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. 2022 Apr;58(2):316-323.
doi: 10.23736/S1973-9087.21.06897-0. Epub 2021 Oct 4.

Functional assessment and rehabilitation protocol in acute patients affected by SARS-CoV-2 infection hospitalized in the Intensive Care Unit and in the Medical Care Unit

Susanna Ricotti  1 , Lucia Petrucci  2 , Gabriella Carenzio  2 , Ettore Carlisi  2 , Giuseppe DI Natali  2 , Annalisa DE Silvestri  3 , Claudio Lisi  2 ; Covid Rehabilitation Group
Collaborators, Affiliations

Functional assessment and rehabilitation protocol in acute patients affected by SARS-CoV-2 infection hospitalized in the Intensive Care Unit and in the Medical Care Unit

Susanna Ricotti et al. Eur J Phys Rehabil Med. 2022 Apr.

Abstract

Background: Coronavirus disease (COVID-19) is characterized by different clinical pictures that may require prolonged hospitalization and produce disabilities challenging the recovery of previous independence.

Aim: The aim is to evaluate the impact of an early assisted rehabilitation program on the functional status of an acutely hospitalized population affected by COVID-19.

Design: Single-institution retrospective longitudinal study.

Setting: Inpatient intensive care units (ICU) and medical care units (MCU).

Population: Acute COVID-19 patients.

Methods: General information was collected; age-adjusted Charlson Comorbidity Index was used for comorbidities. Duration of hospital stay, the length of stay in ICU and/or MCU, the length of the rehabilitative treatment, and the destination at the discharge were collected. Evaluation was performed when patients were clinically stable (T0), and at hospital discharge (T1); for subjects enrolled in ICU functional status was assessed at the time of transfer to the MCU. Muscle strength of the four limbs was measured with the Medical Research Council (MRC) sum-score. Functional status was assessed using the 3-item Barthel Index (BI-3) and the General Physical Mobility Score (GPMS). Early assisted-tailored rehabilitation protocol was applied in ICU and in MCU: the aims were the maintenance (or recovery) of the range of motion and of the strength and the recovery of sitting/standing position and gait.

Results: We evaluated 116 patients (mean age 65, SD 11) (65% male), 68 in ICU (mean age 60, SD 10), 48 in MCU (mean age 73, SD 9). At discharge, BI-3 and GPMS significantly improved in both ICU (P<0.001) and MCU (P<0.001) subgroups of patients. MRC sum-score significantly improved in ICU patients (P<0.001). Patients hospitalized in ICU had a significantly longer hospital stay. At discharge, patients admitted to the ICU reach a functional state that is close to that of patients admitted to the MCU.

Conclusions: The results suggest that an early assisted rehabilitation program may be helpful in improving the short-term functional status of an acutely hospitalized population affected by COVID-19, with discharge at home of 48% CLINICAL REHABILITATION IMPACT: this study focuses on a functional assessment method to be used to identify the rehabilitation needs and verify the results of an early rehabilitation protocol applied to the acute COVID-19 patient admitted to ICU and MCU.

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Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—BI-3 total score and GPMS score at baseline and at discarge in ICU patients.
Figure 2
Figure 2
—BI-3 total score and GPMS score at baseline and at discarge in MCU patients.
Figure 3
Figure 3
—Monitoring of MRC sum score in ICU patients.
Figure 4
Figure 4
—Monitoring of MRC sum score categories in ICU patients.
See this image and copyright information in PMC

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