Functional decline in hospitalized patients with COVID-19 in the early months of the pandemic

Introduction Coronavirus disease 2019 (COVID-19) survivors are at risk of functional decline. To address the current gap in knowledge about post-acute needs of those infected by COVID-19, we examined discharge function data to better prepare patients, providers, and health systems to return patients to optimal levels of functioning. Objective To examine the prevalence of functional decline and related rehabilitation needs at hospital discharge. Design Prospective chart review. Setting Academic tertiary care hospital. Participants Hospitalized adults with a laboratory confirmed COVID-19 diagnosis, with admission dates between March 4, 2020 and May 1, 2020. Interventions Not applicable. Main Outcome Measures Discharge location; need for outpatient physical, occupational, or speech therapy; need for durable medical equipment at discharge; presence of dysphagia at discharge; functional decline. Results Three hundred eleven potential cases were reviewed. The final number of cases included in analysis was N = 288; patient ages ranged from 20 to 95 years old (mean 66.80 +/- 15.31 years). Nearly 20 % of COVID-19 survivors were discharged to a location other than their home. Forty-five percent of survivors experienced functional decline impacting their discharge. Eighty-seven survivors (80.6%) who showed functional change during hospitalization were referred for additional therapy at discharge. At least 73 (67.6%) of these patients required durable medical equipment at discharge (in 12 cases this was not clearly documented). Twenty-nine (26.7%) of the survivors who showed functional changes had ongoing dysphagia at the time of hospital discharge. Ninety-seven of the survivors (40.6%) were never assessed by a PM&R physician, physical therapist, occupational therapist, or speech language pathologist during their hospitalization. Conclusions COVID-19 mortality rates are frequently reported in the media, whereas the effects on function are not as well described. The information provided here highlights the need for rehabilitative services during and after hospitalization for COVID-19.