Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Ann Phys Rehabil Med. 2023 Jun;66(5):101737. doi: 10.1016/j.rehab.2023.101737. Epub 2023 Feb 10.
The comparison of recovery patterns for different care pathways following COVID-19 is necessary for optimizing rehabilitation strategies.
To evaluate cognitive and psychological outcomes across different care pathways up to 12 months after hospitalization for COVID-19.
CO-FLOW is an ongoing multicenter prospective cohort study with assessments at 3, 6, and 12 months after hospitalization for COVID-19. The main outcomes are cognitive deficits (Montreal Cognitive Assessment, score <26), cognitive failure (Cognitive Failure Questionnaire, score >43), posttraumatic stress disorder (PTSD; Impact of Event Scale-Revised, score ≥33), and anxiety and depression (Hospital Anxiety and Depression Scale, subscale score ≥11).
In total, data from 617 participants were analyzed. Mean age was 59.7 (SD 11.4) years and 188 (31%) were female. Significant recovery occurred within the first 6 months post-discharge (p ≤ 0.001). Cognitive deficits persisted in 21% (101/474), and psychological problems in 15% (74/482) of people at 12 months. Significantly improved cognition scores were reported for people who did not receive rehabilitation ('No-rehab'; 124/617, 20%; mean difference, MD 2.32, 95% CI 1.47 to 3.17; p<0.001), those who received community-based rehabilitation ('Com-rehab'; 327/617, 53%; MD 1.27, 95% CI 0.77 to 1.78; p<0.001), and those who received medical rehabilitation ('Med-rehab'; 86/617, 14%; MD 1.63, 95% CI 0.17 to 3.10; p = 0.029). Med-rehab participants experienced more cognitive failure from 3 to 6 months (MD 4.24, 95% 1.63 to 6.84; p = 0.001). Com-rehab showed recovery for PTSD (MD -2.43, 95% -3.50 to -1.37; p<0.001), anxiety (MD -0.67, 95% -1.02 to -0.32; p<0.001), and depression (MD -0.60, 95% -0.96 to -0.25; p<0.001), but symptoms persisted at 12 months.
Survivors of COVID-19 showed cognitive and psychological recovery, especially within the first 6 months after hospitalization. Most persistent problems were related to cognitive functioning at 12 months. Recovery differed rehabilitation settings. Additional cognitive or psychological support might be warranted in people who medical or community-based rehabilitation.
比较 COVID-19 后不同护理路径的恢复模式对于优化康复策略是必要的。
评估 COVID-19 住院后 12 个月内不同护理路径的认知和心理结局。
CO-FLOW 是一项正在进行的多中心前瞻性队列研究，在 COVID-19 住院后 3、6 和 12 个月进行评估。主要结局是认知缺陷（蒙特利尔认知评估，得分<26）、认知失败（认知失败问卷，得分>43）、创伤后应激障碍（修订后的事件影响量表，得分≥33）以及焦虑和抑郁（医院焦虑和抑郁量表，子量表得分≥11）。
共分析了 617 名参与者的数据。平均年龄为 59.7（11.4）岁，188 名（31%）为女性。出院后前 6 个月内有明显恢复（p≤0.001）。12 个月时，474 人中仍有 21%（101 人）存在认知障碍，482 人中仍有 15%（74 人）存在心理问题。未接受康复治疗的患者（“无康复”，617 人中的 124 人，20%；平均差异，MD 2.32，95%CI 1.47 至 3.17；p<0.001）、接受社区康复治疗的患者（“社区康复”，617 人中的 327 人，53%；MD 1.27，95%CI 0.77 至 1.78；p<0.001）和接受医疗康复治疗的患者（“医疗康复”，617 人中的 86 人，14%；MD 1.63，95%CI 0.17 至 3.10；p=0.029）认知评分显著提高。从 3 个月到 6 个月，医疗康复患者的认知失败更多（MD 4.24，95% 1.63 至 6.84；p=0.001）。社区康复显示 PTSD（MD -2.43，95% -3.50 至 -1.37；p<0.001）、焦虑（MD -0.67，95% -1.02 至 -0.32；p<0.001）和抑郁（MD -0.60，95% -0.96 至 -0.25；p<0.001）的恢复，但 12 个月时症状仍持续存在。
COVID-19 幸存者表现出认知和心理恢复，尤其是在住院后前 6 个月。12 个月时最持久的问题与认知功能有关。恢复因康复环境而异。可能需要对接受医疗或社区康复的患者进行额外的认知或心理支持。
