailored rehabilitation plan on functional outcome in hospitalized COVID-19 patients. | Descriptive: Historical cohort | General postacute rehabilitation | Micro - Interventions (efficacy/harms) | Any other body structure and function-generic (s/b) | Post-acute | COVID-19 | 41 | N/A | Rehabilitation protocol according to patients baseline FiO2 (30 minutes/set, 2 times/day), aimed to improve gas exchanges, reducing dyspnoea, and improving muscle function. | N/A | BI, mMRC Dyspnoea Scale, 6-MWT, Borg RPE scale, length of stay in Rehabilitation Unit. | N/A | N/A | N/A | N/A | N/A | N/A | 41 post-acute COVID-19 patients (25 male and 19 female), mean aged 72.15±11.07 years were included in the study. Their mean LOS was 31.97±9.06 days, as 39 successfully completed the rehabilitation treatment and 2 deceased (pulmonary thromboembolism in a case and spontaneous pneumothorax with acute respiratory failure in the other one). After rehabilitative treatment, the patients' disability was significantly reduced as described by the improvement in BI scale. Moreover, there was an improvement in resistance ( 6-MWT) and fatigue ( Borg RPE scale). These findings suggest that post-acute COVID-19 patients might beneficiate from a motor and respiratory rehabilitation treatment. |
| Wright EV et al. | doi: 10.1186/s13037-020-00279-x | 2021 | UK | From March 11, 2020 to April 30, 2020 | To compare the established mortality of patients presenting with femoral neck fractures during the COVID-19 pandemic to the equivalent period in 2018 | Descriptive: Historical cohort | N/A | Epidemiology - Natural history/Determining and modifying factors | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Acute | Patients presenting with femoral neck fractures | 68 | N/A | N/A | N/A | 30-day mortality | N/A | N/A | N/A | N/A | N/A | N/A | 68 patients presenting with femoral neck fractures were included in the study at hospital arrival. Mean age was 81 years old and 73% of patients where females. 25% of the patients resulted positive for SARS-CoV-2 at arrival or during hospital stay. The average length of stay of COVID-19 positive patients were 17 days, and they had a 30-day mortality of 11.76%. 30-day mortality was significantly different from that of the equivalent 2018 period (6%, p=0.045). No data were presented about the severity of COVID-19 presentation in these patients. Orthogeriatrics reviews were conducted in 71% of the cases within 72 hours, while in 2018 the percentage was 88%. Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. The authors conclude that the augmented mortality is possibly due both to the COVID-19 pneumonia, and the reorganisation of orthogeriatric care due to the pandemic. |
| Bellan M et al. | doi: 10.1001/jamanetworkopen.2020.36142 | 2021 | Italy | From March 1, 2020 to June 29, 2020 | To investigate prevalence and clinical associations of functional and psychological impairment 4 months after recovery from COVID-19. | Analytical: Cross-sectional study | N/A | Epidemiology - Natural history/Determining and modifying factors | Any Activity limitation and participation restriction (d) | Post-acute | COVID-19 | 238 | N/A | N/A | N/A | Clinical and demographical data, Pulmonary function testing, SPPB, IES-R | N/A | N/A | N/A | N/A | N/A | N/A | Seven hundred sixty seven consecutive post-acute COVID-19 patients were contacted by telephone 3 to 4 months after hospitalization. 4.6% of the patients died after discharge, and only 238 (35.6%) agreed to partecipate. Out of 219 patients that were able to perform pulmonary function testing, 51.6% patients (113) presented a diffusing lung capacity for carbon monoxide reduced to less than 80% of estimated value, and in 15.5% (34) of patients was reduced of less than 60%. SPBB score was reduced (score <11) in 22.3% of patients (53). Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). The study suggest that a significative percentage of hospitalized patients still suffer from respiratory, physical and psychological sequelae 3-4 months after discharge. |
| Guler SA et al. | doi: 10.1183/13993003.03690-2020 | 2021 | Switzerland | From May 1, 2020 to September 15, 2020 | To assess pulmonary sequela of COVID-19. | Analytical: Cross-sectional study | N/A | Epidemiology - Natural history/Determining and modifying factors | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-acute | COVID-19 | 113 | 47 patients mild/moderate, 66 patients severe/critical COVID-19 | N/A | N/A | Clinical and demographical data, Pulmonary function testing, CT scan. | N/A | N/A | N/A | N/A | N/A | N/A | One hundred thirteen COVID-19 patients were indagated 4 months after COVID-19 symptoms onset (median: 128 days). Patients were divided in two groups: mild/moderate (47 patients) and severe/critical COVID-19 (66 patients). Severe/critical disease was associated with impaired lung function, reduced percentage of diffusing lung capacity for carbon monoxide predicted, exercise-induced oxygen desaturation. Percentage of diffusing lung capacity for carbon monoxide predicted was the strongest independent factor associated with previous severe/critical disease when age, sex, BMI, 6MWD, and minimal SpO2 at exercise, were included in the multivariable model. Abnormalities for CT scan at follow up were also associated with severe/critical COVID-19 |
| Mandora E et al. | doi: 10.1111/jocn.15637 | 2021 | Italy | From March 10, 2020 to June 10, 2020 | To evaluate the level of frailty in a large cohort of COVID-19 patients with acute respiratory failure admitted to a subacute unit to stabilise their clinical condition after discharge from acute care. | Analytical: Cross-sectional study | General postacute rehabilitation | Epidemiology - Natural history/Determining and modifying factors | Any Activity limitation and participation restriction (d) | Post-acute | COVID-19 | 271 | N/A | N/A | N/A | Clinical and demographical data, respiratory support needed, SPPB, BRASS | N/A | N/A | N/A | N/A | N/A | N/A | In the present study COVID-19 patients were investigated at admission in sub-acute care, during recovery from acute respiratory failure. 236 patients were recruited in the study, with a median age of 77. All patients were administred BRASS and classified into three different levels of frailty risk. Furthermore, SPPB was collected together with clinical data. The median BRASS index was 14.0 (interquartile range 9.0–20.0). On the whole, the patients presented mostly intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). The author concluded that the majority of COVID-19 patients recovering from acute respiratory failure presented lintermidiate or high risk of frailty and require a continuity of care. |
| Ozyemisci T et al. | doi: 10.23736/S1973-9087.21.06551-5 | 2021 | Turkey | From March 15, 2020 to May 11, 2020 | To evaluate the effects of physical rehabilitation in ICU on the overall muscle strength in patients with COVID-19 following discharge. | Analytical: Case-control study | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Acute | COVID-19 | 35 | N/A | Rehabilitation group (N=18) underwent passive, active assisted and active joint mobilization, and, if possible, sit to stand and walking exercises. Neurmuscular electrical stimulation was performed on quadriceps and tibialis anterior. | Control group who did not perform rehabilitation in ICU (N=17). | Clinical and demographical data, handgrip strength, manual muscle strength using MRC scale in 3 muscle groups in each limb (arm abduction, forearm flexion, wrist extension, hip flexion, knee extension and ankle dorsiflexion), ROM, SF-36 | N/A | N/A | N/A | N/A | N/A | N/A | In the study 35 patients with acute respiratory distress syndrome due to COVID-19 were enrolled in ICU. The first 17 patients did not undergo a rehabilitation program, while the last 18 were treated during ICU stay with mobilization and strenghtening exercises and neurmuscolar electrical stimulation on quadriceps and tibialis anterior. Of the rehabilitation group only 11 patients were stable enough during ICU stay to perform rehabilitation. At ICU discharge patients in the rehabilitation group showed no difference in no difference in hand grip or manual muscle strength compared to control group. No adverse event was found. Authors noted that the present study do not support early rehabilitation on improving muscle strength; however rehabilitation was performed safely, and the short follow-up do not allow to understand the possible medium and long term effect of the rehabilitation programme. |
| Townsend L et al. | doi: 10.1513/AnnalsATS.202009-1175OC | 2021 | Ireland | March - May, 2020 | To evaluate medium-term respiratory complications following SARS-CoV-2 infection. | Descriptive: Historical cohort | N/A | Epidemiology - Natural history/Determining and modifying factors | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-acute | COVID-19 | 153 | N/A | N/A | N/A | Clinical and demographical data, Brixia score for chest radiography, 6-MWT, Rockwood’s Clinical Frailty Scale. | N/A | N/A | N/A | N/A | N/A | N/A | At a median of 75 days after diagnosis, 153 patients were re-evaluated as outpatients and investigated for respiratory and functional sequalae. Almost half of the patients (48%) needed hospital admission during acute phase of the disease and 12% needed ICU stay. More than half (62%) of patients felt that they had not returned to full health. The median distance covered during 6-MWT was 460 m, and a shorter distance was associated with frailty (measured using Rockwood Clinical Frailty Scale) and lenght of inpatients stay. Only 4% of the patients had persistent abnormality at chest x-ray. Overall, after 2 to 3 months after diagnosis, most patients still presented objective and subjective signs of COVID-19. |
| Bertolucci et al. | doi: 10.23736/S1973-9087.21.06674-0 | 2021 | Italy | March - August 2020 | To describe the baseline characteristics and rehabilitative outcomes of patients with complex disabilities related to pneumoniae due to COVID 19 referring to a Rehabilitation Unit | Analytical: Cohort study | General postacute rehabilitation | Epidemiology - Natural history/Determining and modifying factors | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-acute | COVID-19 | 39 | N/A | N/A | N/A | BI, FAC, CIRS, nonrespiratory manifestations; dysphagia, mental confusion; PaO2/FiO2 | N/A | N/A | N/A | N/A | N/A | N/A | BI score increased significantly (p<0.001) from 7.5 at admission to 65 at discharge. Even FAC score increased signifcantly (p<0.001), from 0 at admission to 3 at discharge. Thirty-eight patients were discharged at their home. The authors concluded that the activation of comprehensive rehabilitation settings able to assist subacute COVID-19 patients would be desirable to counteract this pandemic. |
| Cortes Telles et al. | doi: 10.1016/j.resp.2021.103644. | 2021 | Mexico | N/A | To compare spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), and 6-minute walk distance (6MWD) in Mexican survivors of COVID-19 with and without persistent dyspnoea. | Analytical: Cross-sectional study | General postacute rehabilitation | Epidemiology - Clinical presentation | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-acute | COVID-19 with dyspnoea | 70 | Study participants showed mild COVID-19 in the 27%, moderate COVID-19 in the 14%, and severe COVID-19 in the 59%. | N/A | COVID-19 with no dyspnoea (n=116) | FVC, FEV1, FEV1/FVC, DLCO, 6MWT, Borg 0-10 Dyspnoea, Borg 0-10 Fatigue | N/A | N/A | N/A | N/A | N/A | N/A | Patients with persistent dyspnoea had significantly lower FVC (p=0.03), FEV1 (p=0.04), and DLCO (p=0.01), with 47 % having a restrictive ventilatory pattern compared to 33% in the non-dyspnoea group. Patients with persistent dyspnoea also had significantly lower 6MWT (p=0.03) and significantly higher Borg 0-10 dyspnoea (p<0.001) and fatigue (p<0.001) compared to those without dyspnoea. |
| Paneroni et al. | doi: 10.1016/j.apmr.2020.12.021 | 2021 | Italy | March - April 2020 | To report the level of physical function in COVID-19 patients after acute respiratory failure admitted to a subacute Rehabilitation Unit. The secondary aim was to investigate which clinical characteristics during hospitalization could predict physical function. | Analytical: Cross-sectional study | General postacute rehabilitation | Epidemiology - Clinical presentation | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Post-acute | COVID-19 | 184 | N/A | N/A | N/A | SPPB score and ins sub-items: standing balance, 4-MGS, and sit-to-stand test. | N/A | N/A | N/A | N/A | N/A | N/A | The total SPPB score was 3.1±3.9, with 64% of patients exhibiting SPPB≤3. Patients with a better functional status (SPPB>3) was inversely related to previous disability (p<0.001), age (p<.0001), invasive mechanical ventilation (p<0.001), use of NIV or CPAP (p=0.001). The Authors concluded that the majority of COVID-19 patients experienced acute respiratory failure could exhibit substantial physical dysfunction. |
| Pant et al. | doi: 10.31729/jnma.5980. | 2021 | Nepal | December 2020 | To determine the prevalence of functional limitation in COVID-19 recovered patients using the PCFS | Analytical: Cross-sectional study | N/A | Epidemiology - Prevalence | Any other environmental factors - generic (e) | Chronic | Post-COVID-19 | 106 | N/A | N/A | N/A | PCFS | N/A | N/A | N/A | N/A | N/A | N/A | More than half of the POST-COVID-19 patients (56.6%) reported having no functional limitation (PCFS=0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients. The majority of patients (89.6%) had at least one of the pulmonary or extra-pulmonary symptoms during COVID-19 infection. The 45.3% showed fatigue and 9.4% showed myalgia. |
| RIch et al. | doi: 10.1177/1751143721991060 | 2021 | UK | April - May 2020 | To collect the incidence and frequency of physiotherapy interventions performed during the COVID-19 pandemic in a critical care setting. | Descriptive: Historical cohort | Rehabilitation in acute care | Epidemiology - Clinical presentation | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 163 | N/A | N/A | COVID-19 patients (n=50) | Physiotherapy interventions for example, endotracheal suctioning, functional rehabilitation for every patient in the critical care setting, CPAx | N/A | N/A | N/A | N/A | N/A | N/A | The most frequent critical care physiotherapy interventions resulted to be: suctioning (430 occasions), followed by positioning (101 occasions), assisted cough (140 occasions), ventilator hyperinflation (67) and manual techniques (83 occasions); weaning interventions were completed on 271 patients. Seventy-six COVID-19 patients completed both an initial and discharge CPAx reporting a mean admission CPAx=9.1 in COVID-19 positive and a mean CPAx=10.5 in COVID-19 negative patients. On discharge. COVID-19 positive patients demonstrated a mean CPAx=24.3 versus a mean score of 28.9 in COVID-19 negative patients. |
| Tay et al. | doi: 10.3389/fmed.2020.615997 | 2021 | SIngapore | January - May 2020 | To describe the acute functional outcomes and associations of dependence in walking in critically ill COVID-19 patients after ICU stay; to describe the cardiopulmonary and neurological sequelae of critical illness contributing to functional dependence. | Descriptive: Historical cohort | N/A | Epidemiology - Natural history/Determining and modifying factors | Any other environmental factors - generic (e) | Post-acute | COVID-19 | 51 | N/A | N/A | N/A | FAC, Charlson Comorbidity Index, PaO2/FiO2 ratio at the admission to ICU, length of ICU stay, the ICU therapies received, number of patients with continuous supplementary oxygen required, dependent in walking, dependent in 1 or more basic ADLs | N/A | N/A | N/A | N/A | N/A | N/A | The 47.1% of patients were dependent ambulators upon transferring out of ICU. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (OR: 14.02; p=0.039) and a longer length of ICU stay (OR: 1.50; p=0.029) were associated with dependent ambulation upon discharge from ICU. |
| Turcinovic et al. | doi: 10.1016/j.arrct.2021.100113. | 2021 | USA | April - June 2020 | To optimize the ability of hospitalized patients isolated due to COVID-19 to participate in physical therapy | Analytical: Cohort study | Community-based rehabilitation (CBR) | Epidemiology - Natural history/Determining and modifying factors | Any other environmental factors - generic (e) | Post-acute | COVID-19 | 39 | N/A | Hybrid approach to delivery of physical therapy, with a combination of in-person and tele-rehabilitation visits, consisted of therapeutic exercise in supine, sitting and/or standing positions (depending on the patient’s functional ability determined from the in-person sessions). Tele-rehabilitation exercises are focused on deep breathing, balance and strengthening and were tailored to patient’s current abilities. | N/A | AM-PAC 6 | N/A | N/A | N/A | N/A | N/A | N/A | There was an improvement from admission to discharge in terms of AM-PAC 6 (19.0±4.8 vs 21.8±3.3). The authors concluded that this pilot quality improvement project showed the feasibility of a hybrid combination of in-person and tele-rehabilitation sessions for hospitalized patients isolated with COVID-19 | Udina et al. | doi: 10.14283/jfa.2021.1. | 2021 | Spain | N/A | To describe the pre-post impact on physical performance of multi-component therapeutic exercise for post-COVID-19 rehabilitation | Analytical: Cohort study | Specialized postacute rehabilitation | Micro - Interventions (efficacy/harms) | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Chronic | Post-COVID-19 | 20 | N/A | The 30-minute 7 days/week multi-component therapeutic exercise intervention consisted of: a) resistance training (1-2 sets with 8-10 repetitions each with an intensity between 30-80% of the Repetition Maximum); b) endurance training (up to 15-minutes aerobic training with a cycle ergometer, steps or walking); c) balance training (walking with obstacles, changing directions or on unstable surfaces). | Post-COVID-19 patients not referred to ICU previously (n=13) | BI; SPPB score and its sub-items (standing balance, 4-MGS, and sit-to-stand test), single leg stance test, unassisted gait, 6MWT | N/A | N/A | N/A | N/A | N/A | N/A | Furthermore, post-ICU patients experienced a greater improvement compared to non-ICU in terms of SPPB (4.4±2.1 vs 2.5±1.7, p<0.01) and gait speed (0.4±0.2 vs 0.2±0.1, p<0.01). None of the patients died during the intervention and all were discharged home. Moreover, mean 6MWT walked distance improved from 158.7±154.1 to 346.3±111.5 m (p<0.001) in a subsample of 22 participants. | Alemanno F et al. | 10.1371/journal.pone.0246590 | 2021 | Italy | From March 27th to June 20th, 2020 | To investigate the impact of COVID-19 on cognitive functions of patients admitted to the COVID-19 Rehabilitation Unit | Analytical: Cohort study | General postacute rehabilitation | Epidemiology - Prevalence | Nervous system structures (s1) and related functions (Mental functions b1) | Post-acute | COVID-19 | 87 | N/A | N/A | N/A | MMSE, MoCA, FIM, Hamilton Rating Scale for Depression | N/A | N/A | N/A | N/A | N/A | N/A | 87 patients, about 10 days after symptoms onset, were included and they were separated in 4 different groups according to the type of respiratory assistance they benefited in the acute phase: Group1 (orotracheal intubation), Group2 (B-PAP), Group3 (Venturi Masks), Group4 (no oxygen therapy). Out of the 87 patients, 80% had neuropsychological deficits and 40% showed mild-to-moderate depression. Group1, the most young, had higher scores than Group3 for visuospatial/executive functions, naming, short- and long-term memory, abstraction, and orientation. Cognitive impairments correlated with patients’ age. FIM (<100) did not differ between groups. Patients partly recovered at one-month follow-up and 43% showed signs of post-traumatic stress disorder. Patients with severe functional impairments had important cognitive and emotional deficits which might have been influenced by the choice of ventilatory therapy, but mostly appeared to be related to aging, independently of FIM scores. These findings should be integrated for correct neuropsychiatric assistance of COVID-19 patients in the subacute phase, and show the need for long-term psychological support and treatment of post-COVID- 19 patients. | Wiertz CMH et al. | 10.1016/j.arrct.2021.100108 | 2021 | The Netherlands | From April 2 to May 13, 2020 | To describe clinical characteristics of post-ICU COVID-19 patients, admitted for inpatient rehabilitation. | Analytical: Cross-sectional study | General postacute rehabilitation | Epidemiology - Prevalence | Any other body structure and function-generic (s/b) | Post-acute | COVID-19 | 60 | N/A | N/A | N/A | ICU-stay parameters, Muscle strength, sensory neuropathy and range of motion , BI, NRS (fear, fatigue or dyspnoea) | N/A | N/A | N/A | N/A | N/A | N/A | This study included 60 patients, mean age of 59.9, 75% of them were men. In the first week after discharge to the rehabilitation centre 38.3% of all patients experienced exercise-induced oxygen desaturation, in 72.7% muscle weakness was present in all major muscle groups and 21.7% had a reduced mobility in one or both shoulders. Furthermore 40% suffered from dysphagia and 39.2% reported symptoms of anxiety. These data confirm the importance of being aware of PICS in post-ICU COVID 19 patients and support the need for an early and effective multidisciplinary rehabilitation program that is adapted to the specific needs of COVID-19 patients. | Xu F et al. | 10.1016/j.sleep.2021.02.002 | 2021 | China | From February to April 2020. | To investigate sleep and mood status, and detect the influencing factors of the psychological status of the COVID-19 patients after recovery. | Analytical: Cross-sectional study | N/A | Epidemiology - Prevalence | Nervous system structures (s1) and related functions (Mental functions b1) | Chronic | COVID-19 | 125 | N/A | N/A | N/A | Insomnia Severity Index (ISI), Center for Epidemiology Scale for Depression (CES-D) | N/A | N/A | N/A | N/A | N/A | N/A | This study included 121 COVID-19 patients, mean age 41.72 and 69 males (57.02%) at two weeks after hospital discharge. The patients had a high prevalence (26.45%) of insomnia and a relatively low percentage of depression (9.92%). There were significant differences in physical, mental impairment, and the need for psycho- logical assistance between the COVID-19 recovered patients with depression and the patients without depression. Age and health status may be the influencing factors for insomnia. Caring about the views of others may be the influencing factors of depression. We need to pay more attention to their sleep condition than mood status | Piquet V et al. | 10.1016/j.apmr.2021.01.069 | 2021 | France | From March 25, 2020. | To determine the benefits associated with brief inpatient rehabilitation for COVID-19 patients | Descriptive: Historical cohort | Specialized postacute rehabilitation | Micro - Interventions (efficacy/harms) | Any Activity limitation and participation restriction (d) | Post-acute | COVID-19 | 100 | N/A | Overall motor strengthening with body weight exercises, elastics, and weights, respiratory rehabilitation exercises, aerobic work included bicycle ergometer sessions at submaximal intensity | N/A | Barthel Activities of Daily Living Index, 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry), ICU lenght of stay | N/A | N/A | N/A | N/A | N/A | N/A | In this retrospective study on the first 100 patients (mean age 66 years, 66%men) with COVID-19 infection admitted to a specialized rehabilitation unit (mean delay from symptom onset was 20.4 day), inpatient therapy (mean length of rehabilitation stay was 9.8 days) was associated with substantial functional, motor, and cardiorespiratory improvement, particularly in patients who had undergone severe acute disease: Barthel index increased from 77.3 to 88.8 without recovering baseline values, there was a 37% improvement in sit-to-stand frequency, a 13% decrease in post-test respiratory rate, and a 15% increase in grip strength. Nonetheless, loss of autonomy and motor weakness persisted at discharge, which occurred approximately a month after the onset of COVID-19. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care. | Simioli F et al. | 10.5152/TurkThoracJ.2021.20158 | 2021 | Italy | From mid-March to April 2020 | To investigate the effects and feasibility of PP on COVID-19-associated awake patients with ARDS in a subintensive setting of care | Analytical: Case-control study | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 29 | N/A | Prone positioning | No Prone positioning | artery blood gases | N/A | N/A | N/A | N/A | N/A | N/A | A total of 29 patients (25 men, mean age 64 years) underwent noninvasive ventilation, and PP was initiated 12 h from admission; 18 patients tolerated prone and side positioning for at least 10 h/d and cycled their position every 2 h, and 11 patients had no complaints with PP. The data demonstrated that the Severity of gas exchange impairment in COVID-19 is not correlated to inflammatory status. PP may be an effective adjunctive therapy in patients with COVID-19-related ARDS. Oxygenation improves when PP is initiated early and performed for more than 10 h/d. The patient’s compliance is crucial, and several attempts should be made to find the best interface to fit every patient. | Nikam PP et al. | 10.18311/jeoh/2020/25676 | 2021 | India | N/A | To study the effect of twist and raise walking technique on ICU-acquired Weakness | Analytical: Cohort study | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 32 | N/A | twist and raise walking technique for a period of 7 days | N/A | inspiratory hold duration and forced expiratory volume | N/A | N/A | N/A | N/A | N/A | N/A | The aim of the twist and raise walking technique was to facilitate chest expansion along with initiation of early ambulation in order to reduce the possible complications of ICU acquired weakness in 32 COVID-19 subjects. Clinically significant results were seen in post-test scores of all the subjects in terms of Inspiratory Hold Capacity as well as Forced Expiration Volume This technique can be advocated as a effective rehabilitation intervention especially in COVID-19 patients to minimize the possible complications of ICU-acquired weakness. |