Comprehensive rehabilitation treatment for sub-acute COVID-19 patients: an observational study.

BACKGROUND: COVID-19 is a respiratory infection, but it should be considered as a systemic illness with increasing interest on the survivors' sequelae and their management. Considering multi-organ disabilities, a comprehensive rehabilitation provided in sub-acute phase could be considered a suitable setting for these patients. AIM: The aim of this article was to report the features and rehabilitative outcomes of patients requiring rehabilitation due to disabilities related to severe COVID-19 infection. DESIGN: Longitudinal Observational Study. SETTING: Department of Rehabilitation in General Hospital. POPULATION: Patients showing multiple disabilities due to severe COVID-19 infection. METHODS: Thirty-nine consecutive patients were admitted to a rehabilitation ward transferred from ICU or Medical wards. Barthel Index (BI) and Functional Ambulation Categories (FAC) were scored as disabilities measures. Data regarding comorbidity, rehabilitation course, swabs, procedures in acute phase, non-respiratory manifestations, dysphagia, mental confusion, PaO2/FiO2, oxygen supplementation have been collected to admission and discharge. For all patients a comprehensive rehabilitation treatment have been provided. RESULTS: Functional outcome is good with a statistically significant improvement in BI and FAC scores. Thirty-eight patients were discharged at their home. Mean lenght of stay (LOS) in acute wards was 46 days. Mean LOS in rehabilitation was 20 day. Eleven patients still had tracheostomy at admission, none at discharge and all dysphagic patients recovered a normal oral feeding. The change in PaO2/FiO2 and the reduction of the oxygen supplementation testify a good recovery of pulmonary function. CONCLUSIONS: Our results showed a consistent recovery with little caregiver burden at discharge. Fast relocation from ICU makes beds available which are very valuable during pandemic. Comprehensive rehabilitation treatment provided in sub-acute phase for patients still positive for SARS-CoV-2, would be desirable as it seems to be an effective setting. In this setting a strong medical assistance must be ensured. CLINICAL REHABILITATION IMPACT: The activation of comprehensive rehabilitation settings able to assist sub-acute patients still positive would be desirable as it could be a very efficient Healthcare Systems answer to the catastrophic pandemic, decompressing acute hospital as well. Furthermore, contagious patients with swabs positivity affected by other kind of disabilities (i.e. Stroke, Femur Fracture) can be treated avoiding to lose the early rehabilitation.

First impact of COVID-19 on services and their preparation. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by COVID-19. In a country with almost 5000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the COVID-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.