Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 rehabilitation unit and proposal of a treatment protocol. A cross-sectional study.

Curci, Claudio; Pisano, Fabrizio; Bonacci, Eleonora; Camozzi, Danila Marta; Ceravolo, Claudia; Bergonzi, Roberto; De Franceschi, Silvia; Moro, Paolo; Guarnieri, Rodolfo; Ferrillo, Martina; Negrini, Francesco; De Sire, Alessandro

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 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 Dyspnoea 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 dyspnoea 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 subacute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.