By Carol Davis
Nearly half of COVID-19 patients left the hospital with significant functional decline post-discharge, a new study from Michigan Medicine found.
Of those survivors who suffered functional decline, 80% were referred for additional therapy after discharge. Nearly 20% of all patients declined to the point that they were no longer able to live independently, says the study, Functional Decline in Hospitalized Patients with COVID-19 in the Early Months of the Pandemic, published in PM&R.
“Rehabilitation needs were really common for these patients,” lead author Alecia K. Daunter, MD, a pediatric physiatrist at Michigan Medicine, said in a media release. “They survived, but these people left the hospital in worse physical condition than they started. If they needed outpatient therapy or are now walking with a cane, something happened that impacted their discharge plan.”
“These patients may have needed to move to a subacute facility, or they might have needed to move in with a family member, but they were not able to go home,” Daunter says.
Researchers viewed charts of nearly 300 adult patients hospitalized for COVID-19 at Michigan Medicine during the pandemic’s first wave between March and April 2020. They analyzed patients’ discharge locations, therapy needs at time of release, and whether they needed durable medical equipment or other services.
Because the study period occurred in the early days of the pandemic, as healthcare providers focused primarily on minimizing exposures and managing patient overflow, about 40% of patients never had a rehabilitation evaluation by a therapist or PM&R physician while hospitalized.
“The things we do in the hospital to maximize functioning, like mobility interventions and assessing activities of daily living, were not happening as often,” Daunter says.
That likely means the number of patients who are losing ability is underreported, she says.
COVID-19 can damage organs, causing neurological and musculoskeletal impairments. In response to ongoing COVID side effects, Michigan Medicine recently opened two clinics to address the growing population of “long COVID” patients.
However, the virus’ effect on daily functioning is rarely discussed, which can’t be ignored any longer, says Edward Claflin, MD, a Michigan Medicine physiatrist and study co-author.
“These results help to highlight the true impact of the COVID-19 disease on our patients,” Claflin says. “They fill in that gap in knowledge about how patients with COVID recover and what kind of rehabilitation needs they have.”
The study is a snapshot of acute therapy needs during a time when knowledge of the unprecedented virus was even more limited. While additional research examining the long-term effects of COVID on functionality is needed, health systems can use the current data to conduct rehabilitation assessments and prepare resources for this underserved population, Daunter says.
“These problems are frequent, and the stakes are pretty high if we miss them, or allow them to progress during hospitalization,” she says. “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.”
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.