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Patients With and Without COVID-19 in the Intensive Care Unit: Physical Status Outcome Comparisons 3 Months After

Bastiaan Cijs¹, Karin Valkenet¹, Germijn Heijnen¹

¹Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands.

Physical Therapy

|April 20, 2023

Insights

COVID-19 patients in intensive care units (ICUs) show comparable physical functioning and health status to non-COVID-19 patients three months post-discharge. Personalized rehabilitation and outpatient aftercare are recommended for all ICU survivors.

Area of Science:

Intensive Care Medicine
Pulmonology
Rehabilitation Medicine

Background:

Physical impairments are common sequelae of intensive care unit (ICU) stays.
The long-term physical recovery of COVID-19 patients compared to non-COVID-19 ICU patients remains unclear.

Purpose of the Study:

To compare handgrip strength, physical functioning, and health status between COVID-19 and non-COVID-19 ICU patients at 3 months post-discharge.
To identify factors associated with physical functioning and health status in COVID-19 ICU patients.

Main Methods:

Observational, retrospective chart review comparing 92 COVID-19 patients with 91 non-COVID-19 patients.
Assessed handgrip strength, physical functioning (PROMIS PF), and health status (EQ-5D-5L) using linear regression.
Multilinear regression identified factors associated with outcomes in the COVID-19 cohort.

Main Results:

No significant differences in handgrip strength, physical functioning, or health status were observed between COVID-19 and non-COVID-19 groups at 3 months.
In the COVID-19 group, male sex was associated with better physical functioning compared to female sex.

Conclusions:

Physical functioning and health status appear comparable between COVID-19 and non-COVID-19 ICU survivors at 3 months post-discharge.
Post-ICU care focusing on physical rehabilitation is warranted for both groups, especially those with prolonged ICU stays (>48 hours).

Read full analysis

Abstract

Objective:

Many patients with coronavirus disease 2019 (COVID-19) infections were admitted to an intensive care unit (ICU). Physical impairments are common after ICU stays and are associated with clinical and patient characteristics. To date, it is unknown if physical functioning and health status are comparable between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The primary objective of this study was to compare handgrip strength, physical functioning, and health status between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The second objective was to identify factors associated with physical functioning and health status in patients in the ICU with COVID-19.

Methods:

In this observational, retrospective chart review study, handgrip strength (handheld dynamometer), physical functioning (Patient-Reported Outcomes Measurement Information System Physical Function), and health status (EuroQol 5 Dimension 5 Level) were compared between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 using linear regression. Multilinear regression analyses were used to investigate whether age, sex, body mass index, comorbidities in medical history (Charlson Comorbidity Index), and premorbid function illness (Identification of Seniors At Risk-Hospitalized Patients) were associated with these parameters in patients in the ICU with COVID-19.

Results:

In total, 183 patients (N = 92 with COVID-19) were included. No significant between-group differences were found in handgrip strength, physical functioning, and health status 3 months after ICU discharge. The multilinear regression analyses showed a significant association between sex and physical functioning in the COVID-19 group, with better physical functioning in men compared with women.

Conclusion:

Current findings suggest that handgrip strength, physical functioning, and health status are comparable for patients who were in the ICU with COVID-19 and patients who were in the ICU without COVID-19 3 months after ICU discharge.

Impact:

Aftercare in primary or secondary care in the physical domain of postintensive care syndrome after ICU discharge in patients with COVID-19 and in patients without COVID-19 who had an ICU length of stay >48 hours is recommended.

Lay Summary:

Patients who were in the ICU with and without COVID-19 had a lower physical status and health status than healthy people, thus requiring personalized physical rehabilitation. Outpatient aftercare is recommended for patients with an ICU length of stay >48 hours, and functional assessment is recommended 3 months after hospital discharge.

Keywords:

COVID-19 Health Status Intensive Care Unit Physical Functioning Physical Therapy Rehabilitation

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