The Need for Rehabilitation Following a COVID-19 Hospitalization

RATIONALE: Patients admitted with COVID-19 may demonstrate lasting symptoms of breathlessness, fatigue and emotional distress. The acute COVID-19 event can also impact activities of daily living and return to work;therefore COVID-19 can have lasting physical, emotional and social effects. Pulmonary rehabilitation services are well placed to provide the complex, multidisciplinary intervention required to treat the lasting effects of COVID-191, however the volume of patients requiring input is unknown. This study aims to explore the numbers of patients that self-identify a need for a rehabilitation intervention following discharge from hospital post COVID-19. Methods: Patients admitted to the University Hospitals of Leicester, UK between March and August 2020 were called by a healthcare professional following discharge to discuss lasting symptoms and offer a face to face rehabilitation assessment and intervention. Where it was not possible to contact patients, a letter was sent with contact details for patients to call back if they displayed ongoing symptoms. Patients that presented to hospital without a primary diagnosis of COVID and no respiratory symptoms were screened out and not contacted for the COVID rehabilitation pathway. Results: 938 patients who were discharged from the University Hospitals of Leicester between March and August 2020 were screened for rehabilitation. 37% (n=348) patients were deemed not appropriate (discharged to nursing home= 23, palliative=5, transferred out of area=18, incidental positive test without COVID symptoms= 127, not stated= 173). 13% (n=124) patients were not able to be contacted and did not return a call following postal contact. The mean [SD] time to telephone call was 32[18] days2. 50% (n=466) patients were assessed for ongoing symptoms and rehabilitation needs and 39% (n=184) of those assessed did not identify any rehabilitation needs. 61% (n=282) of patients assessed identified rehabilitation needs and were referred to a COVID rehabilitation program. The primary reported symptoms were fatigue, breathlessness, and limitations with activities of daily living2. Conclusion: 30% of patients discharged following COVID-19 identified rehabilitation needs. 37% of patients discharged were deemed unsuitable. Of those contacted, 61% identified ongoing symptoms that required a referral to rehabilitation, which places a burden on current pulmonary rehabilitation services. 1.Spruit, M., et al. (2020) COVID-19: Interim Guidance on Rehabilitation in the Hospitals and Post Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. ERJ 50(6).2.Daynes, E., et al (2020) COPD assessment test for the evaluation of COVID-19 symptoms. Thorax 0(1-3).