Exploring the Ability to Perform Activities of Daily Living and Cognitive Status after Hospitalization with COVID-19: A Multiple Case Study.
Kate Allen Christensen, Jan Christensen, Signe Janum Eskildsen
PMID 35418813WHAT IT FOUND
Eleven COVID-19 survivors had reduced ADL ability at discharge and three months later.
Motor skills improved in 75% of those followed up, but process skills and cognition often stayed impaired. OT should assess ADL performance, not rely on cognitive screens alone.
Key findings
01At discharge, all cases had ADL motor ability below the 2.0-logit cut-off, indicating clumsiness or increased physical effort or fatigue; at follow-up, all improved, and six cases (75%) showed a significant motor improvement.
02ADL process ability was more variable: nine cases (82%) were below or just above the 1.0-logit cut-off at discharge, and only three cases (38%) showed significant improvement at follow-up.
03Cognitive screening was often abnormal, but MoCA scores did not follow ADL process scores: at discharge, the median MoCA score was 24 and eight cases (73%) scored below 26; at follow-up, four of six cases (67%) scored below 26.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 11 patients were included, and follow-up data were incomplete: AMPS was available for 8 patients and MoCA for 6 patients at three months. There was no control group, so the study cannot show that time, hospital treatment, or OT caused the changes. The sample was convenience and nonconsecutive, with varied age, illness severity, ICU stay, length of hospital stay, and prior ADL ability. Some patients had a primary diagnosis other than COVID-19, making it harder to attribute findings to COVID-19 alone. The AMPS tasks chosen for some patients may have been too easy to reveal process-skill difficulties, especially at follow-up. Follow-up settings differed: some assessments were done in community rehabilitation units and some at the hospital, which may have affected performance. Baseline AMPS scores before hospital admission were not known, so the study could not compare follow-up scores with each patient's true pre-illness level. MoCA was also used in a separate project, causing one missing follow-up MoCA and one 60-day gap between MoCA and AMPS. The study explored patterns rather than testing an intervention, so it cannot recommend a specific OT treatment.
The easy way to misread this
Do not read the 75% motor improvement as proof that rehabilitation restored ADL ability. There was no control group, only eight follow-up AMPS were available, and process ability and cognition often remained impaired.