COVID-19 Rehabilitation after the ICU period and post-hospital rehabilitation

No effect studies are currently available on the optimal rehabilitation or aftercare for patients with COVID-19 and their relatives ⁽¹⁴⁾. Physiotherapy rehabilitation is based on expert opinions and literature on rehabilitation in other infectious diseases (SARS, MERS and others).

Fortunately, the profession is busy writing guidelines and protocols for treating patients recovering from COVID-19 ⁽²⁴⁾.

There are also recommendations for physiotherapy in patients after hospital discharge or patients who have recovered at home ⁽²²⁾.

Patients in isolation can be approached by the lung physiotherapist via eConsult. The Dutch Federation of Medical Specialists recommends home discharge for patients with mild complaints, with support from general practitioner, home care and rehabilitation primary care professionals. Physiotherapy pulmonary rehabilitation is of the utmost importance in this respect ^(19,20,21). It is not yet clear how long patients with COVID-19 will be contagious after hospitalization / isolation ⁽²²⁾.

If complaints of shortness of breath, sputum or cough persist, then a pulmonologist can be consulted for drug therapy⁽¹⁴⁾. Pulmonologists and lung physiotherapists should set up the rehabilitation in a safe and strictly separated way from uninfected patients participating in lung rehabilitation ⁽²¹⁾.
The overview below forms the basis of the PICS rehabilitation program after COVID-19 concerning physiotherapy and sport and must be adapted to a tailor-made program during the process at the individual level.

Clinimetry (e.g. physiotherapeutic treatment parameters)
Based on the REACH project of the Hoogstraat Rehabilitation and the Italian position paper, there are the following recommendations regarding clinimetry at PICS after COVID-19 ^{(8. 21}):

Exercise capacity / intensity: 6-minute walking test (6MWT), 10-meter walking test and Steep Ramp Test
Functional capacity and bicycle ergometry (submaximal capacity) like te Steep Ramp Test
Respiratory function: MIP and MEP
Muscle strength: MRC scale, HKK, handheld dynamometry, Motricity Index

For the cardiorespiratory evaluation (both for the exercise capacity evaluation as for the functional capacity evaluation) we recommend the Steep Ramp Test (SRT). This test is short and very submaximal and therefore feasible with severely weakend patients. The outcome of the test is an excellent input for the training program and can be used for re-evaluation and for feedback tot the patient about his progress.

The Steep Ramp Test - how to

"Corona lungs"

Especially patients who need to be ventilated on the IC have a risk of permanent damage to the lung tissue. Inflammation can develop that causes scar tissue on the lungs. For example, if a lot of scar tissue develops, it can lead to decreased stamina^{(5, 21)}. Severe respiratory limitations persist after hospitalization, reducing the burden on patients during therapy ⁽⁹⁾. The COVID-19 group is likely to have more permanent lung damage compared to the average PICS revalidant and to suffer more and longer-term excessive psychosocial stress (with a high risk of psychiatric morbidity).

It is sometimes said "take 1 to 2 months of recovery time for each week in the ICU". Your condition is poor, your muscle mass is gone, your organs are losing. Also there is the possible lung damage, which only reveals itself in 6 to 9 months ⁽³⁹⁾.

Thus, treatment of patients recovering from COVID-19 will focus on increasing muscle strength, improving lung function / capacity and improving aerobic and anaerobic endurance.

With the EN-DYNAMIC and EN-CARDIO exercise machines, the physical load and physical performance of COVID-19 patients can be measured and improved.

The EN-CARDIO exercise machines have various sub-maximum exercise tests as standard. For example, the 6-Minute Walking Test (EN-MOTION treadmill) provides insight into walking distance, average speed, step frequency, heart rate, VO₂ max and fitness level. The BIKE-REHA bicycle ergometer is ideal for measuring physical endurance. The bike has, amongst other things, the Åstrand bike test, a submaximal test to obtain an impression of endurance in 6 minutes and calculate the VO₂max and especially for patient with a limimited load capability, like COVID-19 patients, we recommend the Steep Ramp Test (SRT).

In combination with the EN-TRAIN Software package you can easily record measurement data and training protocols and track progress per treatment session. This data can be presented in report form (printed or as PDF).

Go here for the treatment summary >>