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European Journal of Physical and Rehabilitation Medicine 2020 October;56(5):633-41

DOI: 10.23736/S1973-9087.20.06339-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol

Claudio CURCI 1, Fabrizio PISANO 1, Eleonora BONACCI 2, Danila M. CAMOZZI 1, Claudia CERAVOLO 3, Roberto BERGONZI 3, Silvia DE FRANCESCHI 3, Paolo MORO 3, Rodolfo GUARNIERI 2, Martina FERRILLO 4, Francesco NEGRINI 5, Alessandro de SIRE 6, 7

1 Neurorehabilitation Unit, San Marco Polyclinic Hospital, San Donato Groups, Zingonia, Bergamo, Italy; 2 Pulmonary Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy; 3 Orthopedic Rehabilitation Unit, San Marco Polyclinic Hospital, San Donato Group, Zingonia, Bergamo, Italy; 4 Department of Surgical Sciences, University of Turin, Turin, Italy; 5 IRCCS Galeazzi Orthopedic Institute, Milan, Italy; 6 Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy; 7 Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy



BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial role in reducing disability in order to reintroduce patients in the community.
AIM: The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit.
DESIGN: Cross-sectional observational study.
SETTING: Inpatients Rehabilitation Unit.
POPULATION: Post-acute COVID-19 patients.
METHODS: Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2.
RESULTS: We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
CONCLUSIONS: Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients.
CLINICAL REHABILITATION IMPACT: This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.


KEY WORDS: COVID-19; Coronavirus; Severe acute respiratory syndrome coronavirus 2; Rehabilitation; Physical and rehabilitation medicine

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