Rehabilitation plus robotic therapy improves functional outcomes in COVID-19 patients

Inpatient rehabilitation with a comprehensive rehabilitation program offers benefits to post-COVID-19 patients, reports a Singapore study, noting that functional outcomes may be further improved with adjunct robotic therapy.

“Frailty may also be considered when establishing rehabilitation goals, as meaningful functional gains can still be achieved,” the researchers said.

This retrospective study was conducted among COVID-19 patients who were transferred for acute inpatient rehabilitation from 1 November 2021 to 31 December 2021.

Participants who underwent such rehabilitation showed improvements in the Functional Independence Measure (FIM; median 109 vs 82), Functional Ambulation Category (median 3 vs 2), distance walked with physiotherapist (mean 143.5 vs 18.7 m), and the Hospital Anxiety and Depression Scale (HADS; mean 4.5 vs 7.8) from baseline. [Proc Singap Healthc 2023;doi:10.1177/20101058221150078]

Notably, the addition of daily robotic therapy with Andago correlated with a shorter rehabilitation medicine length of stay (median 13 vs 19.5 days) and a higher FIM efficiency (mean 2.3 vs 1.2).

On the other hand, patients with a higher frailty score seemed to have a slower 10 Meter Walk Test (10MWT) speed at discharge (Spearman’s rho, ‒0.542).

“Our findings concur with those of previous studies demonstrating the benefits of rehabilitation after COVID-19,” the researchers said. “Significant improvements in functional outcome measures and mood symptoms were noted in the overall cohort, reiterating the role of acute inpatient rehabilitation after COVID-19.” [Arch Phys Med Rehabil 2021;102:1067-1074; PLoS One 2021;16:e0248824]

Robotic therapy

Oxygen desaturation on exertion may occur in patients recovering from COVID-19, and those with early or severe desaturation risk further decondition if physiotherapists fail to mobilize them.

The researchers applied robotic therapy to all participants who were transferred to the inpatient rehabilitation unit and were willing and suitable, based on previous experience in patients with restrictive lung disease and postcritical care COVID-19 patients. [Ann Acad Med Singap 2020;49:401-404; Proc Singapore Health 2020;29:67-69]

“The principle was to provide off-loading of body weight, increase support and confidence, provide supplemental oxygen as needed, reduce the physical burden on the therapist, and enable the patient to walk a further distance than they could overground without the device,” the researchers said. “In doing so, it builds up neuromuscular endurance and possibly lower extremity strength.”

Frailty

Patients who were frail had lower FIM efficiency and a lower discharge walking speed on the 10MWT than those who were not frail or only prefrail. Regardless of the presence of frailty, patients demonstrated better FIM, distance ambulated with physiotherapists, and HADS scores.

The improvements in HADS showed a minimally significant difference in both groups, the researchers noted. [J Cardiopul Rehab Preven 2019;39:E6-E11; Health Quali Life Outcomes 2008;6:46; Acta Psychiatri Scandina 1983;67:361-370]

“However, from the baseline data, it was found that patients who did not receive robotic therapy were frailer. This may account for the increased length of stay, reduced FIM efficiency, and poorer 10MWT, rather than solely because of the lack of robotic therapy,” the researchers said.

“Patients who are frailer may have less energy to participate in more activities (two patients declined robotic therapy),” they added.