Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19 - an observational cohort study

Eur J Phys Rehabil Med. 2021 Jan 15. doi: 10.23736/S1973-9087.21.06549-7. Online ahead of print.

Abstract

Background: The Corona Virus Disease 2019 (COVID-19) pandemic increases the demand for post-acute care in patients after a severe disease course. Various longterm sequelae are expected and rehabilitation medicine is challenged to support physical and cognitive recovery.

Aim: We aimed to explore the dysfunctions and outcome of COVID-19 survivors after early post-acute rehabilitation.

Design: Observational cohort study.

Methods: This study evaluated the post-acute sequelae of patients hospitalized for SARS-Cov-2 infection and analyzed rehabilitative outcomes of a subgroup of patients included in the prospective observational multicenter CovILD study.

Results: A total of 23 subjects discharged after severe to critical COVID-19 infection underwent an individualized, multi-professional rehabilitation. At the start of post-acute rehabilitation, impairment of pulmonary function (87%), symptoms related to postintensive care syndrome, and neuropsychological dysfunction (85%) were frequently found, whereas cardiac function appeared to be largely unaffected. Of interest, multidisciplinary rehabilitation resulted in a significant improvement in lung function, as reflected by an increase of forced vital capacity (p=0.007) and forced expiratory volume in one second (p=0.014), total lung capacity (p=0.003), and diffusion capacity for carbon monoxide (p=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of six-minute walking distance by 176 (SD ± 137) meters. Contrarily, a considerable proportion of patients still had limited diffusion capacity (83%) or neurological symptoms including peripheral neuropathy at the end of rehabilitation.

Conclusions: Individuals discharged after a severe course of COVID-19 frequently present with persisting physical and cognitive dysfunctions after hospital discharge. Those patients significantly benefit from multi-disciplinary inpatient rehabilitation.

Clinical rehabilitation impact: Our data demonstrate the highly promising effects of early post-acute rehabilitation in survivors of severe or critical COVID-19. This finding urges the need for further prospective evaluations and may impact future treatment and rehabilitation strategies.