What does rehabilitation look like for COVID-19 survivors?
06/02/2020
Understanding the long-term effects of COVID-19 is keeping investigators around the world working around the clock. Lisa Sheehy, PT, PhD, is a research associate at Bruyère. She is exploring how rehabilitation programs will need to adapt for COVID-19 survivors to help them regain their independence and quality of life following a hospital stay.
As an academic hospital with a dedicated focus on rehabilitation, we were eager to learn from her recent publication and sat down with her to hear more about her findings.
Who is most likely to need rehabilitation after experiencing COVID-19?
We can mainly expect to see older adults and people with multiple co-morbidities. People who have had COVID-19, who have had a very severe case, and who have survived—they likely have also spent time in the ICU or on ventilators. They probably will have other risk factors such as older age, diabetes, heart disease. And they might have had some other complications related to COVID-19, like ongoing respiratory problems, cardiac issues, or kidney issues. These people quite possibly will not be able to go straight home because they will be too deconditioned to operate in the home environment.
What are the main rehabilitative needs of people who have survived COVID-19?
Deconditioning is going to be a big factor here. COVID-19 survivors may have poor cardio-respiratory fitness. They will be recovering from a respiratory ailment. Ongoing respiratory damage is possible. They’ll have poor muscle strength and cardiovascular condition. A big focus will be on bringing these elements back up to strength.
Patients recovering from COVID-19 may also have poor physical function. A lot of this population will be elderly and will have comorbidities, so they may have problems with activities of daily living, things like walking around their home, cleaning, or doing their normal day-to-day activities. They will need some rehabilitation to get back to regular daily living.
Some people might also face mental health challenges, such as depression, anxiety, or PTSD, or cognitive changes. This is based on comments from people who have experienced being in an ICU, so we can also expect to see this from COVID-19 patients in rehabilitation.
What do you see as the biggest challenge in providing rehabilitation to COVID-19 survivors?
One is keeping the rehab environment safe from the virus that causes COVID-19. It is possible that survivors still carry the virus for a period after they have recovered.
I also suspect that a lot of survivors will face mental health problems. People in ICU frequently have anxiety, depression, PTSD, survivor guilt, and similar symptoms. Stigma might also come into this. Because they’ve had this particular virus, they might experience some negative interactions. So we should be ready to rehabilitate patients who are also facing these mental health challenges.
There are also many different presentations of COVID-19. Anyone who is admitted for rehabilitation after surviving COVID-19 could present very differently than other patients. They could have neurological issues, sensory problems, or other problems that we don’t see frequently on the units. Each person will have to be assessed very carefully and treated based on the individual assessment, and not just grouped together because they have all had COVID-19.
How can inpatient rehabilitation units prepare to treat COVID-19 survivors?
There are issues around the physical environment that we need to address. Having proper infection prevention and control, including masking and appropriate physical distancing, will be necessary.
Physiotherapists will also need to be aware of the many ways COVID-19 patients can present to their unit or clinic. In addition to this, physios may also want to brush up on respiratory therapy, since these kinds of cases have historically been rare in inpatient rehab environments. This is especially important for COVID-19 survivors who may also have other lung conditions, such as asthma.
What options are there for helping COVID-19 survivors rehabilitate at home?
It is possible that some of these patients will be discharged right to home from acute care. However, my hope is for these patients to have adequate home-support services so they can continue their recovery. This could be outpatient rehab provided through hospital, it could be home care, it could be accessed through a private care provider, or done online, through telerehabilitation. Telerehab uses technology and the internet to provide rehab services, often through videoconferencing, or monitoring the patient’s exercise remotely.
The caveat is that we need to make sure these services are planned on an individual level. Not everyone may have access to Internet or is able to receive home care, so we need to make sure we’re working with the patient to get the best rehabilitation option for them.
Read Lisa Sheehy’s full publication and considerations here.
Lisa Sheehy is an investigator at Bruyère. She has worked as a physiotherapist in hospital and private clinic settings, including in geriatric and neurological rehabilitation, since 1993. She returned to school in 2004 and completed her MSc and PhD in Rehabilitation Science at Queen’s University in 2013. She has worked at Bruyère since 2014, first as a Postdoctoral Fellow and now as a Research Associate. Her primary research area is the use of technology for rehabilitation.