Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors.

Single-centre observational study with convenience sampling, so prone and supine groups were not randomly assigned and may differ in ways not measured. Prone patients were more severely ill: they had longer invasive mechanical ventilation (24 vs 12 days), longer neuromuscular blockade (18 vs 7 days), longer ICU stay (27 vs 14 days), and more tracheostomies (15 of 34 vs 7 of 53). All patients received physiotherapy after neuromuscular blockade withdrawal, so the study cannot separate the effect of prone positioning from the effect of rehabilitation or other ICU exposures. Muscle strength was assessed with manual muscle testing, a subjective five-point method, not with a hand-held dynamometer. Neurologists did not perform peripheral nerve assessment, so nerve injuries could have been missed. The timing of arm position changes was not recorded, so the study cannot link muscle strength outcomes to how often the swimmer position was rotated. Corticosteroid exposure was not recorded, which could influence muscle deterioration. Follow-up ended at hospital discharge, so longer-term recovery after discharge was not assessed. Patients who died before ICU discharge and those treated only with noninvasive ventilation were excluded; 87 of 128 admitted patients were analysed.

This research received no specific grant from any funding agency. The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work.

Do not read this as proof that the swimmer position is safe or that prone positioning cannot cause nerve injury. The study was observational, arm-position timing was not recorded, neurologists did not assess the limbs, and the report only says that no significant adverse events were reported.