The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Protocol, and Patients
2.2. Assessment of Disability and Health Using the WHODAS 2.0 Questionnaire
2.3. Evaluation of Patients and Grouping Them into Levels for Starting the Rehabilitation Program
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- Level 0 includes the patients that did not pass the BMA assessment, who were still admitted into ICU units, and who have an S5Q of 0; the rehabilitation program for them includes 2 h turning, splinting, and positioning.
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- Level 1 includes the patients that passed the BMA, with an S5Q score between 1 to 5, for whom transfer to a chair is not allowed because of a neurological condition; the rehabilitation program for them includes 2 h turning, splinting, Fowler′s position, a passive/active range of motion (ROM), passive/active leg and/or arm cycling in bed, neuromuscular electrical stimulation (NMES), and activities of daily living (ADL) performance.
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- Level 2 includes patients that passed the BMA with an S5Q score ranging between 3 to 5, for whom transfer to a chair is allowed but the patient cannot do it without the help of another person; the rehabilitation program includes 2 h turning, splinting, upright siting position in bed, passive transfer from a bed to a chair, a passive/active ROM, passive/active leg and/or arm cycling in bed, NMES, and ADL performance.
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- Level 3 includes patients that passed the BMA with a minimum S5Q score of 4, and an MRC sum score ≥ 36, with BBS sit to stand = 0, BBS standing = 0, and BBS sitting ≥ 1; the rehabilitation program includes 2 h turning, passive transfer from a bed to a chair, sitting out of bed, standing with at least 2 persons assisting, a passive/active ROM, resistance training for arms and legs, active leg and/or arm cycling in a bed or chair, standing (with assistance/frame), NMES, and ADL performance.
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- Level 4 includes patients that passed the BMA with an S5Q score of 5 and an MRC sum score ≥ 48, with BBS sit to stand ≥ 0, BBS standing ≥ 0, and BBS sitting ≥ 2; the rehabilitation program includes active transfers from a bed to a chair, sitting out of bed, standing with 1 person assisting, a passive/active ROM, resistance training for arms and legs, active leg and/or arm cycling in a bed or chair, walking (with assistance/frame), NMES, and ADL performance.
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- Level 5 includes patients that passed the BMA with an S5Q score of 5 and an MRC sum score ≥ 48, with BBS sit to stand ≥ 1, BBS standing ≥ 2, and BBS sitting ≥ 3; the rehabilitation program includes active transfers from a bed to a chair, sitting out of bed, standing, passive/active ROM, resistance training for arms and legs, active leg and/or arm cycling in bed or chair, walking (with assistance), NMES, and ADL performance.
2.4. Statistical Analysis
3. Results
3.1. ICU Admission History
3.2. Rehabilitation Admission Levels
3.3. Rehabilitation Hospitalization Duration
3.4. WHODAS 2.0 Domains and Their Correlations
4. Discussion
Healthcare Management Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | n = 27 |
---|---|
Age (years), mean (SD) | 63.4 ± 8.6 |
Females, %, Males, % | 51.9% 48.1% |
Independent in the community, % | 81.5% |
Education (years), mean (SD) | 13.14 ± 2.9 years |
Marital status (married), % | 70.4% |
Employment status (retirees), % | 77.8% |
Characteristics | n = 27 |
---|---|
ICU unit admission (%) | 59.3% |
Number of hospitalization days, median (IQR) | 18 (11.5,24) |
Rehabilitation level at admission | |
Level 2 (%) | 29.63% |
Level 3 (%) | 29.63% |
Level 4 (%) | 22.22% |
Level 5 (%) | 18.52% |
Peripheral oxygen saturation (%), median (IQR) | 90% (88.5 to 91.5) |
Average oxygen therapy requirement (L/min), median (IQR) | 1.24 L/min (1 to 3) |
Characteristics | n = 27 |
---|---|
Type 2 Diabetes Mellitus (%) | 55.5% |
Grade 1 HBP (%) | 18.5% |
Grade 2 HBP (%) | 62.9% |
Urinary tract infection (%) | 74.1% |
Clostridium difficile infection (%) | 22.2% |
Pressure ulcers grade I (%) | 14.8% |
Pressure ulcers grade II (%) | 18.5% |
Pressure ulcers grade III (%) | 3.7% |
Peripheral neurological deficit | 62.9% |
Central neurological deficit | 14.8% |
Disability Categories | Disability Percentages | |
---|---|---|
Cognition | 22.99% | |
Mobility | 35.93% | |
Self-care | 28.01% | |
Getting along with people | 28.89% | |
Life activities | Household | 51.79% |
Work or school activities | 3.13% | |
Participation in society | 39.81% | |
Overall disability | 35.09% |
Days in Hospital | O2 Saturation | DM | Peripheral Neurologic Deficit | Central Neurologic Deficit | HBP | ICU Admission | |
---|---|---|---|---|---|---|---|
Cognition (d1) | r = −0.245, p = 0.217 | r = 0.308, p = 0.119 | r = 0.280, p = 0.497 | r = −0.151, p = 0.453 | r = 0.562, p = 0.002 | r = −0.082, p = 0.658 | r = −0.397, p = 0.041 |
Mobility (d2) | r = −0.251, p = 0.207 | r = 0.261, p = 0.188 | r = 0.383, p = 0.048 | r = −0.158, p = 0.430 | r = 0.495, p = 0.009 | r = 0.028, p = 0.888 | r = −0.579, p = 0.002 |
Self-care (d3) | r = −0.275, p = 0.165 | r = −0.293, p = 0.138 | r = −0.263, p = 0.184 | r = −0.204, p = 0.308 | r = 0.683, p = 0.000 | r = −0.093, p = 0.646 | r = −0.455, p = 0.017 |
Getting along with people (d4) | r = −0.206, p = 0.302 | r = 0.251, p = 0.206 | r = 0.308, p = 0.119 | r = −0.190, p = 0.342 | r = 0.550, p = 0.003 | r = 0.049, p = 0.810 | r = −0.307, p = 0.119 |
Life activities (d5) | r = −0.306, p = 0.121 | r = −0.405, p = 0.036 | r = 0.237, p = 0.234 | r = −0.114, p = 0.572 | r = 0.505, p = 0.007 | r = 0.157 p = 0.433 | r = −0.433, p = 0.024 |
Participation in society (d6) | r = −0.214, p = 0.283 | r = 0.322, p = 0.101 | r = 0.275, p = 0.164 | r = −0199, p = 0.321 | r = 0.599, p = 0.001 | r = 0.104, p = 0.604 | r = −0.420, p = 0.029 |
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Potcovaru, C.-G.; Salmen, T.; Potcovaru, A.M.; Săndulescu, I.-M.; Chiriac, O.; Balasa, A.-C.; Diaconu, L.S.; Poenaru, D.; Pantea Stoian, A.; Cinteza, D.; et al. The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study. J. Clin. Med. 2024, 13, 4694. https://doi.org/10.3390/jcm13164694
Potcovaru C-G, Salmen T, Potcovaru AM, Săndulescu I-M, Chiriac O, Balasa A-C, Diaconu LS, Poenaru D, Pantea Stoian A, Cinteza D, et al. The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study. Journal of Clinical Medicine. 2024; 13(16):4694. https://doi.org/10.3390/jcm13164694
Chicago/Turabian StylePotcovaru, Claudia-Gabriela, Teodor Salmen, Ana Mădălina Potcovaru, Ioana-Miruna Săndulescu, Ovidiu Chiriac, Ana-Cristinel Balasa, Laura Sorina Diaconu, Daniela Poenaru, Anca Pantea Stoian, Delia Cinteza, and et al. 2024. "The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study" Journal of Clinical Medicine 13, no. 16: 4694. https://doi.org/10.3390/jcm13164694