ReCov: Rehabilitation after covid-19 in Stockholm

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ReCov: Rehabilitation after covid-19 in Stockholm

Malin Nygren-Bonnier, PT, docent, senior lecturer

Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet

Medical unit Occupational therapy and Physiotherapy, Theme Women's health and Health professionals, Karolinska University Hospital

In collaboration with UppCov:

PI: Judith Bruchfeld, senior consultant, docent , Karolinska University Hospital and Karolinska Institutet Co-PI: Michael Runold, senior consultant, PhD, Karolinska University Hospital

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Number of cases 576 606 W: 304 052 M:272554

Number of deaths 11 815

W:5473 M:6342 ICU

4819

W: 1371 M: 3448

Sweden

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Varying symptoms and signs from different organs

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Physical function

Work ability and daily activities

Röst- och sväljfunktion Psychological function

Cognitive function

Fatigue

Belli S et al. Eur Respir J, 2020 Halpin SJ et al. J Med Virol, 2020 Carfi A et al. JAMA 2020

Gupta A, et al. Nat Med. 2020

Neurological function

Pain Cardiovascular

function

Respiratory function

Smell and taste

Patient

Dyspnea

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Rehabilitation

• A coordinated multidisciplinary and multi-professional approach

• Acute care

• Post discharged

• Long-term

• Post-covid-19 syndrom rehabilitation

• Patient-centered and tailored to individual needs

• Rehabilitation is central to optimize recovery for older people to maintain function. The need is dependent on the severity of illness, and also the degree of pre-existing frailty and functional impairment

Singh SJ et BMJ Open, 2020 Spruit et al. Eur Respir J 2020

Agostini F et al. J Rehabil Med 2021

Trisha Greenhalgh et al. BMJ, 2020

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Respiratory rehabilitation in elderly patients with covid-19

Liu et al 2020, Complementary Therapies in Clinical Practice

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• Physical exercise and respiratory muscle training

• 6 weeks

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Rehabilitation through the care chain

Non hospitalized patients Care at residential care/

nursing homes

Acute Care Post-acute care

-Inpatient rehabiliation -Specialized rehabiliation

-Outpatient and home-based rehabilitation

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Multidisciplinary and multi-professional

follow-up after covid-19 (ReCov + UppCov)

• Infectious diseases

• Pulmonary medicine

• Cardiology

• Neurology

• Nephrology

• Psychiatry

• Health professionals

• Intensive care unit

• Diagnostic radiology

• Clinical physiology

Patient

Physician

Nurse

Physiotherapist

Occupational therapist Speech

therapist Medical social

worker Dietician

Psychologist

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ReCov - overall aim

To describe and evaluate recovery and disability with regards to physical and psychological function and, also associations with work ability and health related quality of life (HrQoL) in people who have undergone covid-

19, at 6-8 weeks, 6 months and 12 months, as well as describe interventions and the experiences of recovery and rehabilitation.

• Record auditing:

• Care and treatment

• Type of care

• Length of stay

Hospital stay

• Physical function

• Psychological health

Follow- up at 6- 8 weeks

• Psychologic al health

• Interviews Follow-

up at 6 months

• Psychological health

• Record auditing:

Follow- up at 12

months

Specialized rehabilitation

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Assessment and screening

Physical function:

• Pulmonary function

• Maximal inspiratory/expiratory pressure

• Handgrip strength

• Sit-to-stand

• 6-min walk test

• Physical activity (ActivPal and score)

• Post Covid Functional Status

• mMRC

Psychological health and cognitive function

• Depression (PHQ-9)

• Anxiety (GAD-7)

• Posttraumtic stress disorder, PTSD (PCL-5)

• Cognition: MoCA

Other assessments (UppCov)

• Neurological status

• Radiologhy (HRCT, MRT)

• Clinical physiology (EKG, ECHO)

• Blood samples (Biobank)

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Patient cohorts

• Hospitalized patients; ICU or/and other wards with a higher demand of ventilatory support and oxygen or a complex clinical course

(approximately 500 patients).

• Majority of men in the upper middle age with co-morbidities

• Mean age: 53 years

• 20% over 65 years

• Non hospitalized patients: referral from primary care with symptoms

> 3 months (approximately 100 patients).

• Majority of women, 25-55 years, previous healthy and often physical

active

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Clinical findings 2 months after discharged

• Pulmonary function - a restrictive pattern

• Maximal inspiratory pressure ↓

• 6-minute walk test (desaturation, tachycardia)

• Discomfort and chest pain

• Dyspnea (during activity)

• Fatigue (mental and physical)

• Decreased physical activity

• Psychological factors (depression, anxiety and PTSD)

• Cognitive impairment

• Health-related quality of life

Team conference: plan for rehabilitation and further

assessments and examinations

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Rehabilitation in the acute care

• Change of position( e.g. prone position)

• Range of motion

• Mobilization

• Breathing exercises and airway clearance

• Training of physical function(muscle strength, muscle function, transfer, gait training, balance)

• Activities in daily life

• Communication

• Interventions for swallowing and voice function

• Nutritional interventions

• Psychosocial support (patient and next of kin)

Picture: Malin Sellberg

Spruit et al. Eur Resp J, 2020

Lazzeri M et al. Mon Arch Chest Dis, 2020.

Baldwin TP et al. Int J Physiother 2020

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Rehabilitation post- covid-19

• Physical exercise (aerobic training, strength and endurance)

• Breathing exercises and respiratory training, (inspiratory muscle training)

• Energy saving interventions due to fatigue

• Cognitive behavioral therapy

• Education (in groups if possible)

• Prepare for return to work

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Demeco A et al. J Inter Med Res, 2020 Wang et al, Am J Phys Med Rehab, 2020

Barker-Davies RM, et al. Br J Sports Med, 2020

Spruit et al. Eur Resp J, 2020

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Summary

• New disease - long-term effects are still unknown

• Importance of a multidisciplinary and multi-professional team

• Follow-up with screening and assessment

• Extended examination when deviating findings

• Few studies about rehabilitation after covid-19 (long-term)

• Individual tailored rehabilitation

• Alternative forms of rehabilitation e.g digital alternatives

• Important to be aware of pre-existing frailty and

functional impairment in older people

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Project group Re-Cov

• Malin Nygren-Bonnier (PI), Physiotherapist, Docent

• Elisabeth Rydwik, Physiotherapist, Docent

• Malin Regardt, Occupational therapist, PhD

• Ylva Orrevall, Dietician, Docent

• Anita McAllister, Speech therapist, Docent

• Linda Holmström, Physiotherapist, PhD

• Urban Ekman, Psychologist, PhD

• Mike Kemani, Psychologist, PhD

• Maria Bragesjö, Psychologist, PhD-student

• Marie Nilsson, Medical Social Worker, PhD

• Maria Flink, Medical Social Worker, PhD

• Lena Anmyr, Medical Social Worker, PhD

• Reza Zarenoe, Audiologist, PhD

• Linda Nordstrand, Occupational therapist, PhD

• Oili Dahl, Nurse, PhD

• Eva Åkerman, Nurse, PhD

• Anna Svensson-Raskh, Physiotherapist, PhD-student

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ReCov: Rehabilitation after covid-19 in Stockholm