Title: A Closer Look at Covid-19: The Global Rehabilitation Response for Patients Hospitalized with Moderate to Severe Disease
Name: Brandon Bigelow
Primary Presenters: Brandon Bigelow
College of Health Sciences
Clinical Doctorate, Undergraduate
Faculty Sponsor(s): Caitlyn Anderson, PT, DPT, NCS, GCS

Abstract:

Background: Recommendations for physical therapy (PT) rehabilitation protocols for patients (pts) hospitalized with Covid-19 continues to demonstrate extreme variability, especially those with moderate to severe disease. Additionally, regional differences in Covid-19 response may play a role in decreased congruity of practice.

Objective: The goal of this search is to review existing literature stemming from different regions regarding PT intervention selection, discharge (DC) destinations, and utilization of outcome measures (OM) specifically for pts with moderate to severe Covid-19 infection to observe trends and provide best practice recommendations, if appropriate.

Method: A review using the Population, Intervention, Comparison and Outcome (PICO) method was used. Four authors independently screened titles and abstracts of all studies, then determined inclusion of potentially relevant articles. Studies were eligible if (1) pts were hospitalized due to Covid-19 and participated in PT; (2) pts were categorized as moderate, severe, or critical; (3) the article was written in English. Two separate searches were conducted between October 2021 and March 2022 to reflect the emerging nature of information. Of the 139 total papers identified, 35 met inclusion criteria.

Results: 18/35 articles outlined interventions beyond early mobilization. 17/35 articles documented OM use. DC recommendations with skilled rationale were listed in 8/35 studies, ranging from DC to home to a rehabilitation center for regular PT. Top locations for dissemination of research were Italy, the United States (US), United Kingdom (UK), and China.

Discussion: PT services were generally accepted to be beneficial across all hospital settings with discussion of early mobilization. Chart review and mobilization protocols were not discussed; additionally, interventions beyond general treatment outlined chest or airway clearance techniques, predominantly performed outside the US. Despite the APTA making specific OM recommendations, US-authored publications did not use any. The top OM used globally was the 6-minute walk test.
The US authored 7/35 articles which may affect consistency of care across our national medical systems. Lack of DC destination recommendations was surprising given the severity of illness and may play a role in the now high prevalence of post-Covid/post-ICU syndromes.

Conclusion: Limited evidence exists to guide clinicians in managing pts with are critically ill with Covid-19 despite an expanding body of literature. Future pointed research is warranted to provide recommendations specific to the pathophysiology of Covid-19 and continuum of care.