Comparing rehabilitation outcomes for patients admitted to the intensive care unit with COVID-19 requiring mechanical ventilation during the first two waves of the pandemic: A service evaluation.
Jonathan Weblin, Adam Harriman, Katrina Butler and 2 others
PMID 36528463WHAT IT FOUND
Patients in the second pandemic wave, who received physiotherapy five days a week instead of seven, had significantly lower mobility at ICU and hospital discharge.
They were also more likely to need ongoing rehabilitation after going home.
Key findings
01Patients in Wave 2 had significantly lower Manchester Mobility Scores at ICU discharge (median 4 vs 5) compared to Wave 1.
02At hospital discharge, 44% of Wave 2 patients could walk over 30 meters unaided (MMS 7), compared to 83% of Wave 1 patients.
0366% of Wave 2 patients required further rehabilitation after discharge, significantly higher than the 49% of Wave 1 patients.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a single-centre observational service evaluation, not a randomised controlled trial, so causality cannot be firmly established. Staffing ratios and patient acuity (APACHE II scores) differed between waves, and other clinical management factors like tracheostomy rates and potential new viral variants may have influenced outcomes. Data collection methods differed between waves (prospective for Wave 1, mixed for Wave 2), introducing potential bias. The study did not record the consistency or frequency of rehabilitation delivered, only the staffing model. The impact of evolving treatments, such as increased dexamethasone use in Wave 2, was not controlled for and may explain some differences.
Declared interests
No additional funding was received. The authors declare no competing financial interests or personal relationships.
The easy way to misread this
Do not conclude that five-day physiotherapy alone caused the worse outcomes. The study is observational and confounded by other changes between waves, including lower patient severity scores, different tracheostomy rates, and evolving medical treatments like dexamethasone use.