Catalan Micah G, Ignacio Sharon D
Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Nov 15;58(20):35-46. doi: 10.47895/amp.v58i20.8479. eCollection 2024.
COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living.
This was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge.
A total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status.
COVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.
新型冠状病毒肺炎（COVID-19）是一种主要影响呼吸系统的新型疾病。在感染者中，约20% 需要在医院环境中接受治疗，这可能导致身体机能下降。为控制病毒传播而采取的措施也限制了医院和社区环境中的行动能力。本研究的目的是描述从中度至重度COVID-19临床康复的患者的特征（年龄、性别、合并症）、住院情况（住院时间、重症监护病房停留时间、转介至康复医学科）以及在参与日常生活活动方面的长期功能结局。
这是一项描述性前瞻性队列研究，在一家三级政府医院进行，于2020年9月至2021年2月招募参与者，包括经逆转录聚合酶链反应（rRT-PCR）确诊为COVID-19且具有中度、重度或危重症风险状态的临床康复成年患者。获取描述性统计数据，并进行多元回归分析，以确定患者人口统计学特征与其出院时、出院后1个月和出院后6个月随访时的巴氏指数评分之间的关联。
共有63名患者纳入本研究，平均年龄为52.4岁。更多康复患者符合中度疾病标准（46%），最常见的合并症为慢性肺病（42.1%）和糖尿病（42.1%）。几乎所有患者病前完全独立，COVID-19重症患者的基线功能评分更高。大多数患者（63.5%）未被转介接受康复服务。在所有患者中，出院时的巴氏指数评分表明，在进行日常生活活动方面，从轻度依赖显著下降至中度依赖，病前状态在多元回归分析中显著预测出院时的评分（β = 0.621，p = 0.001）。未发现患者人口统计学特征、住院和重症监护病房停留时间及结局以及转介至康复医学科是显著因素。在随访过程中，观察到整个人群的失访率很高，到研究结束时，57.1% 的参与者存活，在失访者中，20.6% 已死亡，其余22.2% 状态不明。
以巴氏指数衡量，COVID-19在日常生活活动方面显著影响患者的功能结局。从我们的研究中收集的初步数据以及高失访率支持需要更好的随访，并选择一种能够更好地描述影响功能和参与日常生活活动的非人口统计学因素的工具。
