Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019

Abstract

Objectives: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019.

Design: Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways.

Setting: ICU Recovery Clinic in an academic medical center.

Patients: Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019.

Interventions: Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training.

Measurements and main results: Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life.

Conclusions: A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Keywords: cognitive dysfunction; coronavirus disease 2019; implementation; intensive care unit recovery; physical rehabilitation; postintensive care syndrome; posttraumatic stress disorder; safety.

Figure 1.

Flow diagram for study recruitment, enrollment, and attrition. HF = heart failure, OP = outpatient, PT = physical therapy.

Figure 2.

Distance ambulated on the 6-mintue walk test in severe coronavirus disease 2019 survivors pre-post treatment delivery. A, Distance improved from 216 ± 142 meters at baseline to 326 ± 143 meters at 3-month assessment; significant change over time (* represents t = 7.43 and p < 0.0001), which is statistically lower than predicted distances (** represents t = 5.6 and p < 0.0001). At postevaluation, distances on 6-mintue walk distance (6 MWD) were a mean 61% ± 26% of the predicted distance. B, Distances improved for both groups from baseline to 3 months, but patients in the in-person group had a slightly higher change than that in the telehealth (110 vs 80 meters, mean difference of 30.5, p = 0.51 using Satterthwaite equivalence t test). Distances at postassessment were not statistically different between the in-person and telehealth cohorts with independent t test (t = 1.34, p = 0.19).

Figure 3.

Patients surviving critical coronavirus disease 2019 (COVID-19) self-report health-related quality of life (HrQOL). A, HrQOL improved from mean 71 at baseline to 83 at postassessment in 29 survivors of critical COVID-19 (t = 3.85, p = 0.0005); seven patients reported no change or worse quality of life from baseline to 3 mo post. B, QOL improved in both cohorts (+11.2 for in-person and +11.3 in telehealth groups), which was approaching statistically significant for equivalence (mean difference = 0.095, t = 1.40, p = 0.096). EQ-5D = EuroQol, VAS = Visual Analog Scale.