Rehabilitation and In-Hospital Mortality in COVID-19 Patients

Anne Felicia Ambrose; Anupama Kurra; Lana Tsirakidis; Kate Collins Hunt; Emmeline Ayers; Andrew Gitkind; Sandeep Yerra; Yungtai Lo; Nicole Ortiz; Faraz Jamal; Vikram Madan; Matthew N Bartels; Joe Verghese

doi:10.1093/gerona/glab321

Rehabilitation and In-Hospital Mortality in COVID-19 Patients

J Gerontol A Biol Sci Med Sci. 2022 Apr 1;77(4):e148-e154. doi: 10.1093/gerona/glab321.

Authors

Anne Felicia Ambrose^{1

2}, Anupama Kurra^{1

3}, Lana Tsirakidis³, Kate Collins Hunt³, Emmeline Ayers⁴, Andrew Gitkind^{1

2}, Sandeep Yerra², Yungtai Lo⁵, Nicole Ortiz², Faraz Jamal^{2

6}, Vikram Madan², Matthew N Bartels^{1

2}, Joe Verghese^{2

4}

Affiliations

¹ Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
² Montefiore Health Systems, Bronx, New York, USA.
³ White Plains Hospital, White Plains, New York, USA.
⁴ Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.
⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶ Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA.

PMID: 34679166
DOI: 10.1093/gerona/glab321

Abstract

Background: Coronavirus disease 2019 (COVID-19) guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients.

Method: A single-center retrospective study, involving 990 COVID-19 patients (42.4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital, was conducted. Association of rehabilitation during hospitalization with in-hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications.

Results: Over the 3-month study period, 475 (48.0%) inpatients were referred for rehabilitation. Patients who received rehabilitation were older (73.7 ± 14.0 vs 62.3 ± 17.2). There were 61 hospital deaths (12.8%) in the rehabilitation group and 165 (32.0%) in the nonrehabilitation group. Receiving rehabilitation was associated with an 89% lower in-hospital mortality (odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.06-0.19) after adjusting for multiple confounders and COVID-19 disease markers. In sensitivity analyses, the results were significant in subpopulations defined by age group, sex, race, length of hospitalization, or pulmonary presentations. Each additional rehabilitation session was associated with a 29% lower risk of in-hospital mortality (OR per session: 0.71, 95% CI: 0.64-0.79) in the fully adjusted model.

Conclusion: Among hospitalized COVID-19 patients, receiving early rehabilitation was associated with lower in-hospital mortality. Our findings support implementation of rehabilitation services for COVID-19 patients in acute care settings, but further research from randomized clinical trials is needed.

Keywords: COVID-19; Epidemiology; Mortality; Rehabilitation.

MeSH terms

Aged
COVID-19*
Comorbidity
Female
Hospital Mortality
Hospitalization
Humans
Male
Retrospective Studies