Variability in the Transition of Care to Post-Stroke Rehabilitation During the First Wave of COVID-19.

OBJECTIVE: Evaluate transitions of acute stroke (AS) and Inpatient Rehabilitation Facility (IRF) care during the first wave of COVID-19. DESIGN: Retrospective observational study (3 Comprehensive Stroke Centers with hospital-based IRFs) between 1/1/2019-5/31/2019 (AS = 584, IRF = 210) and 1/1/2020-5/31/2020 (AS = 534, IRF = 186). AS characteristics included stroke type, demographics and medical comorbidities. The proportion of patients admitted for AS and IRF care was analyzed graphically and using t-test assuming unequal variances. RESULTS: The proportion of intracerebral hemorrhage patients (28.5 vs 20.5%, P = 0.035) and those with history of transient ischemic attack (29 vs 23.9%; P = 0.049) increased during the COVID-19 1st wave in 2020. Uninsured AS admissions decreased (7.3 vs 16.6%) while commercially insured increased (42.7 vs 33.4%, P < 0.001).AS admissions decreased from 116.5/month in 2019 to 98.8/month in 2020 (P = 0.008) with no significant difference in IRF admissions (39/month in 2019, 34.5/month in 2020; P = 0.66).In 2019, monthly changes in AS admissions coincided with IRF admissions.In 2020, AS admissions decreased 80.6% from January to February, while IRF admissions remained stable. AS admissions increased 12.8% in Mar 2020, remained stable in April, while IRF admissions decreased by 92%. CONCLUSION: Acute stroke hospitalizations significantly decreased per month during the 1st wave of COVID-19, with a delayed effect on the transition from AS to IRF care.

COVID-19 Guide for the Rehabilitation Clinician: A Review of Nonpulmonary Manifestations and Complications.

Severe acute respiratory syndrome coronavirus 2-also known as COVID-19-is primarily known for respiratory illness. Although it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extrapulmonary involvement. This report will summarize key nonpulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.