Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

Abstract

Objective: To determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients.

Design: Retrospective chart review.

Setting: A newly created specialized rehabilitation unit in a tertiary care medical center.

Participants: Consecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation.

Intervention: Inpatient rehabilitation for postacute care COVID-19 patients.

Main outcome measures: Measurements at admission and discharge comprised a Barthel Activities of Daily Living Index (including baseline value before COVID-19 infection), time to perform 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in the intensive care unit (ICU) were explored.

Results: Upon admission to rehabilitation, 66% of the patients were men, the age was 66±22 years, mean delay from symptom onset was 20.4±10.0 days, body mass index was 26.0±5.4 kg/m², 49% had hypertension, 29% had diabetes, and 26% had more than 50% pulmonary damage on computed tomographic scans. The mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index increased from 77.3±26.7 to 88.8±24.5 (P<.001), without recovering baseline values (94.5±16.2; P<.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; P<.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; P=.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; P<.001). At both admission and discharge, Barthel score correlated with grip strength (ρ=0.39-0.66; P<.01), which negatively correlated with time spent in the ICU (ρ=-0.57 to -0.49; P<.05).

Conclusions: Inpatient rehabilitation for COVID-19 patients was associated with substantial motor, respiratory, and functional improvement, especially in severe cases, although there remained mild persistent autonomy loss upon discharge. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.

Keywords: COVID-19; Pandemics; Rehabilitation.

Fig 1

Changes in Barthel index (n=89). (A) Barthel index items; items laid out to highlight motor tasks. (B) Barthel index total score. Data expressed in mean ± standard error of the mean. ^∗P<.05. ^†P<.01. ^‡P<.001.

Fig 2

Functional data upon admission and at discharge. (A) Sit-to-stand parameters; (B) Borg scale before and after sit-to-stand test; (C) Grip strength in right-handed patients. Data expressed in mean ± standard error of the mean. ^∗P<.05. ^†P<.01. ^‡P<.001.

Fig 3

Correlations between motor and functional tests and Barthel index or number of ICU days. (A) Barthel total score and sit-to-stand frequency at admission and discharge. (B) Barthel total score and mean grip strength at admission and discharge. (C) Grip strength and number of days spent in the ICU at admission and discharge. Spearman or Pearson tests were used according to conditions of normality on Shapiro–Wilk tests. Outliers beyond 2 standard deviations on Z-tests were excluded.