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Right now in the physiotherapy profession all eyes are on the growing need for post COVID rehab. As we are still early days in being in a position to fully understand this unmet need, we are learning as we go along. To be able to create rehab programmes or create services to solve this need we first need to understand how long we expect someone to be unwell for post-covid infection. As we are living through the pandemic this is difficult but we can learn from history and previous coronavirus infection.
This is exactly what a new systematic review published in Physical Therapy at the end of July has aimed to do. The research team aimed to compare physical function and fitness outcomes in people infected with SARS-CoV to healthy controls. They searched reputable and relevant databases specifically using the key words associated to SARS-CoV and physical fitness. 10 articles were used for the review including 516 patients. The measures used to assess fitness and function were VO2 max and the 6MWT.
Unsurpirsingly the VO2max and 6MWT were reduced after SARS infection than the control groups. The degree of reduction was influenced by many factors including pre-existing co-morbidity and length of infection but exercise and rehab was effective at increasing speed of recovery.
Clinical Implications
Firstly it is important to consider that the applicability of these findings are based on the similarities between SARS-CoV and COVID-19 both in clinical presentation and pathology. What this evidence tries to do is help shape how long we should be thinking symptoms persist for and the impact on quality of life and function. According to the findings from this systematic review most of the recovery in function happens in the first few months post-infection. However for many people incomplete recovery takes place and we should be thinking impairments may last for up to 2 years post infection.
The aim of this systematic review was to help consider implications for COVID-19 rehab not tell us exact answers as this is not known.
It is also interesting to consider that there is likely a different need for those who required ICU level care versus normal hospital care as there is mixed picture of COVID-19 related post-viral fatigue and lung tissue damage as well as the well understood post critical care aquired weakness and delirium.
Also it is worth stating that this is only considering an individual being infected a single time not multiple times as current COVID-19 evidence suggests is possible. Additionally only using the 6MWT as the physical outcome measure does limit real-world applicability as does not consider more socioeconomic considerations as occupation health considerations.
Are you involved in Post-COVID-19 rehabilitation and want to learn about the current best practice? Why not take a look at our course below.
People with severe COVID-19 infection have rehabilitation needs in the acute, post-acute and long-term phases of the disease. Many people who have suffered from COVID-19 may now be at risk of long-term impairment or disability. Physiotherapists are critical to the rehabilitation efforts in all phases of this disease. Rehabilitation has a positive effect on health and functioning outcomes, it improves recovery and can reduce disability, it may facilitate early discharge and reduce the risk of readmission. Physiotherapists also play a key role in supporting and empowering people through rehabilitation process.