L’équipe a récemment publié dans la revue américaine de Médecine Physique et de Réadaptation « Archives of Physical Medicine and Rehabilitation » la plus grosse série mondiale sur les effets d’une rééducation dans la prise en charge du Covid-19.
Cet article révèle un bénéfice très important du travail rééducatif intense puisqu’il y a des améliorations très significatives sur une grande majorité des tests fonctionnels utilisés. Cette étude a eu lieu pendant l’épidémie de 2020 (mars – juin 2020) dans laquelle notre service de rééducation a pris en charge environ 150 patients. Pour rappel, le service avait aussi été le lieu de la première collaboration entre Médecins Sans Frontières et l’AP-HP, dans ce contexte de crise exceptionnelle. L’abstract est ci-dessous et l’article ci-joint en PDF.
ABSTRACT
Objective To determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients. Design Retrospective chart review. Setting A newly created specialized rehabilitation unit in a tertiary care medical center. Participants Consecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation. Intervention Inpatient rehabilitation for postacute care COVID-19 patients. Main Outcome Measures Measurements at admission and discharge comprised a Barthel Activities of Daily Living Index (including baseline value before COVID-19 infection), time to perform 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in the intensive care unit (ICU) were explored. Results Upon admission to rehabilitation, 66% of the patients were men, the age was 66±22 years, mean delay from symptom onset was 20.4±10.0 days, body mass index was 26.0±5.4 kg/m2, 49% had hypertension, 29% had diabetes, and 26% had more than 50% pulmonary damage on computed tomographic scans. The mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index increased from 77.3±26.7 to 88.8±24.5 (P<.001), without recovering baseline values (94.5±16.2; P<.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; P<.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; P=.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; P<.001). At both admission and discharge, Barthel score correlated with grip strength (ρ=0.39-0.66; P<.01), which negatively correlated with time spent in the ICU (ρ=–0.57 to –0.49; P<.05). Conclusions Inpatient rehabilitation for COVID-19 patients was associated with substantial motor, respiratory, and functional improvement, especially in severe cases, although there remained mild persistent autonomy loss upon discharge. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.
Covid Rehabilitation Study Group: Violaine Piquet, MBS, Ce´dric Luczak, MBS, Fabien Seiler, PT, Jordan Monaury, PET, Estelle Le´pine, PT, Lucile Chambard, PT, Marjolaine Baude, MD, Emilie Hutin, PhD, Alexandre Martini, MD, Andrés Samaniego, MD, Nicolas Bayle, MD, Anthony B Ward, MD, Jean-Michel Gracies, MD, Damien Motavasseli, MD.