People admitted to inpatient rehabilitation after hospitalization with COVID-19 showed deficits in mobility, cognition, speech, and swallowing at admission and improved significantly in all of these capabilities by the time they were discharged. However, a considerable number of patients exhibited residual deficits at discharge, highlighting the post-acute care needs of these patients.

Image credit: Univerzita Palackého v Olomouci via Wikimedia (CC BY-SA 4.0)

These are the findings of a retrospective study conducted by a team based at Spaulding Rehabilitation Hospital and the Harvard Medical School Department of Physical Medicine and Rehabilitation, published in PLOS One. The study is believed to be the first to quantitatively characterize the functional and cognitive deficits that survivors of COVID-19 exhibit during inpatient rehabilitation.

Cameron Olezene, study first author and HMS clinical fellow in physical medicine and rehabilitation, noted that, although patients demonstrated significant functional improvement in all areas, persistent deficits in mobility, cognition, and swallowing remained pervasive among the people in the study group.

“This highlights the importance of post-acute rehabilitation and the potential for long-term impairments in COVID-19 survivors,” Olezene said.

“As we now start to understand the long-term aspects of COVID-19 infections and the aftermath, this study begins to create a road map to create the care designs that will be critical to enable people to maximize their recoveries. The study also demonstrates the need for long-term characterization of both the recovery and deficits experienced by those with post-acute COVID syndrome,” said co-author Ross Zafonte, head of the Department of Physical Medicine and Rehabilitation at HMS and senior vice president of medical affairs research and education at Spaulding Rehabilitation Network.

The researchers examined patients admitted during the first surge of COVID-19 during Spring 2020. The study’s 29 patients were 70 per cent male and 58.6 per cent white, with a mean age of 59.5. The mean length of acute hospitalization was 32.2 days with a mean of 18.7 days intubated. Patients spent a mean of 16.7 days in inpatient rehabilitation, and 90 per cent were discharged to their homes. Patients demonstrated significant improvement from admission to discharge in measures of fall risk, endurance, gait speed, mobility, cognition, speech, and swallowing.

The patients with severe COVID-19 experienced multidimensional functional deficits in mobility, cognition, speech, and swallowing which were pervasive at the time of admission to rehabilitation. Although the study population demonstrated significant improvements in all of the characteristics examined, deficits remained in fall risk, gait speed, and cognition at rehab discharge.

“This study highlights the prevalence of persistent functional deficits after severe COVID-19 that will require ongoing treatment and may, in some cases lead to longer-term impairments,” said co-author Jeffrey Schneider, HMS associate professor of physical medicine and rehabilitation and medical director of the Burn and Trauma Rehabilitation Program at Spaulding. “Additionally, this study begins to illuminate the post-acute care needs of this population. We need to devote resources to further study this population and begin to understand how we can address these long-term impacts and to determine what post-acute care settings and services are needed.”

Source: HMS