Pan-European Study on Functional and Medical Recovery and Geriatric Rehabilitation Services of Post-COVID-19 Patients: Protocol of the EU-COGER Study (original) (raw)
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Age and ageing, 2024
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The COVID-19 infection has particularly affected older adults. Clinical observations in this population highlight major respiratory impairment associated with the development or aggravation of the patient's frailty state. Mr. P is a 93-year-old frail patient, hospitalized after a COVID-19 infection. The assessment process of this patient has been supported by an innovative multisystemic tool developed in view of the COVID-19 clinical consequences and a systemic evaluation of motor functions by the Frail'BESTest. This process allowed a mixed clinical picture associated with significant respiratory distress (linked with acute respiratory distress syndrome) and an evident motor frailty. The care plan was developed accordingly, and four assessments were done in the same manner until Mr. P returned home. This case report allows us to see a holistic COVID-19 clinical picture, showing the different axes of clinical reasoning to enhance the rehabilitation process. Furthermore, this case report illustrates the importance of rehabilitation in the COVID-19 context.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus that causes coronavirus disease 2019 (COVID-19) infection and is responsible for a deadly pandemic. The elderly population have a high risk to be infected by COVID-19 and tend to have worse outcomes compared to adult population. Elderly patients also have higher comorbidity than the whole population. Therefore, management of COVID-19 in the elderly needs special attention in terms of regarding drug doses, drug interactions, and side effects of the drugs given. Approach from Physical Medicine and Rehabilitation (PM&R) in elderly population known as Geriatric Rehabilitation is required for COVID-19 because PM&R will go through all phases of treatment during the acute, sub-acute, and long-term care phases. The targets are relieving symptoms, assisting in the mechanical ventilation weaning process, preventing decondition of the airway and other organ systems, and managing psychosocial aspects, especially in the vulnerable and high-risk elderly population. The geriatric rehabilitation approach to COVID-19 patients resulted in improved functional prognosis, optimized role of function, and improved Quality of Life.
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Rehabilitation is important for patients with coronavirus disease 2019 (COVID-19) infection. Given the lack of guidelines in English on the rehabilitation of these patients, we conducted a review of the most recent reports. We performed this literature review using the principal research databases and included randomized trials, recommendations, quasi-randomized or prospective controlled clinical trials, reports, guidelines, field updates, and letters to the editor. We identified 107 studies in the database search, among which 85 were excluded after screening the full text or abstract. In total, 22 studies were finally included. The complexity of the clinical setting and the speed of spread of the severe acute respiratory syndrome coronavirus 2, which leads to rapid occupation of beds in the intensive care unit, make it necessary to discharge patients with COVID-19 who have mild symptoms as soon as possible. For these reasons, it is necessary to formulate rehabilitation programs for...
Rehabilitation and In-Hospital Mortality in COVID-19 Patients
The Journals of Gerontology: Series A, 2021
Background Coronavirus disease 2019 (COVID-19) guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients. Method A single-center retrospective study, involving 990 COVID-19 patients (42.4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital, was conducted. Association of rehabilitation during hospitalization with in-hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications. Results Over the 3-month study period, 475 (48.0%) inpatients were referred for rehabilitation. Patients who received rehabilitation were older (73.7 ± 14.0 vs 62.3 ± 17.2). There were 61 hospital death...
Outcomes of patients with COVID‐19 after inpatient rehabilitation
PM&R, 2021
BackgroundRehabilitation outcomes of patients with coronavirus disease 2019 (COVID‐19) are unknown.ObjectiveTo describe patients with COVID‐19 who are undergoing inpatient rehabilitation and their rehabilitation outcomes.DesignRetrospective observational cohort study of all inpatients from a rehabilitation hospital between March 1 and September 30, 2020.SettingInpatient rehabilitation hospital.PatientsAmong all inpatients, inclusion criteria are: ≥18 years of age and admission and discharge within the study time frame. The initial search yielded 920 patients; 896 met the inclusion criteria. Subjects were stratified by COVID‐19 status and rehabilitation impairment.Main Outcome MeasuresData included age, gender, body mass index (BMI), length of stay (LOS), discharge location, and functional ability in self‐care and mobility (FA‐SC, FA‐Mob). One‐sample t‐tests were used to assess the difference of age, BMI, LOS, FA‐SC, FA‐Mob, and FA efficiency between COVID‐19+ and COVID‐19− patients....
European Journal of Physical and Rehabilitation Medicine, 2022
BACKGROUNDCoronavirus disease (COVID-19) is characterized by different clinical pictures that may require prolonged hospitalization and produce disabilities challenging the recovery of previous independence.AIMThe 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.DESIGNSingle-institution retrospective longitudinal study.SETTINGInpatient intensive care units (ICU) and medical care units (MCU).POPULATIONAcute COVID-19 patients.METHODSGeneral 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.RESULTSWe 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.CONCLUSIONSThe 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 IMPACTthis 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.