Rehabilitation to enable recovery from COVID-19

Background

On March 11th 2020 the World Health Organisation (WHO) classified COVID-19 as a pandemic. Most people infected with the SARS-COV-2 virus will experience mild to moderate disease with acute shortness of breath, myalgia and fatigue, a proportion will have a more severe form requiring admission to hospital and critical care wards. Spending time in hospital particularly in critical care wards can result in muscle weakness and functional impairment. It has also been recognised that ongoing symptoms such as pain, fatigue, difficulty thinking, vertigo and insomnia may last several months. Although, the main focus of health services has been to maximise survival with a strong emphasis on sufficient critical care facilities, pharmacological treatments and the development of a vaccine, physical rehabilitation, in hospital and in the community has a vital role in the recovery of those surviving COVID-19.

Project Aims

As there is no existing evidence to support rehabilitation interventions effective in recovery from COVID-19 our aim was to undertake a systematic review of the relevant evidence for rehabilitation which is likely to be applicable to adults recovering from COVID-19.
We collaborated with health care professionals and researchers from the University of Exeter, Nottingham Universities NHS Trust, the University of East Anglia and the University of Nottingham.

Project activity

We conducted a systematic review to address the following research questions:
Our primary research question was:
• What rehabilitation interventions could improve functional ability and quality of life for adults recovering from COVID-19?
We were also interested in:
• What rehabilitations interventions could improve functional ability and quality of life in older people (age 65+) and people with pre-existing conditions or frailty recovering from COVID-19? And
• The views and experiences of those undergoing such rehabilitation, and
• What COVID-19-related circumstances and context would need to be considered when implementing interventions into practice?

Outputs and Impact

Our systematic review included evidence from 24 systematic reviews, 11 randomised control trials and eight qualitative studies, which interviewed patients about their rehabilitation, to explore their views and experience.
We found evidence that in those with severe respiratory illness and in mixed respiratory and surgical populations progressive exercise and getting people mobile early may help people recover from severe respiratory illness, and that those findings could be applied to COVID-19 care. We also found that rehabilitation programmes with a number of different components could be beneficial.

Study lead Vicki Goodwin said:

“COVID-19 can have a devastating impact on people’s lives, long after they leave hospital. We urgently need to find the best ways to support people to regain their health, both in hospital and when they return home. Our research found that getting people moving early on is a key component that can help shape rehabilitation programmes, to get people back on their feet as swiftly as possible ”.

The qualitative research evidence showed that rehabilitation can bring hope and build confidence on the recovery journey, however an individualised approach is needed. These are key issues for those people surviving COVID-19.

Publications

The review was published in February 2021 in the journal Physiotherapy – a free to access version is available from the Open Repository Exeter.

Our review was featured in a news item from the University of Exeter in February 2021.
More details of the methods we used are available in our protocol [link to PDF] which is also registered on Open Science Framework.