Effectiveness of a multidisciplinary programme to improve functional outcomes of patients following severe COVID-19 infection in Malaysia: a retrospective study

Abstract

Evidence-based, specialised rehabilitation interventions are key to improving functional outcomes for patients with complications caused by severe COVID-19 infection, who often have complex needs and a wide range of functional impairments. The aims of this study were to determine the effectiveness of a structured inpatient, personalised, interdisciplinary rehabilitation programme, namely the COVID-19 Rehabilitation Inpatient Specialised Services, and to identify clinical predictors of rehabilitation effectiveness in patients after contracting COVID-19. This retrospective study involved 154 patients who underwent rehabilitation under the COVID-19 Rehabilitation Inpatient Specialised Services programme at a single centre between 1 July and 31 October 2021. The modified Barthel Index, Post-COVID-19 Functional Scale, modified Medical Research Council Dyspnoea Scale scores, and actual effectiveness derived from the modified Barthel Index scores were used to measure outcomes. The mean age of patients was 49.8 ± 14.3 years. Overall 48.1% (n=74) had required intubation, 70.1% (n=108) had been critically ill, and 21.4% (n=33) remained dependent on oxygen therapy beyond discharge. There was a statistically significant improvement in mean modified Barthel Index scores (45.2 vs 66.3, P<0.001), median post-COVID-19 Functional Scale score (4 vs 3, P<0.001) and median modified Medical Research Council scores (4 vs 3, P<0.001) following the rehabilitation intervention. Acute kidney injury, oxygen therapy dependency, neurological complications and initial modified Barthel Index scores were significant predictors of rehabilitation effectiveness (adjusted R2=0.23, P<0.001). The COVID-19 Rehabilitation Inpatient Specialised Services programme was effective in improving functional outcomes of hospitalised patients with severe to critical COVID-19 infection. By identifying factors that predict rehabilitation effectiveness, allied healthcare professionals can administer more focused rehabilitation efforts tailored to the specific needs of patients, thereby enabling them to achieve their maximum potential functional outcomes.