Patients with rheumatologic diseases who contract COVID-19 may need more than straightforward treatment for their infection. At least half of patients who are hospitalized for COVID-19 will need some sort of rehabilitation.
“The whole world still has an incomplete understanding of COVID-19, but some things are becoming more clear,” said Lisa Sheehy, PT, PhD, research associate, Bruyère Research Institute, and clinical research coordinator, University of Ottawa Heart Institute Research Corporation. “The literature on rehabilitation needs and outcomes after COVID-19 is very thin, but there are respiratory programs that have been shown to help.”
Dr. Sheehy explored expectations for post-COVID-19 rehab during Impact of a Worldwide Pandemic: Physical Rehab Needs Post-COVID-19 and Psychosocial Implications for Patients. Registered attendees have on-demand access to watch a replay of the session through Wednesday, March 11.
Complications of severe COVID-19 likely boost the need for rehabilitation, Dr. Sheehy cautioned. Frequent post-COVID respiratory problems include dyspnea, respiratory muscle dysfunction and weakness, thick secretions, and chest pain. Cardiac arrhythmias, myocarditis, hypertension, decondition, and postural hypotension are common, as are vascular events such as stroke, vasculopathy, and DVT/pulmonary embolism. Expect loss of range of motion, loss of strength, myopathy, impaired balance, reduced mobility and walking ability, and other musculoskeletal and functional deficits as well as anxiety, depression, PTSD, and sleep disorders.
“What is most important is to do what rehabilitation professionals always do, create an individualized treatment plan based on a thorough assessment and consideration of the patient’s rehabilitation goals,” Dr. Sheehy said. “Focus on function and returning to participating in society and go slow. Trying to move too quickly can set patients back.”
Creating a rehab program during the pandemic depends largely on local resources and goals. For inpatient rehab, it may be helpful to cohort patients on a single floor. Rehab in patient rooms is ideal, but a gym could be used with appropriate distancing between patients.
It is also wise to minimize shared equipment. One simple alternative is TheraBands for each patient rather than sharing hand weights.
And patient mental health is just as important as physical health. Providers need a ready list of referrals for psychology, psychiatry, and social work as well as more familiar support services such as nutrition, medication review discharge planning, and patient/caregiver education.
COVID-19 patients and their families or caregivers may be terrified by the disease, warned Adena Batterman, MSW, LCSW, senior manager, inflammatory arthritis support and education programs, Hospital for Special Surgery. Patients may be reluctant to leave home for any kind of medical care, including ongoing rheumatologic treatment. Some may discontinue rheumatologic medications without consulting their providers.
“Having accurate information helps alleviate some of the fear and stress people fells, Dr. Batterman said. “And people who were marginally getting by before COVID are now at high socioeconomic risk. Loss of social support, connections, and resources intensifies isolation and psychological distress.”
Patients with rheumatologic diseases are at higher risk of COVID-related problems. Patients tend to be medically complex with functional limitations. Some rheumatologic conditions are more prevalent in communities of color and in older adults who may already be at risk for poverty as well as food and housing insecurity. Patients may lack reliable digital access for virtual health visits or other online services. “We need to increase our outreach to potential at-risk patients and populations,” Dr. Batterman said. “There are small changes we can make in our practice that help, routinely assessing psychosocial status; substance abuse; food, housing and financial insecurity; safety from abuse at home. Best practices are the same as before the pandemic, but they are easy to forget.”