R. Gatti1,2, F. Temporiti1,2, S. Pierini1, B. Bernardini1, S. Respizzi1, D. Pini1
1Humanitas Clinical and Research Center - IRCCS, Milan, Italy, 2Humanitas University, Milan, Italy
Background: The pandemic new coronavirus (Covid-19) is revealing a high risk to develop severe complications, especially in older adults with comorbidities. A considerable number of patients requires intensive or sub-intensive care in hospital, where the bedrest strongly increases the likelihood of developing disability, affecting the return to activities of daily living. To date, no studies have investigated the effects of a rehabilitative intervention in patients with functional decline after hospitalization for Covid-19 infection. Moreover, clinical and functional features of patients with functional loss who may benefit from rehabilitation after hospitalization for Covid-19 infection have never been studied.
Purpose: To assess the effects of rehabilitation in patients hospitalized for Covid-19 infection on functional variables, vitals and respiratory parameters and quality of life, and to investigate what variables could be used as predictors of functional recovery in these patients.
Methods: Data on 29 patients admitted to our Rehabilitation Department for functional decline due to Covid-19 infection from March to June 2020 were retrospectively analyzed. Patients had an ongoing Covid-19 infection, functional loss compared to pre-morbidity status, age ≥ 40 years and clinical stability. They underwent a personalized rehabilitation program based on strength, balance and aerobic training, bronchial clearance techniques and performance of functional tasks. Functional variables such as handgrip strength (HGS), balance and chair subtests of the Short Physical Performance Battery (SPPB), 30-second and 1-minute Sit-to-stand tests (30s-STS, 1m-STS) were assessed the day of admission in the Rehabilitation Department (T0) and the day of discharge (T1). Moreover, vitals (heart rate, O2 saturation and blood pressure) and respiratory parameters (O2 need, BORG related to dyspnea and muscle fatigue and blood-gas values) were investigated at each time-point. Finally, quality of life (EQ-5D and EQ-5D-VAS) was collected at T0.
Results: After a mean length of stay of 13.1±6.6 days, all functional parameters improved (p≤0.002), whereas O2 need (p<0.001) and BORG related to dyspnea (p=0.012) and muscle fatigue (p=0.003) decreased. Changes in SPPB balance subtest showed strong negative correlations with baseline scores of SPPB balance and chair subtests, 30s-STS and 1m-STS (r>-0.6, p<0.001), and moderate negative correlations with EQ-5D and EQ-5D-VAS (r>-0.5, p≤0.013). Changes in 30s-STS and 1m-STS revealed moderate to strong negative correlations with baseline scores of SPPB balance and chair subtests, 30s-STS and 1m-STS (-0.44≤r≤-0.64, p≤0.016). In addition, changes in HGS test with the right and left hands showed positive moderate correlations with baseline scores of SPPB balance subtest and EQ-5D (r≥0.39, p≤0.037). Finally, changes in SPPB balance showed moderate correlations with O2 flow (r=0.399, p=0.032) and heart rate (r=0.462, p=0.012).
Conclusion(s): Functional abilities and respiratory function of patients who developed disability due to hospitalization for Covid-19 infection improved after rehabilitation. Balance abilities, muscle strength and perception of health status at admission are predictors of functional recovery in these patients.
Implications: Identification of predictors of functional recovery in patients with functional decline after Covid-19 infection may help clinicians to identify the responders to rehabilitative interventions and for planning personalized interventions delivered in hospital setting or at patients’ home.
Funding, acknowledgements: The authors did not receive any funding.
Keywords: Covid-19 infection, Predictive factors, Functional recovery
Topic: COVID-19
Did this work require ethics approval? No
Institution: Humanitas Clinical and Research Center - IRCCS
Committee: Internal Ethical Committee of the Humanitas Clinical and Research Center
Reason: The study is a restrospective study on data collected in a clinical setting.
All authors, affiliations and abstracts have been published as submitted.
