The importance of rehabilitation in COVID-19 patients

COVID-19, first diagnosed in China in December 2019, has since spread across the world and affected over 37 million individuals. While most people infected with COVID-19 experience mild to moderate illness and recovery without the need for hospitalization or medical intervention, some require intensive care for weeks to months. Despite an estimated 28 million individuals who have “recovered” from COVID-19, there is increasing evidence of persistent symptoms and even organ damage and dysfunction following recovery. In a study with 179 patients in Italy, only 12.6% of patients were symptom-free at a mean follow-up of 60.3 days after onset of first COVID-19 symptoms. While none had acute signs of infection, many patients experienced persistent fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%), and chest pain (21.7%). Worsened quality of life was also reported by 44.1% of patients.

For patients that experience severe cases of COVD-19, especially those who required extensive hospital stays and mechanical ventilation, recovery can be a long process. Physical, cognitive, and mental rehabilitation is vital in these patients to ensure comprehensive health and wellbeing. Many survivors of COVID-19 find performing the simplest tasks difficult and may feel they will never recover. Tasks such as brushing their teeth or eating can cause exhaustion and shortness of breath. Depression is a real threat to recovering COVID-19 patients because they are separated from their families, can no longer do the things they could before, and cannot fathom returning to their previous activities.

Rehabilitation uses an interdisciplinary team approach to optimize each patient’s abilities to improve physical endurance and facilitate a safe discharge home where patients will continue their recovery. Rehabilitation focuses on energy conservation to decrease oxygen demand while building a therapy program to meet patient needs. Integrating speech therapy services assists patients to relearn strategies to perform tasks often taken for granted when well. Patients recovering from COVID-19 often find difficulty with new learning, sequencing of tasks, and some suffer from language and swallowing difficulty due to extreme weakness. Physical therapy works with patients and families to safely transfer and ambulate again using adaptive equipment and safety measures. Occupational therapy helps patients and families learn how to adapt daily life needs such as bathing and dressing to optimize independence. Nurses specially trained in rehabilitation will help patients and families integrate therapy and compensatory techniques into daily life. The rehabilitation nurses carry over training and education delivered by therapy, provide education for self-care, dietary needs, oxygen management, and safety. Social Work and Psychology services assist with the mental well-being of patients and assist with the adjustment needed for recovery.

While most COVID-19 patients experience only mild symptoms, some patients require hospitalization and intensive care for prolonged periods of time. For these patients, a multidisciplinary rehabilitation, including physical, cognitive, and mental rehabilitation, is crucial. Incorporating specialized nursing, physical therapy, occupational therapy, speech pathology, social work, and psychological services is crucial in comprehensive health and well-being during recovery among these COVID-19 patients.

Waneta Carter is a rehabilitation nurse. Christine Lau is a physician.

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