European Journal of Physical and Rehabilitation Medicine 2021 April;57(2):189-98

Bernhard PUCHNER ^{1, 2}, Sabina SAHANIC ², Rudolf KIRCHMAIR ¹, Alex PIZZINI ², Bettina SONNWEBER ³, Ewald WÖLL ³, Andreas MÜHLBACHER ¹, Katja GARIMORTH ¹, Bernhard DAREB ¹, Rainer EHLING ¹, Johanna WENTER ¹, Sybille SCHNEIDER ¹, Christian BRENNEIS ¹, Günter WEISS ², Ivan TANCEVSKI ², Thomas SONNWEBER ² ✉, Judith LÖFFLER-RAGG ²

¹ Clinic for Rehabilitation Münster and Karl Landsteiner Institut für Interdisziplinäre Forschung am Reha Zentrum Münster, Münster, Austria; ² Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria; ³ Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic increases the demand for postacute care in patients after a severe disease course. Various long-term sequelae are expected and rehabilitation medicine is challenged to support physical and cognitive recovery.
AIM: We aimed to explore the dysfunctions and outcome of COVID-19 survivors after early postacute rehabilitation.
DESIGN: Observational cohort study.
METHODS: This study evaluated the postacute sequelae of patients hospitalized for SARS-CoV-2 infection and analyzed rehabilitative outcomes of a subgroup of patients included in the prospective observational multicenter CovILD study.
RESULTS: A total of 23 subjects discharged after severe to critical COVID-19 infection underwent an individualized, multiprofessional rehabilitation. At the start of postacute rehabilitation, impairment of pulmonary function (87%), symptoms related to postintensive care syndrome, and neuropsychological dysfunction (85%) were frequently found, whereas cardiac function appeared to be largely unaffected. Of interest, multi-disciplinary rehabilitation resulted in a significant improvement in lung function, as reflected by an increase of forced vital capacity (P=0.007) and forced expiratory volume in one second (P=0.014), total lung capacity (P=0.003), and diffusion capacity for carbon monoxide (P=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of six-minute walking distance by 176 (SD±137) meters. Contrarily, a considerable proportion of patients still had limited diffusion capacity (83%) or neurological symptoms including peripheral neuropathy at the end of rehabilitation.
CONCLUSIONS: Individuals discharged after a severe course of COVID-19 frequently present with persisting physical and cognitive dysfunctions after hospital discharge. Those patients significantly benefit from multi-disciplinary inpatient rehabilitation.
CLINICAL REHABILITATION IMPACT: Our data demonstrated the highly promising effects of early postacute rehabilitation in survivors of severe or critical COVID-19. This findings urge further prospective evaluations and may impact future treatment and rehabilitation strategies.

KEY WORDS: COVID-19; Rehabilitation; Respiratory physiological phenomena; Karnofsky Performance Status