Authors (including presenting author) :
KongISY, ChanRWY, YeungJTY, ChanBSC, TsuiAYY, ChauRMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Pulmonary dysfunction, physical deconditioning and psychological distress are common after long hospital stay for post-COVID-19 patients especially for the elderly with pre-existing health conditions. Rehabilitation interventions address many sequelae of severe COVID-19. Personalized physical rehabilitation could promote both physical and psychological wellbeing which was also impacted by the acute severe COVID-19.
Objectives :
Sharing on ‘multi-domain’ in the rehabilitation of a “recovered” COVID-19 patient.
Methodology :
A 71-year-old lady with throat saliva tested RT-PCR positive for SARS-CoV-2 on 19 July 2020 started her nCoV treatment in QEH. After substantial medical treatment, with nCoV Cycle Threshold Value of 35 and the present of SARS-CoV2 antibody, she was transferred from QEH to KH for rehabilitation on 21 August 2020. CT Thorax suggested post-COVID-19 pneumonia(absorption stage) with extensive lung fibrosis and scarring. A course of inpatient rehabilitation followed by outpatient custom-tailored pulmonary rehabilitation was given.
Result & Outcome :
Periodic progress review was conducted to monitor patient’s respiratory, physical and psychological condition. For pulmonary function, maximum inspiratory pressure (from 23.0 to 33.7cmH2O) and maximum expiratory pressure (from 23.3 to 47.7cmH2O) was in improving trend. For strength & endurance, right-hand grip strength (from 16 to 20kg) and left-hand grip strength (from 14 to 17kg) increased, 30-Second Chair Stand Test (from 8 to 14 correct stand) improved. For submaximal exercise testing, 2-Minute Walk Test distance (from 35 to 90m) during inpatient stay, 6-Minute Walk Test distance(from 348 to 370m) and incremental ergometry test(from 3.11 to 3.50 METs) showed gradual improvement. Furthermore, successful weaning of oxygen alongside improvement in physical functioning was achieved during hospital stay. For psychological well-being, Depression, Anxiety, Stress Scale(DASS-21) was reduced from extremely severe depression(score 17/21), moderate anxiety(score 7/21), and severe stress(score 11/21) to normal(score 0/21) in all three domains upon inpatient discharge and were well maintained. In addition, the patient becomes happier with Subjective Happiness Scale from below average(score 4.75/7) to well above average(score 6/7).
Significant psychological component was observed for the “recovered” COVID-19 patient especially for the long hospital stay patient with severe respiratory symptoms. A continuum of rehabilitation focused on respiratory, physical and psychological well-being is crucial for a comprehensive management of “recovered” COVID-19 patients to return to their premorbid level of independence.
