Cognitive and psychological recovery patterns across different care pathways 12 months after hospitalization for COVID-19: A multicenter cohort study (CO-FLOW).
L Martine Bek, Merel E Hellemons, Julia C Berentschot and 8 others
PMID 37043952WHAT IT FOUND
Cognitive deficits and psychological symptoms improved over 12 months after hospitalization for COVID-19, but 21% still had cognitive deficits at 12 months.
The no-rehabilitation group had the fewest cognitive and psychological problems. The groups differed in illness severity.
Key findings
01The share of participants with objective cognitive deficits fell from 42% at 3 months to 30% at 6 months and 21% at 12 months.
02PTSD scores decreased between 3 and 6 months, and PTSD prevalence fell from 12% at 3 months to 7% at 12 months.
03At 12 months, the skilled nursing rehabilitation group had the highest prevalence of cognitive deficits (37%), and the medical rehabilitation group had the highest prevalence of cognitive failure (27%) and PTSD (15%).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was observational, so care pathways were not assigned randomly and cannot show that one rehabilitation type caused better or worse outcomes. The groups differed before follow-up: the skilled nursing group was older and had more comorbidities, while the medical rehabilitation group had longer hospital stays, more ICU admission, more delirium, and more employment before COVID-19. There was no pre-COVID measure of cognition or psychological function, so recovery was judged relative to the first study assessment, not to each person's usual baseline. The Montreal Cognitive Assessment was not repeated when the first score was 26 or above, so later cognitive decline could have been missed. Language and migration background may have affected cognitive scores; participants with an overt language barrier were not assessed with the Montreal Cognitive Assessment. Comorbidities such as cardiovascular or pulmonary disease can also cause cognitive deficits, so some scores may reflect other health conditions. Not all participants attended the 3-month visit, and the analysis included those with at least one outcome, which can affect time trends.
Declared interests
The study was supported by a grant from the Netherlands Organization for Health Research and Development, plus Rijndam Rehabilitation and Laurens. The funders had no role in the design, conduct, data management, analysis, interpretation, manuscript preparation, review, approval, or submission. The authors declared no competing interests.
The easy way to misread this
Do not conclude that no rehabilitation is better than rehabilitation, or that medical rehabilitation causes more cognitive failure and psychological symptoms. The groups were formed by clinical need and differed in age, illness severity, hospital stay, ICU admission, delirium, comorbidities, and employment status, so the differences in outcomes may reflect who was referred to each pathway rather than the effect of the pathway.