Letter to the editors | Volume 36, Article 168, 09 Jul 2020 | 10.11604/pamj.2020.36.168.23823

Rehabilitation of post-COVID-19 patients

Mouna Asly, Asmaa Hazim

Corresponding author: Mouna Asly, Department of Physical Medicine Physique and Rehabilitation

Received: 29 May 2020 - Accepted: 03 Jun 2020 - Published: 09 Jul 2020

Domain: Physical medicine and rehabilitation�or Physiatry

Keywords: Rehabilitation- COVID-19- Disabilities

©Mouna Asly et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Mouna Asly et al. Rehabilitation of post-COVID-19 patients. Pan African Medical Journal. 2020;36:168. [doi: 10.11604/pamj.2020.36.168.23823]

Available online at: https://www.panafrican-med-journal.com/content/article/36/168/full

Home | Volume 36 | Article number 168

Letter to the editors

Rehabilitation of post-COVID-19 patients

Rehabilitation of post-COVID-19 patients

Mouna Asly1,&, Asmaa Hazim2

 

1Department of Physical Medicine Physique and Rehabilitation, 2Department of Neurology, University of Mohamed 6 for health sciences UM6SS

 

 

&Corresponding author
Mouna Asly, Department of Physical Medicine Physique and Rehabilitation

 

 

To the editors of the Pan African Medical Journal    Down

Since the first case of coronavirus disease presented in Wuhan, China on December 31, 2019, the disease had rapidly spread to the rest of the World accounting for high morbidity and mortality. In Morocco, the first COVID-19 case was confirmed in Casablanca on 2 March 2020. Then, cases have increased alarmingly in the last month. On 23th March 2020, the Moroccan health ministry has authorised doctors to start using hydroxychloroquine or chloroquine and azithromycine in treating persons hospitalized with confirmed COVID-19, if no contraindications. As of 26 May 2020, there have been 7,577 confirmed cases, of which 4,881 have recovered and 202 have died. The SARS CoV-2 syndrome may be characterized by mild respiratory diseases or moderate-to-severe pneumonia, which can cause Acute Respiratory Distress Syndrome (ARDS) and multi-organ failure (Cardiac injury, Neurologic effects, Venous thromboembolism, liver, kidney). Rodriguez-Morales et al. in a meta-analysis reported that around 32.8% developed ARDS, 20.3% patients required critical care, and 6.2% developed shock. Fatal outcomes were observed in 13.9% patients [1]. Old age, chronic diseases (hypertension, respiratory and cardiovascular diseases, diabetes), smoking history were significantly associated with the severity of the disease [2,3].

 

Post COVID-19 ARDS can progress to restrictive respiratory failure due to respiratory muscle weakness, and secondary pulmonary fibrosis with impaired diffusion [4,5] associated with physical deconditioning. Both of ARDS and the prolonged hospital stay due to COVID-19, including time spent in an intensive care units lead respiratory, physical, and psychological dysfonction in patients. This puts them at greater risk for developing post-intensive care syndrome (PICS). PICS is defined as new or worsening impairment in physical, cognitive, or mental health status arising after critical illness and persisting beyond discharge from the acute care setting. [6,7]. The presentation of PICS can be varied. The common symptoms include: Physical impairment: neuromuscular weakness, fatigue, decreased mobility, recurrent falls, deconditioning; Psychological impairment: anxious or depressed mood, sexual dysfunction, sleep disturbances; Cognitive issues: memory disturbance, slow mental processing, poor concentration, Recognizing Delirium). The symptoms can last for a few months to many years post recovery. Family members of patients can be also affected similarly [8,9].

 

Pulmonary, musculoskeletal, neurological, cardiac, psychological sequelae in some COVID-19 survivors, can affect a person´s ability to perform activities of daily living and lead social restrictions. Rehabilitation care will serve as an important link in the continuum of care, especially for severe forms and dependent elderly with chronic diseases. Rehabilitation interventions must be based on each patient´s individual needs. Therefore, after COVID-19 recovery, patients should be assessed for possible or occuring deficiencies to determine the modalities of rehabilitation (hospital or ambulatory care, intervenants, programs) and they should be managed by a multidisciplinary team which includes physical medicine and rehabilitation doctor, psychologist, physiotherapist, occupational therapist and respiratory therapist, with the use of pharmacological and non-pharmacological interventions. Depending on the deficiencies, Rehabilitation program includes [10]: Neuromotor rehabilitation with: Passive mobilization, active exercises and postures to recover or preserve of joint range of motion of lower limbs, shoulder girdle and cervical spine; Muscle strengthening begin with overall muscle strengthening, using cycloergometers. Progressive-intensity analytical and dynamic muscle strengthening strengthening can be combined with functional exercices (bed mobility, sitting out of bed, sitting balance, sit to stand, walking); Progressive verticalization to fight against orthostatism disadaptation, with appropriate venous compression and monitoring blood pressure and pulse.

 

Respiratory rehabilitation: Breathing exercises aimed to improve breathing control may potentially be proposed, under assessment and monitoring of exercise tolerance. They are effectiveness for increasing tidal volume and reducing psychological consequences (stress, anxiety and depression); Lung secretion clearance should implement, if necessary, using expiratory flow accelerator (EFA) technique; Neuropsychological rehabilitation: can be proposed after assessment to patients with cognitive disorders, related to hypoxic encephalopathy or to encephalic lesions due to coronavirus (stroke, etc.); Speech therapy is proposed in case of swallowing or voice disorders after prolonged intubation or focal brain damage; Occupational therapy: is indicated to elderly, who lost their autonomy and have limitations in carrying out their daily activities. It allows to encourage of independence and to accelerate for return home; Psychological care is offered to patients with psychological disorders: anxiety, depression, post-traumatic stress; Reconditioning for exercise, including cycloergometer exercises and muscular strengthening, will be helpful to prepare for a return to socio-professional activities. Depending on the case, this rehabilitation can be carried out in several organisational modalities: inpatient, outpatient or at home. In the context of the COVID-19 pandemic, the use of remote monitoring and mobile intelligence technologies with wearable devices can made possible to practice intelligent and digital remote rehabilitation. Remote virtual reality exercises can be offered to these patients, the effectiveness and safety of these tools have been proven to be non-inferior to traditional approaches.

 

 

Conclusion    Down

We share the health situation in Morocco during the COVID-19 pandemic and we propose rehabilitation guidelines for patients recovered from COVID-19 and who are still experiencing disabilities.

 

 

Competing interests Up    Down

The authors declare no competing interest.

 

 

Authors' contributions Up    Down

Mouna ASLY did the drafting of the manuscript. Asmaa HAZIM: critical revision. All the authors have read and agreed to the final manuscript.

 

 

References Up    Down

  1. Rodriguez-Morales A, Cardona-Ospina J, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana J et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis. Mar-Apr 2020;34:101623. PubMed | Google Scholar

  2. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Arch Acad Emerg Med. 2020;8(1):e35. PubMed | Google Scholar

  3. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020 May;94:91-95. PubMed | Google Scholar

  4. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020 Jun;30(6):3306-3309. PubMed | Google Scholar

  5. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-4389. Google Scholar

  6. Gautam Rawal, Sankalp Yadav, and Raj Kumar. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017 Jun;5(2):90-92. PubMed | Google Scholar

  7. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders´ conference. Crit Care Med. 2012 Feb;40(2):502-9. PubMed | Google Scholar

  8. Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH et al. Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med. 2003;31(4):1012-6. PubMed | Google Scholar

  9. Gries CJ, Engelberg RA, Kross EK, Zatzick D, Nielsen EL, Downey L et al. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest. 2010;13792):280-7. PubMed | Google Scholar

  10. HAS. Rapid responses in the context of COVID-19-Management of post-COVID-19 patients in Physical Medicine and Rehabilitation units (MPR), in Follow-on Care and Rehabilitation units (SSR) and on return home. 16 April 2020.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Letter to the editors

Rehabilitation of post-COVID-19 patients

Letter to the editors

Rehabilitation of post-COVID-19 patients

Letter to the editors

Rehabilitation of post-COVID-19 patients

Volume 36 (May - Aug 2020)
This article authors
On Pubmed
On Google Scholar
Citation [Download]
EndNote
Reference Manager
Zotero
BibTex
ProCite

Navigate this article
Key words

Rehabilitation- COVID-19- Disabilities

PlumX Metrics
Rehabilitation of post-COVID-19 patients