Highlights
- •After COVID-19, responsiveness to inpatient rehabilitation should be determined.
- •A 10-day stay using predominantly motor rehabilitation improves functional outcomes.
- •Improvement rates were greater in more severely affected patients upon admission.
- •Premorbid autonomy was not fully restored after brief inpatient rehabilitation.
- •COVID-19, a primarily respiratory disease, triggers lasting motor complications.
Abstract
Objective
Design
Setting
Participants
Intervention
Main Outcome Measures
Results
Conclusions
Keywords
List of abbreviations:
COVID-19 (coronavirus 2019), CT (computed tomography), ICU (intensive care unit), PT (physical therapy), RT-PCR (reverse transcriptase polymerase chain reaction)Methods
Creation of the unit and target patients
Nursing and medical care
Logistics and equipment
Organization of the rehabilitation activities
Discharge process
Ethics
Study design and participants
Data analysis
Results
Population description
Demographics | Value, n (%) |
---|---|
Age, median ± IQR, y | 66±22 |
Sex (Male) | 66 (66) |
Mean delay post-onset at admission | 20.4±10.0 |
Mean delay post-onset at discharge | 32.7±10.7 |
BMI, mean ± SD | 26.0±5.4 |
Clinical Characteristics at Time of Diagnosis | Value, n (%) |
Dyspnea | 79 (79) |
Asthenia | 76 (76) |
Fever | 73 (73) |
Cough | 64 (64) |
Myalgia | 33 (33) |
Diarrhea | 25 (25) |
Ageusia | 16 (16) |
Headache | 14 (14) |
Anosmia | 13 (13) |
Pulmonary embolism | 4 (4) |
Thrombosis | 1 (1) |
Background and Comorbidities | Value, n (%) |
High blood pressure | 48 (48) |
Age >70 y | 41 (41) |
Diabetes | 29 (29) |
BMI >30 | 17 (17) |
Renal failure | 13 (13) |
Coronaropathy | 1 (1) |
Stroke | 9 (9) |
Immunosuppression | 3 (3) |
Acute Care | Value, n (%) |
---|---|
Prior intensive care | 23 (23) |
Intubation | 13 (13) |
Duration of intubation, mean ± SD | 8.2±8.5 |
Nasal O2 at admission | 77 (77) |
Nasal O2 at discharge | 58 (58) |
Overall length of stay in acute care, mean ± SD | 14.4±8.7 |
In intensive care, mean ± SD | 13.8±9.0 |
In acute care after ICU, mean ± SD | 10.22±4.87 |
In acute care if no ICU stay, mean ± SD | 11.65±6.48 |
Rehabilitation Care | |
Length of stay, mean ± SD | 9.8±5.1 |
Deaths | 2 (2) |
At Discharge | |
Overall duration of O2 dependency, mean ± SD | 17.4±11.1 |
O2 dependency at discharge | 3 (3) |
Discharge home | 75 (75) |
Discharge to a relative's home | 4 (4) |
Transfer to a COVID-free rehabilitation unit | 15 (15) |
Transfer to acute care | 8 (8) |
Personal assistance before COVID | 19 (19) |
Personal assistance after COVID | 24 (24) |
Overall functional outcomes


Correlations between length of acute stay, motor parameters, and functional autonomy

Between-group comparisons
Discussion
Usefulness of a COVID rehabilitation unit
Effect of motor rehabilitation on severe COVID cases
Study limitations
Conclusions
Supplier
- a.SPSS, v. 25; IBM Corp.
Supplementary data
- Supplementary Material
- Supplemental Fig S1
- Supplemental Fig S2
References
- Rehabilitation after critical illness in people with COVID-19 infection.Am J Phys Med Rehabil. 2020; 99: 470-474
- Post-acute care preparedness for COVID-19: thinking ahead.JAMA. 2020; 323: 2007-2008
- The role of physical and rehabilitation medicine in the COVID-19 pandemic: the clinician's view.Ann Phys Rehabil Med. 2020; 63: 554-556
- Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020.Eur J Phys Rehabil Med. 2020; 56: 846-852
- Role of rehabilitation department for adult individuals with COVID-19: the experience of the San Raffaele Hospital of Milan.Arch Phys Med Rehabil. 2020; 101: 1656-1661
- Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19 - an observational cohort study.Eur J Phys Rehabil Med. 2021 Jan 15; ([Epub ahead of print])
- Functional outcome after inpatient rehabilitation in post-intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study.Eur J Phys Rehabil Med. 2021 Jan 4; ([Epub ahead of print])
- The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status.Respirology. 2010; 15: 543-550
- Functional disability 5 years after acute respiratory distress syndrome.N Engl J Med. 2011; 364: 1293-1304
- Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers.Intensive Care Med. 2016; 42: 725-738
- Early rehabilitation to prevent post-intensive care syndrome in patients with critical illness: a systematic review and meta-analysis.BMJ Open. 2018; 8e019998
- Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.Lancet Infect Dis. 2020; 20: 565-574
- Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases.Radiology. 2020; 296: E32-E40
- The Barthel ADL Index: a standard measure of physical disability?.Int Disabil Stud. 1988; 10: 64-67
- The Barthel ADL Index: a reliability study.Int Disabil Stud. 1988; 10: 61-63
- Simple method for measurement of lower extremity muscle strength.Am J Med. 1985; 78: 77-81
- Muscle thickness contribution to sit-to-stand ability in institutionalized older adults.Aging Clin Exp Res. 2020; 32: 1477-1483
- Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity.Eur J Appl Physiol. 2013; 113: 147-155
- Muscle strength: clinical and prognostic value of hand-grip dynamometry.Curr Opin Clin Nutr Metab Care. 2015; 18: 465-470
- Normative data and associated factors of hand grip strength among elderly individuals: The Yilan Study, Taiwan.Sci Rep. 2020; 10: 6611
- Management of respiratory distress syndrome due to COVID-19 infection.BMC Anesthesiol. 2020; 20: 177
- First impact of COVID-19 on services and their preparation. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.Eur J Phys Rehabil Med. 2020; 56: 319-322
- Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol.Eur J Phys Rehabil Med. 2020; 56: 633-641
- Rehabilitation therapy for a COVID-19 patient who received mechanical ventilation in Japan.Am J Phys Med Rehabil. 2020; 99: 873-887
- Clinical characteristics of coronavirus disease 2019 in China.N Engl J Med. 2020; 382: 1708-1720
- Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score.Front Microbiol. 2019; 10: 2752
- Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?.Lancet Respir Med. 2020; 8: e21
- Intra- and inter-rater reliability and validity of a clinical and quantifying test of the sit-to-stand task in Parkinsonian syndromes.Ann Phys Rehabil Med. 2018; 61: e253
- Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms.ACS Chem Neurosci. 2020; 11: 995-998
- Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review.Clin Neurol Neurosurg. 2020; 194: 105921
- Three months of bed rest induce a residual transcriptomic signature resilient to resistance exercise countermeasures.FASEB J. 2020; 34: 7958-7969
- Consequences of bed rest.Crit Care Med. 2009; 37: S422-S428
- Fourteen days of bed rest induces a decline in satellite cell content and robust atrophy of skeletal muscle fibers in middle-aged adults.J Appl Physiol (1985). 2016; 120: 965-975
- Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis.Front Neurol. 2020; 11: 687
- Guided self-rehabilitation contract in spastic paresis.Springer International Publishing, Cham, Switzerland2016
Article info
Publication history
Footnotes
Disclosures: none.
Covid Rehabilitation Study Group: Violaine Piquet, MBS, Cédric Luczak, MBS, Fabien Seiler, PT, Jordan Monaury, PET, Estelle Lépine, PT, Lucile Chambard, PT, Marjolaine Baude, MD, Emilie Hutin, PhD, Alexandre Martini, MD, Andrés Samaniego, MD, Nicolas Bayle, MD, Anthony B Ward, MD, Jean-Michel Gracies, MD, Damien Motavasseli, MD.