ABSTRACT
BACKGROUND AND PURPOSE: The novel coronavirus (COVID-19) created a large population of survivors with prolonged post-infection symptoms, impacting their quality of life (QOL) with little known about their long-term recovery. Physical therapy is theorized to reduce mortality rates of patients who have been hospitalized with COVID-19;however, there is limited evidence and a critical need for ongoing research to determine best practice within this large, complex and emerging patient population. The disease process impacts all three domains outlined by the International Classification of Functioning, Disability and Health (ICF) - impairment, activities, and participation. Increased psychological symptoms of fear, uncertainty and guilt are also prevalent due to social isolation and the novelty of the disease process. In order to achieve optimal outcomes, a high level of coordination of services with other healthcare providers is necessary. Highly trained, multidisciplinary teams in rehabilitation settings implementing evidence-based recommendations is crucial for better management of survivors of COVID-19. The purpose of this case series is to describe the novel and successful interdisciplinary team approach in the outpatient rehab clinic setting for individuals post-COVID. CASE DESCRIPTION: In the case series, 4 females and 7 males ages 34-67 participated in an 8-week COVID-19 recovered group while enrolled in an intensive interdisciplinary outpatient rehab clinic setting. All patients were previously hospitalized and completed acute inpatient rehab. Patients participated in one, 55-minute group session per week with co-treating physical therapists (PT), psychologists and occupational therapists. Group participants received two to eight hours of additional PT weekly in the clinic. Within the group, patients participated in moderate intensity cardiovascular exercise through use of the Borg Rating of Perceived exertion (RPE) scale. Interdisciplinary education regarding the disease process, activity pacing, coping strategies and psychological trauma post-COVID-19 were provided with incorporation of peer support. OUTCOMES: Pre- and posttreatment assessments of 6-minute walk test (6MWT) and 10- meter walk test self-selected velocity (10MWT SSV) were performed. 6MWT change of 255.78 feet (paired t-test, P- value = 0.002);10 MWT change of 0.27 m/s (paired t-test, P-value 0.001). Ten patients required an assistive device (AD) at the onset of the group. Ninety percent of participants transitioned to a lesser restrictive device within the eight weeks. DISCUSSION: This case series demonstrates the benefits of an outpatient interdisciplinary program through significant improvements in patient's self selected walking speed, cardiovascular endurance and progression to lesser restrictive AD. In conclusion, the outcome of this case series supports the effectiveness of an interdisciplinary team approach to improve functional mobility in patients who are COVID-19-recovered.