key: cord-0989452-f09fxnk9
authors: Lew, Henry L.; Oh-Park, Mooyeon; Cifu, David X.
title: The War on COVID-19 Pandemic: Role of Rehabilitation Professionals and Hospitals
date: 2020-05-04
journal: Am J Phys Med Rehabil
DOI: 10.1097/phm.0000000000001460
sha: 19f1669bb49623bd3dc7bd0fc4f929d3c6e4e2d9
doc_id: 989452
cord_uid: f09fxnk9

The global outbreak of coronavirus disease (COVID-19) has created an unprecedented challenge to the society. Currently, the United States stands as the most affected country, and the entire healthcare system is affected, from emergency department, intensive care unit, post-acute care, outpatient, to home care. Considering the debility, neurological, pulmonary, neuromuscular and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with COVID-19. Clinicians across the nation’s rehabilitation system have already begun working to initiate intensive care unit-based rehabilitation care and develop programs, settings and specialized care to meet the short- and long-term needs of these individuals. We describe the anticipated rehabilitation demands, and the strategies to meet the needs of this population. The complications from COVID-19 can be reduced by (1) delivering interdisciplinary rehabilitation that is initiated early and continued throughout the acute hospital stay, (2) providing patient/family education for self-care after discharge from inpatient rehabilitation at either acute or subacute settings, and (3) continuing rehabilitation care in the outpatient setting, and at home through ongoing therapy either in-person or via telehealth.

In December 2019, a series of patients with severe pneumonia of unknown etiology was reported in the city of Wuhan, Hubei province, China. It came to be known as coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 On March 11 th , 2020, the World Health Organization (WHO) declared the SARS-CoV-2 outbreak a worldwide pandemic. As of April 21, 2020, there were 2,561,044 confirmed cases of Physical Medicine and Rehabilitation (PM&R) physicians in some hospitals were assigned to Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

medical units caring for COVID-19 patients while maintaining their roles in consultation and telehealth outpatient practice. As social distancing, shelter-in-place, and personal protective equipment (PPE) measures have been implemented to reduce the spread of infection, telehealth (also referred to as telemedicine or tele-practice) has become essential for continuity of care, especially in patients with outpatient rehabilitation needs.

Critical illness and intensive care unit (ICU) care influence a wide range of long-term patient outcomes, with some impairments persisting beyond the ICU stay and likely for life. To date, 4-11% of all individuals (i.e., >30,000) infected by SARS-CoV-2 are estimated to develop profound COVID-19 requiring an intensive care unit stay that will include pulmonary support and artificial ventilation. 3 Another 15% (i.e., >95,000) will require acute hospitalization and pulmonary care. While there may be unique neurologic and neuromuscular conditions and sequelae from the SARS-CoV-2 itself (e.g., stroke, encephalopathy, other organ involvement) 4 , the overall debility, acute hospital/ICU stay and need for ventilator usage alone will result in significant physical, cognitive and functional deficits that will require both acute and long-term rehabilitation interventions and care.

Neuromuscular weakness and impairments occur in up to 50% of all individuals who have prolonged ICU stays due to critical illness polyneuropathy (CIP), which can result in ongoing dysfunction for greater than 5 years in 85% of individuals. Pulmonary dysfunction may be seen in up to 40% of individuals who have acute respiratory disorders resulting in the need for ventilators.

In fact, for individuals who require artificial respiration on a ventilator for >48 hours, 65% will Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

continue to have functional deficits at 1 year, 75% will have cognitive impairment at time of hospital discharge and 45% at 1 year, and more than 25% will have significant psychiatric issues related to their illness, including major depression and posttraumatic stress disorder in the first year after discharge. 5 Thus, in addition to pulmonary rehabilitation, survivors of COVID-19 may require long term cognitive and physical rehabilitation, especially those who develop central nervous system dysfunction from ischemia. 4 Physicians, psychologists and therapists across the nation's rehabilitation system have already begun working to initiate ICU-based rehabilitation care for individuals with COVID-19 and are developing programs, settings and specialized care to meet the short-and long-term needs of these individuals. We believe the complications from COVID-19 can be reduced by (1) delivering interdisciplinary rehabilitation that is initiated early and continued throughout the acute hospital stay, (2) providing patient/family education for self-care after discharge from inpatient rehabilitation at either acute or subacute settings, and (3) continuing rehabilitation care in the outpatient setting, and at home through ongoing therapy either in-person or via telehealth.

Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

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