Balance performance in patients with post-acute COVID-19 compared to patients with an acute exacerbation of chronic obstructive pulmonary disease and healthy subjects

Abstract

COVID-19 leaves important sequelae in patients, not only in those who had the experience of a critical illness but also in patients with severe form. Understanding the impairments allows us to target rehabilitation to patients' real needs; balance impairments are an assumed sequela of COVID-19, but no study has specifically evaluated balance performance in these patients. Their performance was compared to that of patients with a pulmonary disease that leads to systemic diseases, such as patients with an acute exacerbation of chronic obstructive pulmonary disease (PwAECOPD), and of healthy subjects. A total of 75 subjects were assessed: 25 patients with COVID-19 (PwCOVID) with a severe form in the acute phase, 25 PwAECOPD and 25 healthy subjects sex- and age-matched. A stabilometric platform was used to evaluate static balance, both with eyes open and closed, while the dynamic balance was assessed with the Mini-BESTest and the Timed Up and Go test. When compared to healthy subjects, results showed that PwCOVID had worse performance in both static (P < 0.005) and dynamic (P < 0.0001) balance, with a large effect size in all measures (>0.8). Moreover, PwCOVID showed similar results to those of PwAECOPD. In conclusion, PwCOVID showed a balance deficit in both dynamic and static conditions. Therefore, as for PwAECOPD, they should require not only respiratory rehabilitation but also balance and mobility physiotherapy to prevent today's PwCOVID from becoming tomorrow's fallers.

Fig. 1

(a) Inset at the top shows an example of a stabilometry recording of center of foot pressure in a representative PwCOVID, PwAECOPD and HS, during quiet stance with EO and EC. (b) The histogram show the sway area of the center of pressure for PwCOVID, PwAECOPD and HS, during quiet stance with EO and EC. (c) The histograms show the sway path of the center of pressure for PwCOVID, PwAECOPD and HS, during quiet stance with EO and EC. (d) Stabilometric assessment was performed by a physiotherapist with a stabilometric platform (Medicapteurs, France), in a room of the COVID-19 Rehabilitation Unit specifically equipped as a Posture Laboratory. Error bars represent the respective standard error, SE. EO, eyes open; EC, eyes closed; HS, healthy subjects; PwAECOPD, patients with acute exacerbation of chronic obstructive pulmonary disease; PwCOVID, patients with COVID-19. *, P < 0.05; **, P < 0.005.