Rehabilitation of COVID-19 Patients in the Acute Hospital Setting: An Observational Retrospective Study
DOI :
https://doi.org/10.25759/spmfr.449Mots-clés :
COVID-19, Intensive Care Units, Physical Therapy Modalities, SARS-CoV-2Résumé
Introduction: COVID-19 has a wide clinical spectrum and, in severe cases, can lead to serious functional impairments. The role of Physical and Rehabilitation Medicine (PRM) in the subacute and chronic phases of this novel disease has become indisputable but remains unclear in the acute phase. Our aim was to describe the impact of a PRM intervention in acute COVID-19 patients.
Methods: Observational retrospective study of the COVID- 19 patients admitted to the ICU and Internal Medicine wards and referred for inpatient intervention by the PRM department of an acute care Portuguese hospital during April and May of 2020. Recommendations from the Portuguese Society of PRM regarding rehabilitation of COVID-19 patients in the intensive care unit (ICU) were followed. Two assessments were performed by a PRM physician: prior to the intervention and at discharge. Demographic data, comorbidities, Medical Research Council Sum Score (MRC-SS), handgrip dynamometry and Chelsea Critical Care Physical Assessment Tool (CPAx) were recorded in electronic health records and were afterwards retrieved for analysis.
Results: Twenty-two patients were eligible. Sixteen (72.7%) were male and six (27.3%) were female with a mean age of 65.36 ± 14.07 years old. Mean duration of hospitalization was 25.64 ± 10.25 days, with 18/22 patients being admitted to the ICU (mean of 11.39 days). At discharge, there was: a mean improvement of 16.96 points in MRC-SS; a difference in median handgrip dynamometry of 10.00 kg, (improvements in 21/22 patients); a difference in median CPAx total score of 24.00 points, (improvements in 21/22 patients); improvements in all CPAx subscores. All results were statistically significant (p<0.05). There were no adverse events in patients or infections in the PRM team.
Conclusion: A PRM intervention in the acute COVID-19 inpatient is safe both for patients and PRM team. It seems to have a positive effect on physical and functional status of the patients, reflected by improvements in all of the parameters evaluated.
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Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382:727- 33. doi: 10.1056/NEJMoa2001017.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:497-506. doi: 10.1016/S0140-6736(20)30183-5.
Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020; 71:769-77.
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012; 40:502-9. doi: 10.1097/CCM.0b013e318232da75.
Sharshar T, Bastuji-Garin S, Stevens RD, Durand MC, Malissin I, Rodriguez
P, et al. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med. 2009; 37:3047-53. doi: 10.1097/CCM.0b013e3181b027e9.
Ali NA, O'Brien JM, Jr., Hoffmann SP, Marsh CB; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008; 178:261-8. doi: 10.1164/rccm.200712-1829OC
Hashem MD, Parker AM, Needham DM. Early mobilization and rehabilitation of patients who are critically ill. Chest. 2016; 150:722-31. doi: 10.1016/j.chest.2016.03.003.
Hashem MD, Nelliot A, Needham DM. Early mobilization and rehabilitation in the icu: moving back to the future. Respir Care 2016; 61:971-9. doi: 10.4187/respcare.04741. E
Bragança RD, Ravetti CG, Barreto L, Ataíde TB, Carneiro RM, Teixeira AL, et al. Use of handgrip dynamometry for diagnosis and prognosis assessment of intensive care unit acquired weakness: A prospective study. Heart Lung. 2019; 48:532-7. doi: 10.1016/j.hrtlng.2019.07.001.
Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020; 66:73-82. doi: 10.1016/j.jphys.2020.03.011.
Zhao HM, Xie YX, Wang C. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J.2020; 133: 1595–602. doi: 10.1097/CM9.0000000000000848.
von Elm E, Altman DG, Egger M, Yarmolinsky J, Davies NM, Swanson SA, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61:344-9.
Jang MH, Shin MJ, Shin YB. Pulmonary and physical rehabilitation in critically
ill patients. Acute Crit Care. 2019; 34:1-13. doi: 10.4266/acc.2019.00444.
Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991; 14:1103-9.
Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, de Jonghe B, et al. A framework for diagnosing and classifying intensive care unit- acquired weakness. Crit Care Med. 2009; 37:S299-308. doi: 10.1097/CCM.0b013e3181b6ef67.
Corner EJ, Wood H, Englebretsen C, Thomas A, Grant RL, Nikoletou D, et al. The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy. 2013; 99:33-41. doi: 10.1016/j.physio.2012.01.003.
Corner EJ, Soni N, Handy JM, Brett SJ. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Crit Care. 2014; 18:R55.
Connolly BA, Jones GD, Curtis AA, Murphy PB, Douiri A, Hopkinson NS, et al. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care. 2013; 17:R229. doi: 10.1186/cc13052.
De Sire A, Andrenelli E, Negrini F, Patrini M, Lazzarini SG, Ceravolo MG. Rehabilitation and COVID-19: a rapid living systematic review by Cochrane Rehabilitation Field updated as of December 31st, 2020 and synthesis of the scientific literature of 2020. Eur J Phys Rehabil Med. 2021;57:181-8. doi: 10.23736/S1973-9087.21.06870-2.
Li L, Yu P, Yang M, Xie W, Huang L, He C, et al. Physical Therapist Management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience. Phys Ther. 2021;101:pzaa198. doi: 10.1093/ptj/ pzaa198.
Gustavson AM, Rud B, Sullivan EK, Beckett A, Gause LR. Role and impact of interdisciplinary rehabilitation in an acute COVID-19 recovery unit. J Am Geriatr Soc. 2021;69:878-81. doi: 10.1111/jgs.17060.
Jiandani MP, Salagre SB, Kazi S, Iyer S, Patil P, Khot WY, et al. Preliminary Observations and Experiences of Physiotherapy Practice in Acute Care Setup of COVID 19: A Retrospective Observational Study. J Assoc Physicians India. 2020; 68:18-24.
Piva S, Fagoni N, Latronico N. Intensive care unit-acquired weakness: unanswered questions and targets for future research. F1000Res. 2019; 8:F1000 Faculty Rev-508. doi: 10.12688/f1000research.17376.1. eCollection 2019.
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