Life after COVID-19:the road from intensive care back to living - a prospective cohort study

OBJECTIVES: The aim of the study was to evaluate recovery of participation in post-COVID-19 patients during the first year after intensive care unit (ICU) discharge. The secondary aim was to identify the early determinants associated with recovery of participation. DESIGN: Prospective cohort study. SETTING: COVID-19 post-ICU inpatient rehabilitation in the Netherlands, during the first epidemic wave between April and July 2020, with 1-year follow-up. PARTICIPANTS: COVID-19 ICU survivors ≥18 years of age needing inpatient rehabilitation. MAIN OUTCOME MEASURES: Participation in society was assessed by the ‘Utrecht Scale for Evaluation of Rehabilitation-Participation’ (USER-P) restrictions scale. Secondary measures of body function impairments (muscle force, pulmonary function, fatigue (Multidimensional Fatigue Inventory), breathlessness (Medical Research Council (MRC) breathlessness scale), pain (Numerical Rating Scale)), activity limitations (6-minute walking test, Patient reported outcomes measurement information system (PROMIS) 8b), personal factors (coping (Utrecht Proactive Coping Scale), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Global Psychotrauma Screen—Post Traumatic Stress Disorder), cognitive functioning (Checklist for Cognitive Consequences after an ICU-admission)) and social factors were used. Statistical analyses: linear mixed-effects model, with recovery of participation levels as dependent variable. Patient characteristics in domains of body function, activity limitations, personal and social factors were added as independent variables. RESULTS: This study included 67 COVID-19 ICU survivors (mean age 62 years, 78% male). Mean USER-P restrictions scores increased over time; mean participation levels increasing from 62.0, 76.5 to 86.1 at 1, 3 and 12 months, respectively. After 1 year, 50% had not fully resumed work and restrictions were reported in physical exercise (51%), household duties (46%) and leisure activities (29%). Self-reported complaints of breathlessness and fatigue, more perceived limitations in daily life, as well as personal factors (less proactive coping style and anxiety/depression complaints) were associated with delayed recovery of participation (all p value <0.05). CONCLUSIONS: This study supports the view that an integral vision of health is important when looking at the long-term consequence of post-ICU COVID-19. Personal factors such as having a less proactive coping style or mental impairments early on contribute to delayed recovery

A PROTOCOL FOR PERMISSIVE WEIGHT-BEARING DURING ALLIED HEALTH THERAPY IN SURGICALLY TREATED FRACTURES OF THE PELVIS AND LOWER EXTREMITIES

Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regimen, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgically treated fractures of the pelvis and lower extremities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)- or intra-articular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The complication rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)- or intra-articular fractures of the pelvis and lower extremities

COVID-19: patient characteristics in the first phase of post-intensive care rehabilitation

Objective To describe clinical characteristics of post-ICU COVID-19 patients, admitted for inpatient rehabilitation. Design A cross-sectional design Setting Inpatient rehabilitation care in the Netherlands Participants All post-ICU COVID-19 patients admitted to the rehabilitation centre between April 2 and May 13, 2020 were invited to participate in the study. Included were patients above 18 years old, needing inpatient rehabilitation after ICU treatment for COVID-19. Intervention Not applicable Main outcomes measures The following information was collected in the first week of inpatient rehabilitation care: 1. Demographics, 2. ICU-stay parameters, 3. Medical, physical and functional characteristics, 4. Self-reported symptoms. Results Sixty patients participated with the mean age of 59.9 and the majority being men(75%). Most important findings for rehabilitation: in the first week after discharge to the rehabilitation centre 38.3% of all patients experienced exercise-induced oxygen desaturation, in 72.7% muscle weakness was present in all major muscle groups and 21.7% had a reduced mobility in one or both shoulders. Furthermore 40% suffered from dysphagia and 39.2% reported symptoms of anxiety. Conclusion Post-ICU COVID-19 patients, display physical and anxiety symptoms as reported in other post-ICU patient groups. However this study showed some remarkable clinical characteristics of post-ICU COVID-19 patients. Rehabilitation programs need to anticipate on this. Long-term follow-up studies are necessary

Evidence-based rehabilitation therapy following surgery for (peri-)articular fractures:A systematic review

Objective: To assess the availability of explicitly reported protocols describing post-surgery rehabilitation of (peri-) articular fractures of the proximal humerus, acetabulum and/or tibial plateau, and to critically review any scientific evidence on the effectiveness of these protocols. Data sources: MEDLINE (PubMed), Cochrane databases, CINAHL, PEDro and Embase (Ovid) were searched to November 2018. Furthermore, stakeholder internet sites, clinical guidelines and standard textbooks were searched. Study selection: Screening was performed independently by 2 researchers based on a priori defined eligibility criteria. Data synthesis: Five papers addressed post-surgical rehabilitation of proximal humerus fractures, one paper addressed acetabulum fractures. No eligible information was found on stakeholder sites or in standard textbooks. Overall, the main focus of the protocols identified was on the International Classification of Functioning, Disability and Health (ICF) "Body Functions and Structures" level. In general, little information about therapy dosage was reported. None of the protocols provided scientific evidence on which the content of described rehabilitation programmes was based. Conclusion: This review reveals a paucity of explicitly formulated protocols focussing on post-surgical rehabilitation of common (peri-) articular fractures targeting patient-centred care at all ICF levels. There is a need for more scientific evidence on which to base protocols regarding common (peri-) articular fracture rehabilitation

Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study

Abstract Background The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study. Methods/design The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery. Primary outcome measure: ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration. Discussion This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol. Trial registration The study is registered in the Dutch Trial Register (NTR6077). Date of registration: 01–09-2016