Study of 288 Covid-19 patients in Michigan finds nearly 1/2 left hospital in worse physical condition than when they arrived

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Coronavirus infections and Covid-19 hospitalizations and deaths continue to decline, but much remains unknown about the lingering consequences of the disease, including the loss of physical abilities, Katie Camero reports for McClatchy News.

A study of 288 patients in Michigan found that 45 percent of Covid-19 patients hospitalized during the first two months of the pandemic experienced “significant functional decline after being discharged” that required medical equipment such as canes, wheelchairs, shower seats, outpatient therapy, caregiver assistance or diet changes, Camero reports.

Of these patients, 80% were referred to physical therapy after being discharged, and nearly 20% were not able to live independently, she reports.

“Rehabilitation needs were really, really common for these patients,” lead author Dr. Alecia K. Daunter, a pediatric physiatrist at Michigan Medicine, said in a Michigan Health Lab blog. “They survived, but these people left the hospital in worse physical condition than they started.” 

The researchers say their study is a “snapshot look at acute therapy needs” of such patients at a time when health-care systems were working to “keep patients safe while maximizing available beds and minimizing exposure to staff,” lead author Dr. Alecia Daunter, a pediatric physiatrist, said on the blog. 

The researchers say more study is needed on Covid-19's long-term effects on functionality, but meanwhile, Daunter said health systems can use this data to inform rehabilitation evaluations and to create plans of care for such patients.

“Acute care therapy can help prevent contractures, preserve muscle strength, address mobility impairments and help maintain cardiorespiratory function when patients are ill,” Daunter told McClatchy News in an email.

“These problems are frequent, and the stakes are pretty high if we miss them, or allow them to progress during hospitalization,” Daunter said on the blog. “Some of these people were working and many were living independently. To lose that level of function is meaningful. We want to make sure we’re addressing those needs, not just looking at the black and white: survival or death.”

The study at the University of Michigan was published in PM&R, the journal of the American Association of Physical Medicine and Rehabilitation.

It used the medical charts of 288 patients between the ages of 20 and 95 who were hospitalized for Covid-19 at the university hospital in March and April 2020. The analysis looked at discharge locations, therapy needs at the time of release, and the patients' need for durable medical equipment or other services.

About 68% of the patients required medical equipment such as a cane after being discharged from the hospital and about 27% who showed “functional changes” had difficulty swallowing at the time of release, Camero reports. In addition, about 40% were never assessed by a physical therapist, occupational therapist or speech language pathologist during their hospitalization.

“Physicians and others in the health-care system were working appropriately to discharge patients” in early in the pandemic, Daunter said on the blog. “So, the things we do in the hospital to maximize functioning, like mobility interventions and assessing activities of daily living, were not happening as often.”

These findings are just the tip of the iceberg when it comes to the effects of Covid on functioning, Anna Kratz, Ph.D., a clinical psychologist at Michigan Medicine and senior author of the paper, said on the blog post. 

“The major shifts in functioning that we highlight are important, but less dramatic declines in physical and cognitive functioning are likely to be found in nearly all previously hospitalized Covid patients,” said Kratz. “And we know from decades of rehabilitation work that even subtle changes in functioning can derail a person’s life trajectory. Future work needs to focus on improving our ability to identify and treat people across the full range of the functional decline spectrum.”

Some advice for rural residents about getting to physical therapy: tap into your 'sheer cussed determination'

Living in a rural area makes it much harder to access physical therapy, to the point where "sometimes it takes sheer cussed determination and good neighbors to help get us back on our feet," Donna Kallner writes for The Daily Yonder. Kallner, a fiber artist living in rural northern Wisconsin, writes that she had a hard time accessing PT after she was hit by a drunk driver in 1998.

"For many people in rural areas, reaching these services might take a longer journey than the 52-mile round trip required where I live," Kallner writes. "More than 40 percent of rural residents spend more than 30 minutes traveling to rehab, compared to 25.3 percent of urban residents. And the distance is an even greater obstacle when you can’t drive yourself."

Some rural residents give up on much-needed PT because of the logistical nightmare involved. Kallner acknowledges rural residents' tendency toward independence, or "pure cussedness," as she calls it, and advises those who need PT to consider the following questions when deciding whether or not to do it:

• What are my options? Visiting nurses or telemedicine therapy might be available. 
• What would be required of me and my family, medically and financially? Medicare could pay for inpatient physical therapy.
• Is it something you want to do? Ask your doctor what the consequences will be for your quality of life if you don't do PT.

Once you commit to doing PT, Kallner advises patients to keep the following in mind:

• Communicate your PT goals clearly to your therapists, especially if you see different ones at some appointments. 
• Ask your physical therapist to explain if you don't understand something.
• Be honest with your physical therapist about whether you've done assigned exercises at home; they can tell anyway, and it affects your care. Bonus: if you have been doing your homework, you might not have to come in as frequently.
• Be realistic about what exercises you can do at home. If they've assigned you a lot of different exercises, review the whole list with your physical therapist and ask if you can discontinue some.

"Even with specialized rehabilitation services, it helps to throw some sheer, cussed determination into the mix," Kallner writes. "But that doesn’t mean you have to do it all on your own. Be honest with family, friends and neighbors about what you need, and grant them the blessing of letting them help."