Inpatient Rehabilitation during COVID-19 Pandemic: Our Experience in a Neurorehabilitation Unit at Ferrara University Hospital

ABSTRACT

Background: Describe the impact of one-year COVID-19 pandemic on subacute rehabilitation of brain injured patients. In this study we propose an analysis of critical points and possible solutions to carry out intensive rehabilitation while preventing the infection spreading. Methods: We delivered an individualized rehabilitation plan that relies on a multidisciplinary and inter-professional teamwork to develop neuromotor, cognitive, occupational and recreational activities. Our facility is based on a 40-beds ward that admits patients from acute care units. During the COVID- 19 outbreak, a deep reorganization of rehabilitative activities was done to prevent the risk of infection. Infection spreading prevention education of health-care professionals, patients and care givers to the correct use of personal protective equipment;symptomatic surveillance and periodic screening;rearrangement of care pathways and spaces. Redefinition of rehabilitation activities reduction of the patients' number in the therapeutic setting;redistribution of the treatments throughout the day;introduction of activities in small groups and specific protocols for robotics. In the early phase, music-therapy, pet-therapy, sports activities, in-hospital school, return-to-work projects were temporary interrupted but later restored. Technology-assisted communications participation of care givers through video-calls to stimulate interaction and reduce isolation;online periodic team meetings for clinical and rehabilitative updating;virtual home visits to prepare discharge. We maintained caregiver direct participation for patients with disorders of consciousness, severe cognitive-behavioral disorders, pediatric patients;we maintained caregivers' training before discharge. Results: From March 2020 to March 2021, we admitted 166 patients (59 females, 107 males;mean age 58,11 years), 104 of which with severe brain injury. Bed occupancy rate was 93,80%;mean length of stay was 63,73 days. Etiology was hemorrhagic in 53, anoxic in 7, traumatic in 38, neoplastic in 11, ischemic in 45, infectious in 8, neuropathic in 4 cases. Delta-FIM (Functional Independence Measure) was 1,42;delta-BI (Barthel Index) was 33,68;delta-DRS (DisabilityRating Scale) was -2,13;delta-RCS -E (Rehabilitation Complexity Scale-Extended) was 6,56. Only five patients and eight health-care professionals resulted COVID-19 positive during this period. Conclusions: Despite COVID-19 pandemic we provided intensive rehabilitation treatment, without reducing the beds and maintaining a COVID-19 free ward. Bed occupancy rate was similar to that of 2019 (92,13%). We had only 13 positive cases over a year. The complexity and intensity of the treatment was maintained. All activities have been guaranteed although with some adjustments. We developed adaptability and a proactive attitude in the continuous search for new solutions. Despite the efforts, COVID-19 pandemic inevitably impacted on the continuum of care and rehabilitation of brain injuries, especially on complex and fragile cases. Future goals could be further personalization of the treatment and implementation of caregiver participation through technology-assisted communication.