Ann Rehabil Med.  2025 Feb;49(1):49-59. 10.5535/arm.240066.

Early Rehabilitation Interventions by Physical Therapists for Severe COVID-19 Patients Were Associated With Decreased Incidence of Post-ICU Physical Impairment

• Oku S
• Hatakeyama J
• Liu K
• Tojo K
• Idei M
• Inoue S
• Yamakawa K
• Nishida T
• Ohshimo S
• Hashimoto S
• Maruyama S
• Ogata Y
• Kawakami D
• Shimizu H
• Hayakawa K
• Fujino Y
• Oshima T
• Fuchigami T
• Yawata H
• Oe K
• Kawauchi A
• Yamagata H
• Harada M
• Sato Y
• Nakamura T
• Sugiki K
• Hakozaki T
• Beppu S
• Anraku M
• Kato N
• Iwashita T
• Kamijo H
• Kitagawa Y
• Nagashima M
• Nishimaki H
• Tokuda K
• Nishida O
• Nakamura K

• KMID: 2565459
• DOI: http://doi.org/10.5535/arm.240066

Abstract

Objective
To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment.
Methods
An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors.
Results
The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006).
Conclusion
Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Keyword

Critical illness; Rehabilitation; Post-intensive care syndrome; COVID-19

Figure

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  Fig. 1. Outline of the study. COVID-19, coronavirus disease 2019; ICUs, intensive care units; PICS, post-intensive care syndrome.

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  Fig. 2. Intensive care unit (ICU) mobility scale up to 7 days after ICU admission for patients with and without rehabilitation interventions (RIs) by physical therapists within 7 days. The bars show median values, and the error bars show quartile ranges.

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