Effects of a structured cardiopulmonary rehabilitation program for individuals recovering from covid-19

PURPOSE/HYPOTHESIS: The purpose of this quality improvement study is to determine if a structured outpatient rehabilitation program can improve physical function, aerobic capacity, and pulmonary function in individuals recovering from COVID-19 infection. These individuals are presenting with impairments similar to those of acute respiratory distress syndrome (ARDS) and other critical illnesses.1,2 Previous research on ARDS and critical illness attests to the benefits of early, targeted outpatient rehabilitation. 1-5 Our hypothesis is that a structured exercise and functional training program based on cardiopulmonary rehabilitation principles will help these individuals regain their functional capacity and independence. NUMBER OF SUBJECTS: 12 patients were scheduled for PT evaluation between 5/15/2020 and 7/24/2020, 9 attended the evaluation and 7 participated in therapy. MATERIALS AND METHODS: Individuals referred to outpatient cardiopulmonary rehabilitation following a diagnosis of COVID-19 infection were included in the study. Outcome measures utilized included the 6 Minute Walk Test (6MWT), 2-minute stepping test (2MST), Short Physical Performance Battery (SPPB), chest wall mobility and excursion, Duke Activity Status Index (DASI), Ferrans and Powers Quality of Life -Pulmonary Version III (F&PQOL), University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ), Patient Health Questionnaire-9 (PHQ-9), and Handheld Dynamometry. RESULTS: Three out of the 9 were intubated with an average length of intubation of 14 days, median hospital length of stay for the 9 individuals was 14 days. Median age for those participating in therapy was 59 years. 57% were female and 43% were male. Five out of 7 completed therapy as of July 24, 2020. A minimally important difference (MID) was found for the 6MWT with an average increase of 325 ft (99 m), well above the 30 m MID for ARDS patients.6 There was also a clinically significant improvement for SPPB with an average improvement of 1.8 points.7 There was also a statistically significant change post-rehabilitation on the 2MST for METs (P = 0.0009), self-selected gait speed (P = 0.03), SPPB (P = 0.05), 6MWT distance (P = 0.03), and 6MWT METs (P = 0.04). Improvements were also found post-rehabilitation on the PHQ-9, UCSD-SOBQ, F&PQOL, chest wall mobility and excursion, and speed performing chair stands, although they were not statistically significant. CONCLUSIONS: The results of these data show that a structured cardiopulmonary rehabilitation program lead by skilled physical therapists will result in enhanced recovery after COVID-19 infection including improvements in physical function, aerobic capacity, and muscular strength. Despite the extremely small sample size, due to the novelty of this virus and the rehabilitation program, there was a statistically significant change in some of the outcome measures. CLINICAL RELEVANCE: Due to the novelty of this virus and limited data on effective intervention during rehabilitation, dissemination of these results will be extremely helpful for other physical therapists to justify treatment for these individuals and guide appropriate methods of skilled intervention and outcomes assessment.