Recovery of activities of daily living in COVID-19 patients requiring intensive care unit or medical care unit: an observational study on the role of rehabilitation in the subacute phase.
Chiara Notarstefano, Federica Bertolucci, Mario Miccoli and 1 others
PMID 38028154WHAT IT FOUND
Post-ICU patients arrived with worse function but recovered to the same level as medical ward patients.
Independence improved from a Barthel score of 10 to 70. This proves early rehab helps severe cases catch up, but without a control group, we cannot separate the treatment's effect from natural recovery.
Key findings
01Patients previously in the ICU had significantly worse function on admission but no significant differences compared to medical ward patients at discharge.
02Overall independence in daily activities improved from a median Barthel Index of 10 to 70, though this did not reach pre-admission levels of 100.
03Dysphagia affected 61.8% of ICU patients on admission compared to 9.84% of MCU patients, but rates were similar at discharge.
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
There was no control group of patients who did not receive rehabilitation, so it is impossible to determine if the improvements were due to the treatment or natural recovery over time. The study was retrospective, which carries a risk of missing data and bias. Physical performance tests like the 6-minute walk test were not performed because most patients were unable to complete them, limiting the granularity of functional assessment. Neurological complications may have been underestimated because neurophysiological investigations were not always available in the COVID setting.
Declared interests
The study was funded by the Tuscany Region Health System under a specific research grant for COVID-19 projects.
The easy way to misread this
Do not assume the rehabilitation program caused the functional recovery. Because there was no control group, the observed improvements from admission to discharge cannot be distinguished from natural recovery that might have occurred without the specific interventions.