This article was originally published here
Am J Phys Med Rehabil. 2021 Jan 11. doi: 10.1097/PHM.0000000000001686. Online ahead of print.
ABSTRACT
OBJECTIVE: The COVID-19 pandemic affects a large number of patients. The impact on feasibility and outcome of rehabilitation during COVID-19 actually remains unclear. Nosocomial infection of health care workers or hospitalized patients are common and prevention of nosocomial infections during rehabilitation are challenging. Therefore, we analyzed a cohort of nosocomial infected COVID-19 patients in a single center inpatient rehabilitation clinic and describe performance and outcome.
DESIGN: The cohort (n=27) describes patients with nosocomial SARS-CoV-2 infection while participating in neuro-musculoskeletal rehabilitation (NMSR). Infection was caused by an initially unidentified so-called superspreader. We compared this cohort with all NMSR inpatients of 2019 (comparison group). Normally distributed continuous variables were presented as mean with standard deviation (SD) and the T-Test was used for comparison between groups. Linear regression was used to assess the impact of COVID-19 on FIM at discharge.
RESULTS: COVID-19 patients were mostly male (66.7%) with an age of 71.5 ±12.3 years. Age, sex and cumulated comorbidities of the comparison group (n=786) were not different from the COVID-19 group. 92.6% of COVID-19 patients had a mild or moderate course and two patients had to be referred to acute hospital due to respiratory failure and one of these patients died in the acute hospital. After implementation of a strict hygiene concept, no further nosocomial COVID-19 infections were detected. The rehabilitation duration was significant longer in the COVID-19 group, 54.2±23.6 days versus 32.1±17.7 days (p<0.001). Daily therapy duration was 132.3±44 minutes before SARS-CoV-2 infection and reduced to 81.9±27.3 minutes during COVID-19 (p<0.001). After discontinuation of isolation measures, therapy duration increased significantly (99.3±70.2 minutes; p<0.05).The baseline Functional Independence Measure (FIM) score was higher in the COVID-19 group (91.93 ±25.64 vs. 82.98 ±22.73 points) and FIM improvements were lower in COVID-19 patients than in the 2019 comparison group (6.96 ±8.96 vs 20.3 ±15.98 points; p<0.001). COVID-19 infection itself had a strong negative impact on FIM change as identified by regression analysis. Linear regression analysis showed that COVID-19 reduced the FIM at discharge by 8.9 points (95% CI -14.725;-3.097; p=0.003) after correction for FIM at admission, age, sex and morbidity index at admission.
CONCLUSION: In conclusion, COVID-19 had a strong negative impact on rehabilitation benefits as assessed by FIM. NMSR could be continued but all patients received less therapy minutes during isolation. After implementation of a strict COVID-19 specific hygiene concept no further infections were detected.
PMID:33443857 | DOI:10.1097/PHM.0000000000001686
