Rehabilitationsergebnisse bei Covid-19-Erkrankung: eine
                    Fall-Kontroll-Studie

Stefanie Petzold; Roisin Carney; JanPieter Kool; Stefan Bachmann

doi:10.1055/a-1729-7706

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Table of Contents

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2023; 33(01): 17-27
DOI: 10.1055/a-1729-7706

Originalarbeit

Rehabilitationsergebnisse bei Covid-19-Erkrankung: eine Fall-Kontroll-Studie

Covid-19 and Rehabilitation Outcomes: A Case-Control Study

Stefanie Petzold

¹Klinik für muskuloskelettale und internistische Rehabiltation, Kliniken Valens Rehazentrum Walenstadtberg, Walenstadtberg, Switzerland

,

Roisin Carney

²Physiotherapien, Kliniken Valens Rehazentrum Walenstadtberg, Walenstadtberg, Switzerland

,

JanPieter Kool

³Forschungsabteilung, Kliniken Valens Rehazentrum Valens, Valens, Switzerland

,

Stefan Bachmann

⁴Klinik für muskuloskelettale und internistische Rehabilitation, Kliniken Valens Rehazentrum Valens, Valens, Switzerland

⁵Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern Faculty of Medicine, Bern, Switzerland

› Author Affiliations

Abstract

Zusammenfassung

Hintergrund Unterscheidet sich der Rehaverlauf von akut Covid-19-Erkrankten von genesenen Covid-19-Patienten und anderen Rehapatienten? Vergleich des Verlaufs zwischen akut Covid-19-Erkrankten, genesenen Patienten und Rehapatienten ohne Covid-19. Design: Fall-Kontroll-Studie.

Material und Methoden Einschluss von im Zeitraum 01.04. bis 30.06.2020 zugewiesenen Patienten mit aktiver Covid-19-Erkrankung (IG), genesenen Covid-19-Betroffenen (PCG) und einer gleichzeitig rehabilitierten, nach Alter, Geschlecht und Komorbidität gematchten Kontrollgruppe (Ko). Primärer Endpunkt war die Selbständigkeit im Alltag (FIM), weitere Endpunkte waren Lebensqualität (EQ5D-VAS), physische und mentale Gesundheit (PROMIS10) sowie Mobilität (TUG und 6MWT).

Ergebnisse 101 Patienten wurden eingeschlossen: IG=15; PCG=22; Ko=64. Die Selbständigkeit und Lebensqualität bei Eintritt waren in der IG signifikant am höchsten (FIM IG 95,3 vs. PCG 78,3, vs. Ko 79,6; ANOVA p=0,029; EQ5D-VAS IG 56.1 vs. PCG 36,6 vs. Ko 51,0; ANOVA p=0,010). Im PROMIS10 sowie in der Mobilität gab es keine Unterschiede. Alle drei Gruppen verbesserten sich von Ein- zu Austritt signifikant. Die IG schnitt bei Austritt im FIM am besten ab (IG 109,7 vs. PCG 97,2 vs. Ko 93,6; ANOVA p=0,039). Die Kontrollgruppe erreichte hinsichtlich Mobilität bei Austritt die schlechtesten Resultate (TUG Ko 19,3 Sek. vs. 9,6 Sek IG und 8,3 Sek PCG). Im 6MWT zeigte die PCG das beste Resultat (471 m vs. IG 416 m und Ko 389 m; Differenz n.s.).

Schlussfolgerung Alle drei Patientengruppen konnten sehr gut vom Rehaprogramm profitieren. Rehamassnahmen bringen auch für isolierte akut Covid-19-Erkrankte einen Benefit. Insbesondere genesene Covid-19-Patienten profitieren sehr von den Rehamassnahmen.

Abstract

Objective Does the rehab process of acutely ill Covid-19 patients differ from recovered Covid-19 patients and other rehab patients? Comparison of the reha-course between acutely ill Covid-19 patients, recovered patients and rehab patients without Covid-19. Design: case-control study.

Material and Methods Patients assigned to rehab in the period from 01.04 to 30.06.2020 with active Covid-19 disease (IG), recovered Covid-19 patients (PCG) and simultaneously rehabilitated persons matched by age, gender and comorbidity (Ko) were included. The primary endpoint was ADL- independence (FIM), secondary endpoints were quality of life (EQ5D-VAS), physical and mental health (PROMIS10) and mobility (TUG and 6MWT).

Results 101 patients were included: IG=15; PCG=22; Ko=64. At entry, ADL-independence and quality of life were significantly highest in the IG (FIM IG 95.3 vs. PCG 78.3, vs. Ko 79.6; ANOVA p=0.029; EQ5D-VAS IG 56.1 vs. PCG 36.6 vs. Ko 51.0; ANOVA p=0.010). There were no differences in PROMIS10 and mobility. All three groups improved significantly from entry to discharge. The IG performed best in the FIM (IG 109.7 vs. PCG 97.2 vs. Ko 93.6; ANOVA p=0.039). The control group achieved the worst results with regard to mobility at discharge (TUG Ko 19.3 sec vs. 9.6 sec IG and 8.3 sec PCG). In the 6MWT, the PCG showed the best result (471 m vs. IG 416 m and Ko 389 m; difference n.s.).

Conclusion All three patient groups benefited well from the rehab program. In addition, rehab measures bring a benefit also for isolated Covid-19 patients. In particular, recovered Covid-19 patients benefit greatly from the rehab program.

Schlüsselwörter

Sars-CoV-2 - Covid-19 - Rehabilitation - Therapie - Ergebnisse

Key words

Sars-CoV-2 - Covid-19 - rehabilitation - therapy - outcomes

Full Text

References

Literatur
1 Zhu N, Zhang D, Wang W. et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733
2 Munster VJ, Koopmans M, van Doremalen N. et al. A Novel Coronavirus Emerging in China – Key Questions for Impact Assessment. N Engl J Med 2020; 382: 692-694
3 Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019; 17: 181-192
4 Rothe C, Schunk M, Sothmann P. et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med 2020; 382: 970-971
5 Wei WE, Li Z, Chiew CJ. et al. Presymptomatic Transmission of SARS-CoV-2 – Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 411-415
6 Xu R, Cui B, Duan X. et al. Saliva: potential diagnostic value and transmission of 2019-nCoV. Int J Oral Sci 2020; 12: 11
7 Ong SWX, Tan YK, Chia PY. et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. Jama 2020; 323: 1610-1612
8 Lauer SA, Grantz KH, Bi Q. et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med 2020; 172: 577-582
9 Gupta A, Madhavan MV, Sehgal K. et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26: 1017-1032
10 Brugliera L, Spina A, Castellazzi P. et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020; 52: jrm00046
11 Gandhi RT, Lynch JB, Del Rio C. Mild or Moderate Covid-19. N Engl J Med 2020; 383: 1757-1766
12 Zheng Z, Peng F, Xu B. et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81: e16-e25
13 Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968; 16: 622-626
14 Linacre JM, Heinemann AW, Wright BD. et al. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil 1994; 75: 127-132
15 Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33: 337-343
16 Evans JP, Smith A, Gibbons C. et al. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK. Patient Relat Outcome Meas 2018; 9: 345-352
17 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148
18 Kool J, Oesch P, Bachmann S. Predictors for living at home after geriatric inpatient rehabilitation: A prospective cohort study. J Rehabil Med 2017; 49: 185-190
19 Hien P, Morr H. Six-minute walk test in chronic lung and heart disease – technical aspects, interpretation, limitations. Pneumologie 2002; 56: 558-566
20 Schweizerische Vereinigung der Forschungsethikkommissionen: Approved and submitted projects related to covid-19 in switzerland. Im Internet: https://swissethics.ch/covid/approved-projects Stand 12.10.2021
21 Curci C, Pisano F, Bonacci E. et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med 2020; 56: 633-641
22 Hermann M, Pekacka-Egli AM, Witassek F. et al. Feasibility and Efficacy of Cardiopulmonary Rehabilitation After COVID-19. Am J Phys Med Rehabil 2020; 99: 865-869
23 Guan WJ, Ni ZY, Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708-1720
24 Li Z, Zheng C, Duan C. et al. Rehabilitation needs of the first cohort of post-acute COVID-19 patients in Hubei, China. Eur J Phys Rehabil Med 2020; 56: 339-344
25 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062
26 Liu K, Zhang W, Yang Y. et al. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract 2020; 39: 101166
27 Belli S, Balbi B, Prince I. et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J 2020; 56
28 Spielmanns M, Pekacka-Egli AM, Schoendorf S. et al. Effects of a Comprehensive Pulmonary Rehabilitation in Severe Post-COVID-19 Patients. Int J Environ Res Public Health 2021; 18
29 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232
30 Weerahandi H, Hochman KA, Simon E. et al. Post-discharge health status and symptoms in patients with severe COVID-19. medRxiv 2020;
31 Jacobs LG, Gourna Paleoudis E, Lesky-Di Bari D. et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS One 2020; 15: e0243882
32 Betschart M, Rezek S, Unger I. et al. Feasibility of an Outpatient Training Program after COVID-19. Int J Environ Res Public Health 2021; 18