key: cord-0991497-34dsftbd
authors: Paneroni, Mara; Vogiatzis, Ioannis; Bertacchini, Laura; Simonelli, Carla; Vitacca, Michele
title: PREDICTORS OF LOW PHYSICAL FUNCTION IN PATIENTS WITH COVID-19 WITH ACUTE RESPIRATORY FAILURE ADMITTED TO A SUB-ACUTE UNIT
date: 2021-01-30
journal: Arch Phys Med Rehabil
DOI: 10.1016/j.apmr.2020.12.021
sha: 67ac14240716cf2f6e2f71d8ea8d03bf7a809ad4
doc_id: 991497
cord_uid: 34dsftbd

Objective To document the level of physical function in patients with COVID-19 recovering from Acute Respiratory Failure (ARF) and investigate which patient clinical characteristics could predict physical function assessed by the Short Physical Performance Battery (SPPB) test. Design Cross-sectional study Setting Sub-acute unit of a Rehabilitation Institute. Participants 184 patients with COVID-19 (aged 18 years or older) who were admitted to a sub-acute unit to stabilize their condition and recover from acute respiratory failure due to COVID-19 Interventions Not applicable Main Outcome Measure At admission patients underwent the SPPB test, represented by the sum of three functional tests: standing balance, 4-meter gait speed (4-MGS), and five-repetition sit-to-stand (5-STS) motion. Comparisons between two SPPB score groups were performed by an unpaired t-test; multivariate stepwise linear regression analysis was employed to detect predictors of the SPPB score considering several clinical parameters. Results Participants were 74±12 years old, 52% were male and with more than two comorbidities in 43% of cases. SPPB score was 3.02±3.87 denoting patients’ profound physical dysfunction. Normal physical function was detected in only 12% of patients, whereas low, intermediate and severe impairment was found in 65%, 13% and 10% respectively. Age, both invasive and non-invasive ventilation use, and the presence of previous disability were significant predictors of SPPB. Patients without any comorbidities (8%) also exhibited low function (SPPB: 5.67±1.12). Conclusions The majority of survivors after COVID-19 experienced ARF due to pneumonia and exhibited substantial physical dysfunction influenced by age, mechanical ventilation need and previous disability. Further studies are needed to evaluate the role of rehabilitation to promote recovery and community reintegration in this population.

Setting: Sub-acute unit of a Rehabilitation Institute. functional tests: standing balance, 4-meter gait speed (4-MGS), and five-repetition sit-to-stand (5-STS) motion. 5 Comparisons between two SPPB score groups were performed by an unpaired t-test; multivariate stepwise 6 linear regression analysis was employed to detect predictors of the SPPB score considering several clinical 7 parameters.

8 Results: Participants were 74±12 years old, 52% were male and with more than two comorbidities in 43% of 9 cases. SPPB score was 3.02±3.87 denoting patients' profound physical dysfunction. Normal physical function 0 was detected in only 12% of patients, whereas low, intermediate and severe impairment was found in 65%, 1 13% and 10% respectively. Age, both invasive and non-invasive ventilation use, and the presence of previous 2 disability were significant predictors of SPPB. Patients without any comorbidities (8%) also exhibited low The aim of this pragmatic cross-sectional study was to show the level of physical function in another 8 cohort of patients with COVID-19 with ARF due to pneumonia, that were admitted to a sub-acute unit to 9 stabilize their condition. The secondary aim was to investigate which clinical characteristics during At the point of admission patients underwent the SPPB test, a standardized, objective, rapid and simple to 0 conduct assessment . 7 The SPPB represents the sum of results from three functional tests: standing balance, 4-1 meter gait speed (4-MGS), and five-repetition sit-to-stand (5-STS) manoeuvre. Each component is scored based 2 on a subscale, and the three sub-scores are added to obtain a summary score. 7 Scores between 0-3 denote severe 3 physical function disability, 4-6 low function, 7-9 intermediate function, and 10-12 normal function. 7 Predicted values for the SPPB were calculated using normative values for total SPPB score and a European population 5 aged ≥40 years, stratified for age and sex. 8 6 SPPB scores have been previously shown to be highly predictive of disability, hospitalization, 7 institutionalisation, and mortality in older patients. 9 The Cumulative Illness Rating Scale (CIRS) 10 score was 8 used to assess the number of comorbidities, whereas cognitive deficits were defined using a Mini Mental State 9 Examination score <20 points. We defined the presence of previous disability as the inability to walk without 0 assistance or a walking aid for at least 45 meters prior to COVID-19 infection.

Comparisons between groups were performed using an unpaired t-test. Stepwise multivariate linear 2 regression analysis was employed to investigate predictors of physical function captured by the SPPB score, The total SPPB score was 3.1±3.9 (26.8± 33.4% predicted normal), with 64% of patients exhibiting SPPB Figure 1 depicts the SPPB score distribution in relation to severity levels. Differences between patients 6 with a SPPB score ≤3.0 (bedbound patients) and those with SPPB >3.0 were significant for age, the number of 7 comorbidities, absence of any reported comorbidities, cognitive deficits and the presence of previous 8 disabilities (Table 1) . This pragmatic study highlights that physical function disability is highly prevalent in patients recovering from 8 ARF from COVID-19 infection, being present in approximately 2/3 of patients admitted to a dedicated sub-9 acute COVID-19 Department. The study confirms recent data from the literature, 4 demonstrating that age, 0 mechanical ventilation need, and previous disability may strongly influence this functional impairment. Importantly, our study confirms the value of the SPPB instrument to stratify physical function as part of 9 the onward referral process to rehabilitation services, in the absence of more sophisticated testing due to 0 infection risk. The routine bedside use of a simple and well documented test, such as the SPPB test, has been 1 well accepted and deemed useful in this population. population discharged from an acute context (we did not take into account patients remained in a high-intensity 7 care setting and patients with mild illness who were discharged home); b) the limited number of variables we 8 included in our regression analysis (due to the lack of other clinical information such as drug therapy performed 9 in the Emergency Area and social status) may limit the amount of valuable information that we could gather 0 from our results; c) the emergency situation in which the study was conducted affecting hospital capacity, 1 patient increase, resources, etc., which could have had a negative impact on patient autonomy. The majority of survivors after COVID-19 experienced ARF due to pneumonia exhibit substantial 7 physical dysfunction, influenced by age, mechanical ventilation need and previous disability. Screening 8 rehabilitation needs in the acute and sub-acute setting should be performed through simple functional and 9 disability assessments. Future studies on rehabilitation interventions are mandatory in order to define the role 0 rehabilitation could play in those recovering from COVID-19 pneumonia as severe dysfunction is observed 1 among these patients. 

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