Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: A multicenter prospective cohort study (CO-FLOW).

Autor:	Berentschot JC; Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands., Heijenbrok-Kal MH; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.; Rijndam Rehabilitation, Rotterdam, the Netherlands., Bek LM; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands., Huijts SM; Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands., van Bommel J; Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherland., van Genderen ME; Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherland., Aerts JGJV; Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands., Ribbers GM; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.; Rijndam Rehabilitation, Rotterdam, the Netherlands., Hellemons ME; Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands., van den Berg-Emons RJG; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Europe [Lancet Reg Health Eur] 2022 Aug 24; Vol. 22, pp. 100485. Date of Electronic Publication: 2022 Aug 24 (Print Publication: 2022).
DOI:	10.1016/j.lanepe.2022.100485
Abstrakt:	Backgroud: The sudden COVID-19 pandemic forced quick development of care pathways for patients with different needs. Trajectories of physical recovery in hospitalized patients for COVID-19 following different care pathways are unknown. We aimed to assess trajectories of physical recovery and levels of physical function reached within the different care pathways. Additionally, we assessed differences in physical function across care pathways at follow-up visits. Methods: This multicenter prospective cohort study of adults who had been hospitalized for COVID-19 was performed in 10 centers, including 7 hospitals (1 academic and 6 regional hospitals) and 3 rehabilitation centers (1 medical rehabilitation center and 2 skilled nursing facilities), located in the Netherlands. Study visits were performed at 3, 6, and 12 months post-hospital discharge and included assessment of cardiorespiratory fitness (6 min walk test [6MWT], 1 min sit-to-stand test [1MSTST]), muscle strength (maximum handgrip strength [HGS]) and mobility (de Morton Mobility Index [DEMMI]). Findings: We report findings for 582 patients who had been discharged from hospital between March 24, 2020 and June 17, 2021. Patients had a median age of 60·0 years, 68·9% (401/582) were male, 94·6% (561/582) had received oxygen therapy, and 35·2% (205/582) mechanical ventilation. We followed patients across four different rehabilitation settings: no rehabilitation (No-rehab, 19·6% [114/582]), community-based rehabilitation (Com-rehab, 54·1% [315/582]), medical rehabilitation (Med-rehab, 13·7% [80/582]), and rehabilitation in a skilled nursing facility (SNF-rehab, 12·5% [73/582]). Overall, outcomes in 6MWT (14·9 meters [95% CI 7·4 to 22·4]), 1MSTST (2·2 repetitions [1·5 to 2·8]), and HGS (3·5 kg [2·9 to 4·0]) improved significantly ( p< 0·001) from 3 to 6 months and only HGS from 6 to 12 months (2·5 kg [1·8 to 3·1]; p< 0·001). DEMMI scores did not significantly improve over time. At 3 months, percentage of normative values reached in 1MSTST differed significantly ( p< 0.001) across care pathways, with largest impairments in Med- and SNF-rehab groups. At 12 months these differences were no longer significant, reaching, overall, 90·5% on 6MWD, 75·4% on 1MSTST, and 106·9% on HGS. Interpretation: Overall, physical function improved after hospitalization for COVID-19, with largest improvement within 6 months post-discharge. Patients with rehabilitation after hospital discharge improved in more than one component of physical function, whereas patients without rehabilitation improved solely in muscle strength. Patients who received rehabilitation, and particularly patients with Med- and SNF-rehab, had more severe impairment in physical function at 3 months, but reached equal levels at 12 months compared to patients without follow-up treatment. Our findings indicate the importance of rehabilitation. Funding: ZonMw, Rijndam Rehabilitation, Laurens (The Netherlands). Competing Interests: All authors have no conflicts of interest related to this work. (© 2022 The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu