Effectiveness of a Three-Week Inpatient Pulmonary Rehabilitation Program for Patients after COVID-19: A Prospective Observational Study

Abstract

For COVID-19 patients who remain symptomatic after the acute phase, pulmonary rehabilitation (PR) is recommended. However, only a few studies have investigated the effectiveness of PR, especially considering the duration between the acute phase of COVID-19 and the onset of rehabilitation, as well as the initial severity. This prospective observational study evaluated the efficacy of PR in patients after COVID-19. A total of 120 still-symptomatic patients referred for PR after overcoming acute COVID-19 were asked to participate, of whom 108 (mean age 55.6 ± 10.1 years, 45.4% female) consented. The patients were assigned to three groups according to the time of referral and initial disease severity (severe acute; severe after interval; mild after interval). The primary outcome was dyspnea. Secondary outcomes included other respiratory disease symptoms, physical capacity, lung function, fatigue, quality of life (QoL), depression, and anxiety. Furthermore, patients rated the overall effectiveness of PR and their subjective change in health status. At the end of PR, we detected improvements with large effect sizes in exertional dyspnea, physical capacity, QoL, fatigue, and depression in the overall group. Other parameters changed with small to medium effect sizes. PR was effective after acute COVID-19 in all three groups analyzed.

Keywords: COVID-19; course of recovery; inpatient rehabilitation; pulmonary rehabilitation.

Figure 1

Comorbidities.

Figure 2

Changes in clinically relevant outcomes over the course of the rehabilitation (absolute value of Cohen’s d and 95% confidence interval). Notes: 6MWD: 6-min walking distance; BFI: Brief Fatigue Inventory; CRP: C-reactive protein; EQ-5D: 5-level EQ-5D questionnaire; FEV1: forced expiratory volume in one second: GAD-7: Generalized Anxiety Disorder-7; mMRC: modified Medical Research Council; NRS1: Numeric Rating Scale for resting dyspnea; NRS2: Numeric Rating Scale for exertional dyspnea; PaO2: partial pressure of O2; PHQ-9: Patient Health Questionnaire 9; PImax: maximal inspiratory pressure; TLC: total lung capacity; TLCO: diffusion capacity of the lungs for carbon monoxide; VAS: visual analogue scale; VC: vital capacity.

Figure 3

Rates of fatigue.