1887
Volume 2022, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background and Purpose: A growing field of interest is exploration of the functional outcomes of post-coronavirus disease 2019 (COVID-19) patients with stroke after rehabilitation. The association between stroke and COVID-19 infection is still being studied. We had explored the functional gain in post-COVID-19 patients with stroke following active rehabilitation services in Qatar to understand the possible predictors of functional gain.

Methods: We had included twenty patients diagnosed with post-COVID-19 with stroke in this retrospective pilot study conducted at a Qatar rehabilitation setting. We had used preexisting data from electronic medical records. We had included the Functional Independence Measure (FIM), post-COVID-19 functional status (PCFS), Action Research Arm Test (ARAT), Functional Ambulation Category (FAC), and Borg Rating of Perceived Exertion (RPE) as outcome measures. We had used descriptive statistics to summarize the baseline characteristics. A paired t-test had been used to compare the pre and posttests of the study group at admission and discharge. Multiple regression analyses had been performed to assess the predictors of functional gain, including age, employment status, impaired side, family history, and length of stay (LOS). All the results had been presented with associated 95% confidence intervals.

Results: This study had revealed an increase in functional gain (mean FIM gain, 32.9 ± 8.9) and improvements in functional performance throughout active rehabilitation (LOS, 62.45 ± 37.61). Significant differences had been noted in all outcome measures from admission until discharge ( < 0.05). Age (β = − 0.769,  = 0.022) and impaired side (β = 0.573,  = 0.007) had significantly predicted National Institutes of Health Stroke Scale (NIHSS) scores. Age (β = − 0.764,  = 0.047) had been a major factor that significantly predicted FIM gain. LOS (β = − 0.990,  = 0.002) had predicted FAC. The mean age was 56 ± 8 years.

Conclusion: Various factors are independently associated with functional gain after rehabilitation. Our findings suggest that active rehabilitation services and immediate intervention will be required to rehabilitate post-COVID-19 patients with stroke, a vulnerable population, to achieve adequate functional improvement.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2022.10
2022-02-28
2022-09-28
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2022/1/qmj.2022.10.html?itemId=/content/journals/10.5339/qmj.2022.10&mimeType=html&fmt=ahah

References

  1. Covid-19 Qatar national response action plan, Mar 2020. COVID-19 REPORT WEB.pdf [Internet]. cited 2021 Sep 14. Available from:https://www.moph.gov.qa/Style%20Library/MOPH/Videos/COVID-19%20REPORT%20WEB.pdf .
  2. Al Khal A, Al-Kaabi S, Checketts RJ. Qatar's response to COVID-19 pandemic. Heart Views Off J Gulf Heart Assoc. 2020 Sep; 21:(3):129–32. doi:10.4103/HEARTVIEWS.HEARTVIEWS_161_20 .
    [Google Scholar]
  3. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020 Mar 2020; 2020:(2020):970–1. doi:10.1056/NEJMc2001468 .
    [Google Scholar]
  4. Joshi RS, Jagdale SS, Bansode SB, Shankar SS, Tellis MB, Pandya VK, et al. Discovery of potential multi-target-directed ligands by targeting host-specific SARS-CoV-2 structurally conserved main protease. J Biomol Struct Dyn. 2021 Jun; 39:(9):3099–114. doi:10.1080/07391102.2020.1760137 .
    [Google Scholar]
  5. Kundu D, Selvaraj C, Singh SK, Dubey VK. Identification of new anti-nCoV drug chemical compounds from Indian spices exploiting SARS-CoV-2 main protease as target. J Biomol Struct Dyn. 2021 Jun; 2021:(2021):3428–34. doi:10.1080/07391102.2020.1763202. Epub 2020 May 13.
    [Google Scholar]
  6. Jensen JF, Thomsen T, Overgaard D, Bestle MH, Christensen D, Egerod I. Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med. 2015 May; 2015:(2015):763–75. doi:10.1007/s00134-015-3689-1. Epub 2015 Mar 3.
    [Google Scholar]
  7. Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, et al. Depressive symptoms and impaired physical function after acute lung injury. Am J Respir Crit Care Med. 2012 Mar 2012; 2012:(2012):517–24. doi:10.1164/rccm.201103-0503OC. Epub 2011 Dec 8.
    [Google Scholar]
  8. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999 Jul; 1999:(1999):50–6. doi:10.1164/ajrccm.160.1.9708059 .
    [Google Scholar]
  9. Kramer A, Gollhofer A, Armbrecht G, Felsenberg D, Gruber M. How to prevent the detrimental effects of two months of bed-rest on muscle, bone and cardiovascular system: an RCT. Sci Rep. 2017 Dec; 2017:(2017):13177. doi:10.1038/s41598-017-13659-8 .
    [Google Scholar]
  10. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 2009; 2009:(2009):1874–82. doi:10.1016/S0140-6736(09)60658-9. Epub 2009 May 14.
    [Google Scholar]
  11. After-care_needs_of_inpatients_recovering_from_covid-19_5_june_2020.pdf [Internet]. [cited 2021 Sep 14]. Available from:https://www.cambscommunityservices.nhs.uk/docs/default-source/luton-adults-general/c0388_after_care_needs_of_inpatients_recovering_from_covid-19_5_june_2020.pdf .
  12. Barrett H, DeGroute W, Denehy L, Etimadi Y, Gosslink R, Grey D, et al. (2020). Rehabilitation_considerations_during_the_covid-19_outbreak. Washington, DC: Pan American Health Organization/ World Health Organization. Available from:https://iris.paho.org/handle/10665.2/52035_.
  13. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 2020; 2020:(2020):683–690. doi:10.1001/jamaneurol.2020.1127 .
    [Google Scholar]
  14. Tan Y-K, Goh C, Leow AST, Tambyah PA, Ang A, Yap E-S, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020 Oct; 2020:(2020):587–595. doi:10.1007/s11239-020-02228-y .
    [Google Scholar]
  15. Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis. 2020 Aug; 2020:(2020):104953. doi:10.1016/j.jstrokecerebrovasdis.2020.104953. Epub 2020 May 14.
    [Google Scholar]
  16. Wang CC, Chao JK, Wang ML, Yang YP, Chien CS, Lai WY, et al. Care for patients with stroke during the COVID-19 pandemic: physical therapy and rehabilitation suggestions for preventing secondary stroke. J Stroke Cerebrovasc Dis. 2020 Nov; 2020:(2020):105182. doi:10.1016/j.jstrokecerebrovasdis.2020.105182. Epub 2020 Jul 22.
    [Google Scholar]
  17. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus. 2020 Mar 21 [cited 2021 Sep 14]; 12:(3). Available from:https://www.cureus.com/articles/29414-neurological-complications-of-coronavirus-disease-covid-19-encephalopathy:e7352 .
    [Google Scholar]
  18. Diaz-Segarra N, Edmond A, Kunac A, Yonclas P. COVID-19 Ischemic strokes as an emerging rehabilitation population: a case series. Am J Phys Med Rehabil. 2020 Jul 2020; 2020:(2020):876–9. doi:10.1097/PHM.0000000000001532 .
    [Google Scholar]
  19. Dafer RM, Osteraas ND, Biller J. Acute stroke care in the coronavirus disease 2019 pandemic. J Stroke Cerebrovasc Dis. 2020 Jul; 2020:(2020):104881. doi:10.1016/j.jstrokecerebrovasdis.2020.104881. Epub 2020 Apr 17.
    [Google Scholar]
  20. Carod-Artal FJ, Medeiros MSM, Horan TA, Braga LW. Predictive factors of functional gain in long-term stroke survivors admitted to a rehabilitation programme. Brain Inj. 2005 Aug 2005; 2005:(2005):667–73. doi:10.1080/02699050400013626 .
    [Google Scholar]
  21. Sweid A, Hammoud B, Bekelis K, Missios S, Tjoumakaris SI, Gooch MR, et al. Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019. Int J Stroke. 2020 Oct 2020; 2020:(2020):733–42. doi:10.1177/1747493020937189 .
    [Google Scholar]
  22. Fatima N, Saqqur M, Qamar F, Shaukat S, Shuaib A. Impact of COVID-19 on neurological manifestations: an overview of stroke presentation in pandemic. Neurol Sci. 2020 Oct; 2020:(2020):2675–9. doi:10.1007/s10072-020-04637-6. Epub 2020 Aug 6.
    [Google Scholar]
  23. Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, et al. Characteristics and outcomes in patients with COVID-19 and acute ischemic stroke. Stroke. 2020 Jul 13;:51:e254–8. doi:10.1161/STROKEAHA.120.031208 .
    [Google Scholar]
  24. Wade D. Rehabilitation - a new approach. Part two: the underlying theories. Clin Rehabil. 2015 Dec; 2015:(2015):1145–54. doi:10.1177/0269215515601175 .
    [Google Scholar]
  25. Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil. 2020 May; 2020:(2020):571–83. doi:10.1177/0269215520905112 .
    [Google Scholar]
  26. Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil. 2017 Aug; 2017:(2017):995–1004. doi:10.1177/0269215517709890 .
    [Google Scholar]
  27. Wade D. A teamwork approach to neurological rehabilitation [Internet]. Oxford textbook of neurorehabilitation. Oxford University Press; [cited 2021 Sep 14]. Available from:https://oxfordmedicine.com/view/10.1093/med/9780198824954.001.0001/med-9780198824954-chapter-2 .
    [Google Scholar]
  28. Meyer D, Meyer BC, Rapp KS, Modir R, Agrawal K, Hailey L, et al. A stroke care model at an academic, comprehensive stroke center during the 2020 COVID-19 pandemic. J Stroke Cerebrovasc Dis. 2020 Aug; 2020:(2020):104927. doi:10.1016/j.jstrokecerebrovasdis.2020.104927 .
    [Google Scholar]
  29. Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, et al. The functional independence measure: a comparative validity and reliability study. Disabil Rehabil. 1995 Jan; 1995:(1995):10–4. doi:10.3109/09638289509166622 .
    [Google Scholar]
  30. Siegerink B, Rohmann JL. Impact of your results: beyond the relative risk. Res Pract Thromb Haemost. 2018 Oct; 2018:(2018):653–7. doi:10.1002/rth2.12148 .
    [Google Scholar]
  31. Molloy et al. Reliability of a standardized Mini Mental State Examination compared with the traditional Mini-Mental state Examination. Am J Psychiatry. 1991a;:14:102–5.
    [Google Scholar]
  32. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984 Jan; 1984:(1984):35–40. doi:10.1093/ptj/64.1.35 .
    [Google Scholar]
  33. Borg rating scale of perceived exertion [Internet]. Shirley Ryan AbilityLab. [cited 2021 Sep 14]. Available from:https://www.sralab.org/rehabilitation-measures/borg-rating-scale-perceived-exertion .
    [Google Scholar]
  34. Yozbatiran N, Der-Yeghiaian L, Cramer SC. A standardized approach to performing the action research arm test. Neurorehabil Neural Repair. 2008 Feb; 2008:(2008):78–90. doi:10.1177/1545968307305353. Epub 2007 Aug 17.
    [Google Scholar]
  35. Chae J, Johnston M, Kim H, Zorowitz R. Admission motor impairment as a predictor of physical disability after stroke rehabilitation. Am J Phys Med Rehabil. 1995; 74:(3):218–23.
    [Google Scholar]
  36. Brown AW, Therneau TM, Schultz BA, Niewczyk PM, Granger CV. Measure of functional independence dominates discharge outcome prediction after inpatient rehabilitation for stroke. Stroke. 2015 Apr; 2015:(2015):1038–44. doi:STROKEAHA.114.007392. Epub 2015 Feb 24.
    [Google Scholar]
  37. Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P, et al. Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil. 2000; 81:(6):695–700. doi:10.1016/S0003-9993(00)90095-9 .
    [Google Scholar]
  38. Yamakawa M, Kuno T, Mikami T, Takagi H, Gronseth G. Clinical characteristics of stroke with COVID-19: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2020 Dec; 2020:(2020):105288. doi:10.1016/j.jstrokecerebrovasdis.2020.105288. Epub 2020 Aug 29.
    [Google Scholar]
  39. Joseph C, Rhoda A. Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. Afr Health Sci. 2013 Sep; 2013:(2013):646–54. doi:10.4314/ahs.v13i3.18 .
    [Google Scholar]
  40. Helms J, Kremer S, Merdji H, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020; 382: (23):2268–70. doi:10.1056/NEJMc2008597 .
    [Google Scholar]
  41. Mohamed Hussein AA, Saad M, Zayan HE, Abdelsayed M, Moustafa M, Ezzat AR, et al. Post-COVID-19 functional status: relation to age, smoking, hospitalization, and previous comorbidities. Ann Thorac Med. 2021 Jul–Sep; 16:(3):260–5. doi:10.4103/atm.atm_606_20. Epub 2021 Jul 20.
    [Google Scholar]
  42. Taboada M, Carinena A, Moreno E, Rodriguez N, Dominguez MJ, Casal A, et al. Post-COVID-19 functional status six-months after hospitalization. J Infect. 2021 Apr; 82: (4):e31–3. doi:10.1016/j.jinf.2020.12.022. Epub 2020 Dec 26.
    [Google Scholar]
  43. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol. 2021 Feb; 2021:(2021):1013–22. doi:10.1002/jmv.26368. Epub 2020 Aug 17.
    [Google Scholar]
  44. Lang CE, Wagner JM, Dromerick AW, Edwards DF. Measurement of upper-extremity function early after stroke: properties of the action research arm test. Arch Phys Med Rehabil. 2006 Dec; 2006:(2006):1605–10. doi:10.1016/j.apmr.2006.09.003 .
    [Google Scholar]
  45. Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res. 2020;21:163. doi:10.1186/s12931-020-01429-6 .
    [Google Scholar]
  46. Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, et al. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil. 2015; 37:(15):1316–23. doi:10.3109/09638288.2014.963706. Epub 2014 Sep 24.
    [Google Scholar]
  47. Mahase E. Covid-19: why are age and obesity risk factors for serious disease? BMJ. 2020 Oct 26;:371:m4130. doi:10.1136/bmj.m4130 .
    [Google Scholar]
  48. Functional gain after inpatient stroke rehabilitation [Internet]. [cited 2021 Sep 15]. Available from: https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.115.010440 .
  49. Kalenkoski CM, Pabilonia SW. Initial impact of the COVID-19 pandemic on the employment and hours of self-employed coupled and single workers by gender and parental status. 2020;46.
    [Google Scholar]
  50. Changes in the employment status and risk of stroke and stroke types [Internet]. [cited 2021 Sep 14]. Stroke 2017; 48:(5):1176–82. Available from: https://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.117.016967 .
    [Google Scholar]
  51. Mossakowski KN. The influence of past unemployment duration on symptoms of depression among young women and men in the United States. Am J Public Health. 2009 Oct; 2009:(2009):1826–32. doi:10.2105/AJPH.2008.152561. Epub 2009 Aug 20.
    [Google Scholar]
  52. Kessler RC, Turner JB, House JS. Effects of unemployment on health in a community survey: main, modifying, and mediating effects. J Soc Issues. 1988; 44:(4):69–85. doi:10.1111/josi.12156. Epub 2016 Mar 9.
    [Google Scholar]
  53. Domholdt E. Physical therapy research: principles and applications. Philadelphia: W B Saunders Co; 1993:. 454.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2022.10
Loading
/content/journals/10.5339/qmj.2022.10
Loading

Data & Media loading...

Keyword(s): COVID-19functionQatarrehabilitation and stroke
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error