Post-Covid Rehabilitation

Two years after the onset of the COVID-19 pandemic, it has become clear that overcoming the acute phase of the infection and having negative swab results is not always associated to patients recovering a good state of health. Many patients, especially those who are more frail and were forced to a long hospital stay due to the severity of their general and/or respiratory conditions, suffer the consequences of prolonged bedding, such as reduced respiratory function due to lung injury, loss of muscle mass and tone with consequent motor difficulties, and a precarious nutritional, cognitive and psychological status requiring more or less extended periods of rehabilitation. To this end, multidisciplinary rehabilitation programs have been implemented in many countries, including Italy, involving close collaboration between different professional roles (general practitioners, pneumologists, cardiologists, nutritionists and psychologists) with the goal to accelerate and optimize the patients’ recovery.

Patients who overcome the acute phase of the disease are generally divided into three categories:

  • Paucisymptomatic who managed to overcome the disease at home
  • Hospitalized in pneumology and infectious diseases units and discharged with mild motor and respiratory deficits
  • Hospitalized in ICU, often intubated, and discharged with severe motor, respiratory and at times neurological deficits

Patient rehabilitation, either in preexisting or in new dedicated hospital units, is usually dedicated only to this last group of patients. All other patients are not directed to a rehabilitation program despite there is almost always a clinical indication to do so.

Following the indications the European Respiratory Society and of the Italian Society of Physical and Regenerative Medicine (SIMFER)UPMC Institute for Health of Chianciano Terme has launched a Personalized Post-COVID-19 Rehabilitation Program for all patients who have overcome the disease (two negative swabs) but still present one or more of the symptoms listed below (Rivista Società Italiana di Medicina Generale n.3 – vol.27-2020):

  • Difficulty walking (even short distances)
  • Difficulty rolling over when in the bed
  • Difficulty sitting down for long periods
  • Difficulty getting up
  • Difficulties during transfers
  • Severe fatigue
  • Muscle and joint pain
  • Anxiety/depression
  • Severe fatigue
  • Dizziness
  • Dyspnea on modest exertion
  • Bedsores
  • Muscle weakness
  • Constipation
  • Cognitive impairment
  • Mental confusion/disorientation

UPMC Institute for Health post-Covid rehabilitation program:

  • Pneumology assessment
  • Cardiology assessment
  • Physical therapy assessment
  • Nutritional assessment
  • Rehabilitation and respiratory therapy (dedicated sessions for the personalized physical exercise and respiratory therapy program at the Medical and Wellness Center)
  • Psychology assessment (psychological and motivational support)
  • Final assessment to review the achieved outcomes and outline the recommendations for follow-up
  • Motivational, nutritional and physical therapy follow-up (also telemedicine)

The program may be modified and adapted to the initial conditions of the patient. The duration of the program can range between 10 days to 3 months depending on the patient’s needs assessed by the multidisciplinary rehabilitation team. Complementary therapies (Yoga, Tai chi, Qi-Gong, music therapy, Mindfulness) may be added to the program to help manage and mitigate the stress caused by the disease and by its consequences.