By Gerene Bauldoff, PhD, RN, MAACVPR | Nov. 20, 2020
The COVID-19 pandemic has upended human life and healthcare worldwide. The impact on pulmonary rehabilitation (PR) patients continues to be described. An editorial published by Dr. Massimiliano Polastri and colleagues in European Respiratory Journal provides recommendations as we continue to experience this pandemic.
The authors describe the multi-million patient cases with ongoing management and public health planning and continued need for infection prevention. In addition, they report the sequelae of severe COVID-19 infection is increases the risk for protracted pulmonary, functional/physical and cognitive limitations, especially movement-related fatigue. Dysphagia (swallowing difficulty) has also been reported in post-intubated patients.
With the high number of COVID cases, organizing follow-up care needs is critical. To address this issue, the authors recommended that post-discharge pulmonary consultations be organized to include comprehensive symptom assessment of fatigue, anxiety, depression, dysphagia as well as pulmonary function and exercise performance. Importantly, post-intensive care syndrome that impacts cognitive, emotional and physical performance needs to be identified and incorporated into PR care planning.
The authors also recommend definition of PR program components for post-COVID-19 patients that are evidence-based. Due to the wide variability of COVID-19 patient experience, a core set of baseline assessments is necessary to identify the best program site (in-patient rehabilitation, outpatient, tele-rehabilitation or a mixed form) for each patient.
The authors noted limitations including non-randomization to treatment assignment, use of proxies for disease severity (as PFT data was not available), limitations of claims data (lack of information regarding PR program components, patient-centered outcomes, and use of physical therapy or cardiac rehabilitation alternative use). The data used was for 70% of Medicare beneficiaries who are fee-for-service.
What does this mean for the PR Professional?
COVID-19 has and will continue to impact all of us in the PR world. This editorial instructs us develop PR for the COVID-19 patient that reflects the specific issues these patients bring to programs. Core assessments need to be identified and organized to produce the most efficient delivery of PR to this emerging patient population.
Polastri M, Nava S, Clini E, et al. COVID-19 and pulmonary rehabilitation: preparing for phase three. Eur Respir J 2020; 55: 2001822 [https://doi.org/10.1183/13993003.01822-2020].
Public access to the article PDF: https://erj.ersjournals.com/content/erj/55/6/2001822.full.pdf