Scientific brief template
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Rehabilitation is an integral part of universal
health coverage (UHC), alongside health promotion, prevention, curative and palliative care. It is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment (54). It includes a broad range of interventions provided by a multidisciplinary workforce, including education and advice, therapeutic exercise and training, provision of pharmaceutical agents, assistive product provision, and individual adaptations to the home or work environment. Rehabilitation service delivery occurs along the continuum of care, at all levels of health care. Rehabilitation needs of people recovering from COVID-19: scientific brief -4- hospitalized; admitted to intensive care) (20, 43). The most commonly described ongoing symptoms are weakness, general malaise, fatigue, concentration impairment and breathlessness (44). While initial symptoms may persist, cognitive dysfunction, including problems with attention, executive function and memory, may become more prevalent later in the illness (32, 45). Over 50 long-term effects have been described (46); some symptoms may develop in addition to the acute symptoms (47). Patients have reported that physical activity, stress and sleep disturbance commonly trigger symptoms (32). Rehabilitation for people experiencing severe problems or a protracted course of Post COVID-19 Condition most likely requires a person-centred, comprehensive and multidisciplinary approach to interventions which are provided in close collaboration with primary health care and several medical specialties. Interventions for rehabilitation may include advice on resumption of activities; breathing techniques; exercise therapy; psychological interventions; cognitive training; rehabilitation for communication and swallowing difficulties; and occupational rehabilitation (48–52). Currently, the evidence base on interventions for rehabilitation and outcomes is limited; an interim guidance will be developed by WHO based on available evidence and clinical expertise. WHO resources for rehabilitation of COVID-19 1. The use of WHO Post COVID-19 Case Report Form (CRF) is recommended to collect standardized and anonymized patient-level data for the monitoring of mid- and long-term consequences of COVID-19 ( WHO Post COVID-19 CRF ). 2. The WHO COVID-19 Clinical Management: Living Guidance contains a chapter on rehabilitation for physical, cognitive and mental health issues in COVID-19 ( WHO COVID-19 Clinical management: living guidance ). 3. An online training course on the rehabilitation of patients with COVID-19 is available at OpenWHO.org ( WHO Rehabilitation of patients with COVID-19 Course ). 4. To ensure appropriate, effective and safe rehabilitation self-management, a WHO patient-leaflet has been developed ( WHO support for rehabilitation self-management after COVID-19 ). 5. The WHO Rehabilitation Programme is collaborating with Cochrane Rehabilitation to define a research agenda for the rehabilitation of COVID-19 ( WHO Rehabilitation Programme and COVID-19 resources ) Limitations The current body of evidence about the health impact of COVID-19 and rehabilitation needs is limited and has several shortcomings. Describing health impact of COVID-19 and clinical manifestations amenable for rehabilitation remains difficult without widespread use of standardized and comparable outcome measures of functioning in longitudinal trials that include a representative control group. Many studies are based on self-reported symptoms and outcomes, and this may lead to recall biases and case misclassification. The use of an app and social media to recruit patients may result in a selection bias towards recruitment of those more likely to be symptomatic following SARS-CoV-2 infection and lead to an overestimation of the prevalence of symptoms. Publication and reporting bias may be substantial issues; in primary studies that seek to evaluate health impact and limitations in functioning in people recovering from COVID-19, authors may report only those estimates where statistically significant differences are found. Rehabilitation needs of people recovering from COVID-19: scientific brief -5- Funding Funded by WHO. Plans for updating WHO continues to monitor the situation closely for any changes that may affect this scientific brief. Should any factors change, WHO will issue a further update. Otherwise, this scientific brief document will expire one year after the date of publication. References 1. Hanquet G, Benahmed N, Castanares-Zapatero D, Dauvrin M, Desomer A, Rondia K, et al. Post- Intensive Care Syndrome in the aftermath of COVID-19: Appendices. COVID-19 KCE Contributions. 29 October 2020. 2. Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I, et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021;372:n693. 3. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27(4):601–615. 4. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021:397(10270):220–232. 5. Van den Borst B, Peters JB, Brink M, Schoon Y, Bleeker-Rovers CP, Schers H, et al. Comprehensive health assessment three months after recovery from acute COVID-19. Clin Infect Dis 2020. 6. Arnold DT, Hamilton FW, Milne A, Morley AJ, Viner J, Attwood M et al. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Thorax 2021;76:399–401. 7. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324(6):603–605. 8. D'Cruz RF, Waller MD, Perrin F, Periselneris J, Norton S, Smith L-J, et al. Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia. ERJ Open Res 2021;7(1). 9. Sigfrid L, Drake TM, Pauley E, Jesudason EC, Olliaro P, Wei SL, et al. Long Covid in adults discharged from UK hospitals after Covid-19: a prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. medRxiv 2021.03.18.21253888. 10. Xiong X, Xu M, Li J, Liu Y, Zhang J, Xu Y, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single centre longitudinal study. Clin Microbiol Infect 2021;27:89–95. 11. Nasserie T, Hittle M, Goodman SN. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: a systematic review. JAMA Network Open. 2021;4(5):e2111417. 12. Baricich A, Borg MB, Cuneo D, Cadario E, Azzolina D, Balbo PE, et al. Midterm functional sequelae and implications in rehabilitation after COVID19. A cross-sectional study. Eur J Phys Rehabil Med 2021;57(2):199–207. 13. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol. 2021;93:1013–1022. 14. Miskowiak KW, Johnsen S, Sattler SM, Nielsen S, Kunalan K, Rungby J, et al. Cognitive impairments four months after COVID-19 hospital discharge: pattern, severity and association with illness variables. Eur Neuropsychopharmacol 2021;46:39–48. 15. Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax 2021;76:396–398. Rehabilitation needs of people recovering from COVID-19: scientific brief -6- 16. Méndez R, Balanzá-Martínez V, Luperdi SC, Estrada I, Latorre A, González-Jiménez P, et al. Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors. J Intern Med 2021 Feb;10:1111. 17. Taboada M, Cariñena A, Moreno E, Rodríguez N, Jesús Domínguez M, et al. Post-COVID-19 functional status six-months after hospitalization. J Infect 2021 April; 82(4). 18. Physical, cognitive and mental health impacts of COVID-19 following hospitalisation – a multi-centre prospective cohort study. PHOSP-COVID Collaborative Group. medRxiv preprint retrieved April 1st 2021 (https://www.medrxiv.org/content/10.1101/2021.03.22.21254057v1, accessed 9 July 2021). 19. Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr. 2021; 21(1):199. 20. Ghosn J, Piroth L, Epaulard O, Le Turnier P, Mentré F, Bachelet D, et al. Persistent COVID-19 symptoms are highly prevalent 6 months after hospitalization: results from a large prospective cohort. Clin Microbiol Infect 2021;27(7):1041.e1–1041. 21. Tabacof L, Tosco-Mancuso J, Wood J, Cortes M, Kontorovich A, McMarthy D, et al. Post-acute COVID- 19 syndrome negatively impacts health and wellbeing despite less severe acute infection. medRxiv preprint (https://doi.org/10.1101/2020.11.04.20226126, accessed 9 July 2021). 22. Rayner C, Lokugamage AU, Molokhia M, et al. COVID-19: Prolonged and relapsing course of illness has implications for returning workers. BMJ, 2020. 23. Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Persistent symptoms 1.5–6 months after COVID-19 in non-hospitalised subjects: a population-based cohort study. Thorax. 2020; 76(4):405–7. 24. Cirulli ET, Schiabor Barrett KM, Riffle S, Bolze A, Neveux I, Dabe S, et al. Long-term COVID-19 symptoms in a large unselected population. medRxiv 2020 (https://www.medrxiv.org/content/10.1101/2020.10.07.20208702v3, accessed 10 July 2021). 25. Jacobson KB, Rao M, Bonilla H, Subramanian A, Hack A, Madrigal M, et al. Patients with uncomplicated coronavirus disease 2019 (COVID-19) have long term persistent symptoms and functional impairment similar to patients with severe COVID-19: a cautionary tale during a global pandemic. Clin Infect Dis. 2021 Feb 7;ciab103. 26. NIHR. Living with COVID19. Second review. March 2021 (https://evidence.nihr.ac.uk/wp- content/uploads/2021/03/NIHR_COVID_REPORT_FINAL-150321-1_1_.pdf, accessed 10 July 2021). 27. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 July 2021. United Kingdom, Office for National Statistics. 1 July 2021. 28. Vaes AW, Machado FVC, Meys R, Delbressine JM, Goërtz YM, Van Herck M, et al. Care dependency in non-hospitalized patients with COVID-19. J Clin Med. 2020 Sep;9(9):2946. 29. Castanares-Zapatero D, Hanquet G, Van Den Heede K. COVID-19 KCE Contributions. Epidemiology of long COVID: a pragmatic review of the literature. 27 Jan 2021. 30. Office for National Statistics, UK. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK; 1 April 2021. 31. Vaes AW, Goërtz YMJ, Van Herck M, Machado FVC, Meys R, Delbressine JM, et al. Recovery from COVID19: a sprint or marathon? 6 month follow-up data of online long COVID-19 support group members. ERJ Open Res 2021; in press (https://doi.org/10.1183/23120541.00141-2021, accessed 10 July 2021). 32. Nida Ziauddeen, Gurdasani D, O’Hara ME, Hastie C, Roderick P, Yao G, et al. Characteristics of long Covid: findings from a social media survey. medRxiv preprint; March 26, 2021 (https://doi.org/10.1101/2021.03.21.21253968, accessed 10 July 2021). 33. WHO COVID-19 Clinical management: living guidance, 25 January 2021 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1, accessed 10 July 2021). 34. Jaffri A, Jaffri UA. Post-Intensive care syndrome and COVID-19: crisis after a crisis? Heart Lung. 2020 November–December;49(6):883–884. Rehabilitation needs of people recovering from COVID-19: scientific brief -7- 35. Van Aerde N, Van den Berghe G, Wilmer A, Gosselink R, Hermans G, COVID-19 Consortium. Intensive care unit acquired muscle weakness in COVID19 patients. Intensive Care Med. 2020 Nov;46(11):2083–2085. 36. Martillo MA, Dangayach M, Tabacof L, Spielman LA, Dams-O’Connor K, Chan CC, et al. Postintensive care syndrome in survivors of critical illness related to coronavirus disease 2019: cohort study from a New York City critical care recovery clinic. Crit Care Med. March 16, 2021. 37. Wiertz CM, Vints WA, Maas GJ, Rasquin SM, van Horn YY, Dremmen MP, et al. COVID-19: patient characteristics in the first phase of postintensive care rehabilitation. Arch Rehabil Res Clin Transl. 2021;3(2):100108. 38. Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, et al. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med. 2016;42(5):725–738. 39. Mehlhorn J, Freytag A, Schmidt K, Brunkhorst FM, Graf J, Troitzsch U, et al. Rehabilitation interventions for post-intensive care syndrome: a systematic review. Crit Care Med 2014;42:1263– 1271. 40. Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Victor EA, et al. Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 2020;11:687. 41. Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D, et al. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci. 2020;41(12):3437–3470. 42. Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T, et al. Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis of 350 studies. medRxiv preprint (https://doi.org/10.1101/2021.04.20.21255780, accessed 10 July 2021) . 43. Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature. 22 April 2021. 44. Michelen M, Cheng V, Manoharan L, Elkheir N, Dagens D, Hastie C, et al. Characterising long term Covid-19: a living systematic review. medRxiv preprint (https://doi.org/10.1101/2020.12.08.20246025, accessed 10 July 2021). 45. Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, et al. Symptoms and functional impairment assessed 8 months after mild COVID-19 among health care workers. JAMA. 2021;325(19):2015–2016. 46. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. January 30, 2021.medRxiv preprint (https://doi.org/10.1101/2021.01.27.21250617, accessed 10 July 2021). 47. Chopra V, Flanders SA, O’Malley M, Malani AN, Prescott HC. Sixty-day outcomes among patients hospitalized with COVID-19. Ann Intern Med. 2021;174(4):576–578. 48. Sivan M, Taylor S. NICE guideline on long covid. Research must be done urgently to fill the many gaps in this new “living guideline”. BMJ 2020;371:m4938. 49. Royal College of Speech and Language Therapists. New RCSLT report on long COVID and speech and language therapy, 13 May 2021 (https://www.rcslt.org/news/new-rcslt-report-on-long-covid-and- speech-and-language-therapy, accessed 10 July 2021). 50. Daynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – a cohort study. Chron Respir Dis. 2021;Vol 18:1–4. 51. Putrino D, Tabacof L, Tosto-Mancuso J, Wood J, Cortes M, Kontorovich A, McCarthy D. Autonomic conditioning therapy reduces fatigue and improves global impression of change in individuals with post-acute COVID-19 syndrome. Preprint (https://www.researchsquare.com/article/rs-440909/v1, accessed 9 July 2021). Rehabilitation needs of people recovering from COVID-19: scientific brief -8- 52. Nurek M, Rayner C, Freyer A, Taylor S, Järte L, Macdermott N, et al. Recommendations for the recognition, diagnosis, and management of patients with Post COVID-19 Condition ('Long COVID'): a Delphi Study (https://ssrn.com/abstract=3822279, accessed 10 July 2021). 53. Whitaker M, Elliott J, Chadeau-Hyam M, Riley S, Darzi A, Cooke G, et al. Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508 707 people. Preprint (https://spiral.imperial.ac.uk/bitstream/10044/1/89844/9/REACT_long_covid_paper_final.pdf, accessed 28 June 2021). 54. WHO Rehabilitation Definition (https://www.who.int/news-room/fact-sheets/detail/rehabilitation). 55. A clinical case definition of Post COVID-19 Condition (https://apps.who.int/iris/bitstream/handle/10665/345824/WHO-2019-nCoV-Post-COVID-19- condition-Clinical-case-definition-2021.1-eng.pdf) © World Health Organization 2021. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. WHO reference number: WHO/2019-nCoV/Sci_Brief/Rehabilitation/2021.1 Yüklə 326,66 Kb. 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