Do Patients with Covid-19 Benefit from Rehabilitation? Functional outcomes of the first 100 patients in a Covid-19 rehabilitation unit

Piquet, Violaine; Luczak, Cédric; Seiler, Fabien; Monaury, Jordan; Martini, Alexandre; Ward, Anthony B.; Gracies, Jean-Michel; Motavasseli, Damien

Objective To determine the benefits associated with brief inpatient rehabilitation for Covid-19 patients. Design Retrospective chart review. Setting A newly created specialized rehabilitation unit in a tertiary care medical center Participants Consecutive sample of the first 100 patients with Covid-19 infection admitted to rehabilitation. Intervention Inpatient rehabilitation for post-acute care Covid-19 patients Main Outcome Measures Measurements, at admission and discharge, comprised a Barthel Activities of Daily Living Index (including baseline value before Covid-19 infection), time to perform 10 sit-to-stands with associated cardio-respiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in ICU were explored. Results Patient characteristics upon admission to rehabilitation were: men 66%, age 66±22 years, mean delay from symptom onset 20.4±10.0 days, BMI 26.0±5.4 kg/m2, hypertension 49%, diabetes 29%, with 26% having >50% pulmonary damage on CT-scans. Mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index (/100) increased from 77.3±26.7 to 88.8±24.5 (p<0.001), without recovering baseline values (94.5±16.2; p<0.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; p<0.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; p=0.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; p<0.001). At both admission and discharge, Barthel score correlated with grip strength (rho=0.39-0.66; p<0.01), which negatively correlated with time spent in ICU (rho=-0.57 to -0.49, p<0.05). Conclusions Inpatient rehabilitation for Covid-19 patients was associated with substantial motor, respiratory and functional improvement, especially in severe cases, even though there remained mild persistent autonomy loss upon discharge. Following acute stages, Covid-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.