Community-Based Rehabilitation and Patient-Centered Outcomes in Survivors of Critical COVID-19 Attending an Intensive Care Recovery Clinic

Abstract

Objective

To examine the occurrence of physical and cognitive impairments among survivors of critical coronavirus disease of 2019 (COVID-19) who attend an intensive care unit (ICU) recovery clinic and describe their utilization of community-based rehabilitation (physical and occupational therapy).

Design

Retrospective, observational cohort study and multisite practice analysis.

Setting

ICU recovery clinics at 4 academic medical centers.

Participants

Adults (median age 56 [interquartile range, {IQR}, 47–64] years, 60% female) surviving acute respiratory failure caused by COVID-19 who required advanced respiratory support.

Main outcome measures

Six-minute walk test (6MWT) and Montreal Cognitive Assessment (MoCA).

Results

Patients attended the ICU recovery clinic (n=163) in a median of 43 (IQR, 30-60) days after discharge. Ninety-four patients (58%) participated in at least 1 community-based rehabilitation session, 52 (32%) never participated, and 17 (10%) did not have data available. Patients walked a median [IQR] of 282 [150-390] meters on the 6MWT, and the median Short Physical Performance Battery (SPPB) score was 8 [4-11] with 63% of patients classified as physically frail (score ≤9/12). The median MoCA score was 26 [22-27], with 37% at least mild cognitive impairment (score of ≤26). Among patients who were driving before ICU admission, 44% had not returned to driving after hospitalization, and an additional 21% reported driving with new limitations. Patients who participated in at least 1 community-based rehabilitation session had longer ICU lengths of stay as well as worse performance on the 6MWT and SPPB at discharge compared with individuals not receiving postdischarge rehabilitation (P<.001).

Conclusions

Survivors of acute respiratory failure caused by critical COVID-19 who attended an ICU recovery clinic are at high risk of physical and/or cognitive impairments. Two-thirds of survivors participated in physical or occupational therapy at home or an outpatient center after hospital discharge. Patients with longer lengths of stay and more physical impairments at discharge are more likely to participate in community-based rehabilitation interventions.