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European Journal of Physical and Rehabilitation Medicine 2021 Oct 04

DOI: 10.23736/S1973-9087.21.06897-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

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 1, Gabriella CARENZIO 1, Ettore CARLISI 1, Giuseppe DI NATALI 1, Annalisa DE SILVESTRI 2, Claudio LISI 1, on behalf of Covid Rehabilitation Group 

1 Unit of Rehabilitation, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy; 2 Unit of Clinical Epidemiology and Biometrics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy


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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.


KEY WORDS: COVID-19; SARS-CoV-2; Rehabilitation; Functional evaluation

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