key: cord-0873380-nqri9x47
authors: Torres-Castro, Rodrigo; Solis-Navarro, Lilian; Sitjà-Rabert, Mercé; Vilaró, Jordi
title: Functional limitations post-COVID-19: A comprehensive assessment strategy
date: 2020-08-28
journal: Arch Bronconeumol
DOI: 10.1016/j.arbres.2020.07.025
sha: e55b08bfea4f87472949b4b9437769ef6c54c184
doc_id: 873380
cord_uid: nqri9x47

nan

J o u r n a l P r e -p r o o f asymptomatic or mild, and about 20% cause severe respiratory compromises that need hospital management, eventually requiring invasive mechanical ventilation and life support, 2 which can lead to permanent sequelae and even death. 1 Muscle weakness is one of the most frequent problems in the Intensive Care Unit (ICU) and is often generated because of critical conditions that pose a vital risk.

Intensive care unit-acquired weakness (ICUAW) is one factor related to muscle weakness and its prevalence, in people who survive a critical illness, is close to 40%. 3 Critical illness survivors experience marked disability and deficiencies in physical and cognitive function that may even persist for years after their initial ICU stay. 4 Post-ICU-acquired disability is associated with rising health costs and the use of more medical care, reduced health-related quality of life, and prolonged unemployment. 5 Surviving older adults have limited activities of daily life (ADLs), reaching more significant limitations in basic ADLs such as walking, bathing, or dressing. 6 Disability in ADLs is associated with increased risk of institutionalization, more significant health care expenditures, more hospitalizations, and higher mortality rates. 4 Furthermore, post-critical illness patients present cognitive impairments and mental problems such as anxiety or depression that make returning to normal life more difficult. 7 Recent SARS-CoV-2 experience has revealed the need for a multidisciplinary rehabilitation approach, especially for those patients with advanced age, obesity, comorbidities, and organ failure. 8 The dimension of ADLs and physical capacity must be assessed due to the consequences of extended bed rest and/or mechanical ventilation and, in some cases, the use of sedatives. The importance of ADLs lies in the fact that they allow patients to be easily stratified by level of dependency and/or activity limitations and to guide rehabilitation strategies by groups with similar needs. 4 The ADLs and physical capacity evaluation are also a widely used recommendation for assessing the health status of people in the ageing process (those most severely affected by . There are tools to assess ADLs, such as the Barthel index or the Functional Independence Measure (FIM), 9, 10 as well as tests to assess physical fitness such as the six-minute walk test (6MWT) or the sit-to-stand test (STST) which have already been used in patients with COVID-19. 10, 11 The cognitive dimension must be evaluated by the consequences due to the use of medicaments and/or presence of delirium. Hypoglycemia, hyperglycemia, delirium, and in-hospital acute stress symptoms have been identified as prognostic factors of persistent cognitive impairment after critical illness. 7 Additionally, there is strong evidence that patients with delirium in the ICU are at a higher risk of long-term The quality of life dimension is necessary to assess because represent the perceptions, comfort, and feelings experienced during and after COVID-19 by the individual. We must not forget that one of the most crucial purposes of rehabilitation is to improve the quality of life by maintaining, improving, and reacquiring activities of daily living. 7 There are some quality of life questionnaires, such as the Short Form-36 (SF-36) or the European Quality of Life-5 Dimensions (E5-QD) that have been used in this type of patient. 10, 14 Another critical point in the assessment of post-COVID-19 patients is to consider the muscle function (peripheral/respiratory) that involves at least three dimensions. The peripheral muscles are crucial for carrying out the ADLs, for the physical capacity, and the respiratory muscles are important for the respiratory pump function. Their evaluation has been included in rehabilitation programs in the current context. 9, 10 Additionally, other factors would be to influence the functional rehabilitation of post-COVID-19 patients and may affect performance during therapeutic interventions; for The proposed model contemplates four different levels of severity: minimal, mild, moderate and severe functional limitations, which allow for adjusting the intervention according to the functional limitations present in each one. It is essential to classify the people into these groups because not all people will have the same impairments, mainly because the limitations to perform physical, cognitive, or functional tasks depend not only on the magnitude of the post-COVID 19 damage but also on the previous state of health, age, and comorbidities. We believe that in this way, the objectives can be better customized to the needs of each person.

Although there are other compromised systems, we think that these dimensions are the minimum to evaluate in a rehabilitation program. However, if the patient requires it, other important aspects that influence rehabilitation must be evaluated, such as nutritional support, psychosocial support, swallowing, or referral to other medical specialities.

Finally, we call on the professionals involved in rehabilitation to evaluate at least these five dimensions so that we can carry out interventions adjusted to the reality of each patient and thus improve their quality of life.

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Report of the WHO-China Joint Mission on Coronavirus Disease

An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults

Physical Impairments Associated With Post-Intensive Care Syndrome: Systematic Review Based on the World Health Organization's International Classification of Functioning, Disability and Health Framework

Clinical review: intensive care unit acquired weakness

Long-term cognitive impairment and functional disability among survivors of severe sepsis

Post-intensive care syndrome: its pathophysiology, prevention, and future directions

Rehabilitation of COVID-19 patients

Feasibility and Efficacy of the Pulmonary Rehabilitation Program in a Rehabilitation Center: CASE REPORT OF A YOUNG PATIENT DEVELOPING SEVERE COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME

Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study

How the COVID-19 infection tsunami revolutionized the work of respiratory physiotherapists: an experience from Northern Italy