Correlations between Disease Severity and Rehabilitation Outcomes in Patients Recovering from Covid-19 Infection

Abstract

Objective: Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes. Design: Observational cohort study. Subjects: A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment. Methods: The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness. Results: Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation were correlated with lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between WHO-CPS, prolonged acute hospitalization and day of ventilation and funnctional level at discharge. Conclusion: The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings show that even patients with severe acute COVID-19 infection may improve their daily functioning significantly during rehabilitation program. LAY ABSTRACT Many patients worldwide develop severe complications of recent infection with the coronavirus SARS-CoV-2 (COVID-19). These complications include respiratory, motor, cognitive, and functional symptoms. Rehabilitation plays an important role in the recovery of these patients. This study examined whether there is a correlation between the severity of acute COVID-19 infection and the functional level of survivors after rehabilitation. Study participants were 61 post-acute COVID-19 patients who received inpatient and outpatient rehabilitation. Most of the patients improved significantly in daily functions following rehabilitation, and most did not need oxygen support at discharge. Patients with severe COVID-19 infection started the rehabilitation period at a low functional level, but improved significantly during rehabilitation, and at discharge there was no difference between patients with more severe or less severe COVID-19 infections. These findings show that even patients with severe acute COVID-19 infection may improve significantly during rehabilitation program.

Keywords

• interdisciplinary rehabilitation
• COVID-19 infection
• activities of daily living
• Functional Independence Measure