People hospitalised with severe COVID-19 should receive early bedside rehabilitation, be assessed for oxygen requirements prior to discharge and receive a comprehensive assessment of their rehabilitation needs 6 to 8 weeks after discharge, an international task force recommends.

Professor Anne Holland,Professor of Physiotherapy at Monash University and colleagues from the Netherlands, UK and the US noted in interim guidelines published in the European Respiratory Journal that a significant proportion of COVID-19 patients would need rehabilitative interventions during and directly after their hospitalisation.

A conservative estimate of the number of new rehabilitation cases would be the up to 10% of hospitalised patients who required mechanical ventilation, they suggested.

“Data on safety and efficacy of rehabilitation during and/or after hospitalisation in these patients are lacking. Equally, healthcare professionals cannot wait for well-designed randomised controlled trials to be published before they can start these rehabilitative interventions in daily clinical practice, as the number of COVID-19 patients increases rapidly every day,” they wrote.

Overall, the team asked 93 experts within the field of pulmonary rehabilitation, respiratory and critical care medicine of physical medicine and rehabilitation to complete 13 multiple choice questions.  At least 70% agreement was required for it to form a consensus suggestion.

The Task Force recommend that hospitalised patients with COVID-19 should:

• Receive rehabilitation at/around the bedside (critical care and/or ward based) until safe for discharge to the home environment;
• Have an assessment of oxygen requirements at rest and during exertion prior to hospital discharge;
• Be encouraged to do regular daily activities in the first 6–8 weeks, such as low/moderate intensity physical exercise at home, after hospital discharge;
• Have a formal assessment of physical and emotional functioning at 6–8 weeks following discharge;
• Follow up at 6–8 weeks after hospital discharge should include: the core outcomes set for survivors of acute respiratory failure; measures of respiratory function; measures of exercise capacity.
• COVID-19 survivors with a need for rehabilitative interventions at 6–8 weeks should, based on the deficits identified: Receive a comprehensive rehabilitation program; a comprehensive pulmonary rehabilitation program consistent with established international standards; muscle strengthening program; nutritional support; formal psychological assessment.

The guideline authors concluded that:

“It should be noted that several experts identified that during the pandemic there has been an absence of rehabilitation options for patients that suffered from COVID-19 … In absence of a formal evidence-based approach, these findings provide interim guidance for referral and multidisciplinary rehabilitation in a subgroup of patients after hospital admission,” the team concluded.