Rehabilitative treatment of patients with COVID-19 infection: the P.A.R.M.A. evidence based clinical practice protocol
Covid-19 P.A.R.M.A. Protocol
Keywords:
covid-19, coronavirus, rehabilitation, clinical protocolAbstract
Background: The impact of the SARS-CoV-2 on the National Health System (NHS) required a reorganization of the various levels of care, which also involved the rehabilitation reality.
Aim of the work: A clinical practice review of the literature was conducted to provide operational-rehabilitation guidelines adapted to the local reality and to the recent corporate reorganization in the context of the COVID-19 emergency.
Methods: A practice review of the available scientific evidence was regularly conducted from the start of the COVID-19 pandemic to periodically update the clinical practice guidelines. Articles that met the following inclusion criteria were included: studies conducted on human adult subjects with COVID-19 infection, undergoing rehabilitation in any hospitalization setting.
Results: The results of this clinical practice update were periodically discussed with colleagues and collaborators in a multi-professional team, in order to guarantee a good clinical practice protocol, named P.A.R.M.A.
Conclusions: The P.A.R.M.A. protocol is the result of a periodic review literature update, which has allowed us to take charge of patients affected by COVID-19 according to the most up-to-date clinical evidences, guaranteeing a shared and uniform treatment within a local reality in an era of health emergency.
References
Brugliera L, Spina A, Castellazzi P et al. Rehabilitation of COVID-19 patients. J Rehabil Med. 2020 Apr 15;52(4).
Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020 Jun;92(6):568-576.
Gattinoni L, Chiumello D, Caironi P et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020 Jun;46(6):1099-1102.
Documento aziendale 0011897_2020_Allegato 1: ridefinizione degli ambiti di competenza nella rete provinciale: percorsi COVID-19 e percorsi non COVID-19. Azienda Ospedaliero-Universitaria di Parma. 2020.
Meschi T, Rossi S, Volpi A et al. Reorganization of a large academic hospital to face COVID-19 outbreak: The model of Parma, Emilia-Romagna region, Italy. Eur J Clin Invest. 2020 Jun; 50(6).
Chaler J, Fraguas LG, Gómez García A et al. Impact of Coronavirus disease 2019 outbreak on rehabilitation services and physical rehabilitation medicine and rehabilitation physicians' activities: perspectives from the Spanish experience. Eur J Phys Rehabil Med. 2020 Jun;56(3):369-371.
Boldrini P, Bernetti A, Fiore P, SIMFER Executive Committee, SIMFER Committee for International Affairs. Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine (PRM) physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER). Eur J Phys Rehabil Med. 2020 Jun;56(3):316-318.
Bartolo M, Intiso D, Lentino C et al. Urgent Measures for the Containment of the Coronavirus (Covid-19) Epidemic in the Neurorehabilitation/Rehabilitation Departments in the Phase of Maximum Expansion of the Epidemic. Front Neurol. 2020 Apr 30;11:423.
McNeary L, Maltser S, Verduzco-Gutierrez M. Navigating Coronavirus Disease 2019 (Covid-19) in Physiatry: A CAN report for Inpatient Rehabilitation Facilities. PM R. 2020 May;12(5):512-515.
Balkaya IY, Fernandez JA, Wessam Gerguis W et al. When Physical Medicine and Rehabilitation became Medicine-Life in the Time of COVID-19. Am J Phys Med Rehabil. 2020 Jun;99(6):480-481.
Negrini S, Ferriero G, Kiekens C, Boldrini P. Facing in real time the challenges of the Covid-19 epidemic for rehabilitation. Eur J Phys Rehabil Med. 2020 Jun;56(3):313-315.
Mammi P, Ranza E, Petraglia F et al. In response to: Simpson R and Robinson L: Rehabilitation following critical illness in people with COVID-19 infectionl. Am J Phys Med Rehabil. 2020 May 26 : 10.1097/PHM.0000000000001480.
Choon-Huat Koh G, Hoenig H. How Should the Rehabilitation Community Prepare for 2019-nCoV? Arch Phys Med Rehabil. Arch Phys Med Rehabil. 2020 Jun;101(6):1068-1071
Lazzeri M, Lanza A, Bellini R et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020 Mar 26;90(1).
Spruit MA, Holland AE, Singh SJ, et al. Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors (version April 3, 2020).
WHO. Coronavirus disease (COVID-19) Situation Report – 125 Data as received by WHO from national authorities by 10:00 CEST, 24 May 2020.
CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - MMWR United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):343-346.
Huang C, Wang Y, Li X et al. Clinical Features of Patients Infected With 2019 Novel Coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62.
Yang X, yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020 May;8(5):475-481.
WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020.
Zhejiang University School of Medicine. Handbook of COVID-19 Prevention and Treatment. 2020.
Bernheim A, Mei X, Huang M et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020 Jun;295(3):200463.
Colombi D, Bodini FC, Petrini M et al. Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia. Radiology. 2020 Apr 17 : 201433.
Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020; 11: 995-8.
Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020 Jun;92(6):552-555.
Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of the SARS-CoV-2 by full-length human ACE2. Science 2020; 367: 1444-8.
Wu Y, Xu X, Chen Z et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020 Jul;87:18-22.
Mehta P, McAuley DF, Brown M et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033-4.
Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020 May 1;70(9):311-322.
Zhao H, Shen D, Zhou H , Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol 2020 May;19(5):383-384.
Li Y, Wang M, Zhou Y et al. Acute cerebrovascular disease following COVID-19: a single, retrospective, observational study. Lancet 2020 Jul 2;svn-2020-000431.
Mao L, Jin H, Wang M et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020 Apr 10;77(6):1-9.
Giacomelli A, Pezzati L, Conti F et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020 Jul 28;71(15):889-890.
Xu Z, Shi L, Wang Y et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020 Apr;8(4):420-422.
Jaunmuktane Z, Mahadeva U, Green A et al. Microvascular injury and hypoxic damage: emerging neuropathological signatures in COVID-19. Acta Neuropathologica. 2020 Jul 8;1-4.
Toscano G, Palmerini F, Ravaglia S et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020 Jun 25;382(26):2574-2576.
Varatharaj A, Thomas N, Ellul MA et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020 Jun 25;S2215-0366(20)30287-X.
Yang F, Liu N, Hu JY et al. Pulmonary rehabilitation guidelines in the principle of 4S for patients infected with 2019 novel coronavirus (2019-nCoV), Zhonghua Jie He He Hu Xi Za Zhi .2020 Mar 12;43(3):180-182.
Xu K, Cai H, Shen Y et al. Management of corona virus disease-19 (COVID-19): the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 Feb 21;49(1):0.
Chinese Association of Rehabilitation Medicine; Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and Rehabilitation. Recommendations for respiratory rehabilitation of coronavirus disease 2019 in adult. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Apr 12;43(4):308-314.
Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: a call for action. J Rehabil Med. Apr 15;52(4).
McNeary L, Maltser S, Verduzco-Gutierrez M. Navigating Coronavirus Disease 2019 (Covid-19) in Physiatry: A CAN report for Inpatient Rehabilitation Facilities. PM R. 2020 May;12(5):512-515.
Ceravolo MG, Arienti C, De Sire A et al. Rehabilitation and Covid-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Eur J Phys Rehabil Med .2020 Jul 24. doi: 10.23736/S1973-9087.20.06501-6.
Liu K, Zhang W , Yang Y, Zhang J, Li Y , Chen Y Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020 May;39:101166.
Curci C, Pisano F, Bonacci E et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 rehabilitation unit and proposal of a treatment protocol. A cross-sectional study. Eur J Phys Rehabil Med .2020 Jul 15. doi: 10.23736/S1973-9087.20.06339-X.
Indicazioni ad interim per un utilizzo razionale delle protezioni per infezione da Sars-CoV-2 nelle attività sanitarie e sociosanitarie (assistenza a soggetti affetti da COVID-19) nell’attuale scenario emergenziale Sars-CoV-2 Gruppo di Lavoro ISS Prevenzione e Controllo delle Infezioni. Rapporto ISS COVID-19 n. 2/2020 Rev. Aggiornato al 28/03/2020.
Pan American Health Organization. Rehabilitation considerations during the COVID-19 outbreak. 2020 Apr 28
Pedersini P, Corbellini C, Villafañe JH. Italian Physical Therapists' Response to the Novel COVID-19 Emergency. Phys Ther. 2020 Jul 19;100(7):1049-1051.
Hodgson CL, Stiller K, Needham DL et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014 Dec 4;18(6):658.
Calvo-Ayala E, Khan BA, Farber MO, Ely EW, Boustani MA. Interventions to Improve the Physical Function of ICU Survivors: a systematic review. Chest 2013 Nov;144(5):1469-1480.
Tan T, Brett SJ, Stokes T. Rehabilitation after critical illness: summary of NICE guidance. BMJ 2009;338:b822
Bruells CS, Bickenbach J, Marx G. Weaning ward-different from the ICU? Med Klin Intensivmed Notfmed. 2018 Mar; 113(2):94-100.
Smith JM, Lee AC, Zeleznik H et al. Home and Community-Based Physical Therapist Management of Adults With Post–Intensive Care Syndrome. Phys Ther. 2020 Apr 13 : pzaa059.
Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus. 2020 Mar 21;12(3).
Polastri M, Nava S, Clini E, Vitacca M, Gosselink R. COVID-19 and pulmonary rehabilitation: preparing for phase three. European Respiratory Journal. 2020 Eur Respir J. 2020 Jun 25;55(6).
Zeng B, Chen D, Qiu Z et al. Expert consensus on protocol of rehabilitation for COVID‐19 patients using framework and approaches of WHO International Family Classifications. Aging Med (Milton). 2020 Jun; 3(2): 82–94.
Hashem M, Nelliot A, and Needham D. Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future. Respir Care 2016 Jul;61(7):971-9.
Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008 Aug;36(8):2238–43.
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May;373(9678):1874–82.
Zorowitz RD. ICU–Acquired Weakness: A Rehabilitation Perspective of Diagnosis, Treatment, and Functional Management. Chest. 2016 Oct;150(4):966-971.
Sheehy LM. Considerations for Postacute Rehabilitation for Survivors of COVID-19. JMIR Public Health Surveill. 2020 May 8;6(2).
Lew HL, Oh-Park M, Cifu DX. The War on COVID-19 Pandemic: Role of Rehabilitation Professionals and Hospitals. Am J Phys Med Rehabil. 2020 Jul;99(7):571-572.
Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007 Nov;33(11):1876-91.
Prado CM, Purcell SA, Alish C et al. Implications of Low Muscle Mass across the Continuum of Care: A Narrative Review. Ann Med. 2018 Dec;50(8):675-693.
Simpson R, Robinson L. Rehabilitation following critical illness in people with COVID-19 infection. Am J Phys Med Rehabil. 2020 Jun;99(6):470-474.
Moisey LL, Mourtzakis M, Cotton BA et al. Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care. 2013 Sep 19;17(5).
Carda S, Invernizzi M, Bavikatte G et al. The role of physical and rehabilitation medicine in the COVID-19 pandemic: the clinician’s view. Ann Phys Rehabil Med. 2020 Apr 18;S1877-0657(20)30076-2.
Kuzuya M, Izawa S, Enoki H, Okada K, Iguchi A. Is serum albumin a good marker for malnutrition in the physically impaired elderly? Clin Nutr 2007, 26:84–90.
Lucchini A, Valsecchi D, Elli S et al. The comfort of patients ventilated with the Helmet Bundle. Assist Inferm Ric. Oct-Dec 2010;29(4):174-83.
Documento aziendale 0012819 del 26/03/2020. Azienda Ospedaliero-Universitaria di Parma. 2020.
Treger I, Lutsky Treger L, Friedman A.. Organization of acute patients' transfer to rehabilitation services during COVID-19 crisis. Eur J Phys Rehabil Med. 2020 Jun;56(3):366.
Miles A, Connor NP, Desai RV et al. Dysphagia Care Across the Continuum: A Multidisciplinary Dysphagia Research Society Taskforce Report of Service-Delivery During the COVID-19 Global Pandemic. Dysphagia. 2020 Jul 11;1-13.
Frajkova Z, Tedla M, Tedlova E, Suchankova M, Geneid A. Postintubation Dysphagia During COVID 19 Outbreak Contemporary Review. Dysphagia, 2020 May 28 : 1–9.
Brodsky MB, Huang M, Shanholtz C et al. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study. Ann Am Thorac Soc. 2017 Mar;14(3):376–83.
Guidelines and recommendations for the activity of the speech therapist at the time of Covid19. Shared document FLI - Board of Speech Therapists. 2020.
McGrath BA, Ashby N, Birchall M et al. Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia. 2020 May 12 : 10.1111/anae.15120.
Lake MA. What we know so far: COVID-19 current clinical knowledge and research 2020. Clinical Medicine 2020; 20:124-7.
Macht M, White SD, Moss M. Swallowing dysfunction after critical illness. Chest. 2014;146:1681.
Mohan R, Mohapatra B. Shedding Light on Dysphagia Associated With COVID-19: The What and Why. OTO Open. 2020 Apr-Jun; 4(2): 2473974X20934770.
Vitacca M, Nava S, Santus P, Harari S. Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy: from ward to trenches. Eur Respir J 2020 May 21;55(5):2000632.
Kiekens C, Boldrini P , Andreoli A et al. Rehabilitation and respiratory management in the acute and early post-acute phase. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency. Eur J Phys Rehabil Med. 2020 Jun;56(3):323-326.
Zampolini M, Stucki G, Giustini A, Negrini S. The individual rehabilitation project: a model to strengthen clinical rehabilitation in health systems worldwide. Eur J Phys Rehabil Med. 2020 Feb;56(1):1-4.
Vitacca M, Carone M, Clini EM et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration. 2020;99(6):493-499.
Thomas P, Baldwin C, Bissett B et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82.
Zeng B, Chen D, Qiu Z et al. Expert consensus on protocol of rehabilitation for COVID‐19 patients using framework and approaches of WHO International Family Classifications. Aging Med (Milton). 2020 Jun; 3(2): 82–94.
Ronconi G, Ferrara PE, Codazza S, Cerulli S. Is the rehabilitation ready for COVID-19 patients' care? Minerva Med. 2020 May 14. doi: 10.23736/S0026-4806.20.06629-X.
Green M, Marzano V, Leditschke IA, Mitchell I, Bissett B. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscip Healthc. 2016;9:247– 256.
Vitacca M, Lazzeri M, Guffanti E et al. Italian suggestions for pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process. Monaldi Archives for Chest Disease. 2020;90(2).
Criteri di accoglimento e gestione del ricovero ordinario in Riabilitazione Intensiva nella Fase 2 post-emergenza Covid19. Position Paper della Società Italiana di Medicina Fisica e Riabilitativa (SIMFER). 2020 May 29.
Mammi P, Bidini C, Ablondi E, David MR, Brianti R. Early speech-language rehabilitation for stroke patients during the Covid-19 outbreak J Stroke Cerebrovasc Dis. 2020 July 31:105218.
Berg EA, Picoraro JA, Miller SD et al. COVID-19 - A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist. J Pediatr Gastroenterol Nutr. 2020 Jun;70(6):734-740.
Italian Health Minister. Telemedicine. National Guidelines. 2014.
Nota protocollo PG0016056/2020 Rischio Biologico da Coronavirus – REV 1: Trasmissione Documentazione Art. 17 c.1 lett. a) – D.Lgs 81/08 e successive modifiche e integrazioni. Documento aziendale.
Coraci D, Fusco A, Frizziero A, Giovannini S, Biscotti L, Padua L. Global approaches for global challenges: The possible support of rehabilitation in the management of COVID‐19. J Med Virol. 2020 Apr 8:10.
Barker-Davies RM, O'Sullivan O, Senaratne KPP, et alThe Stanford Hall consensus statement for post-COVID-19 rehabilitation. British Journal of Sports Medicine 2020;54:949-959.
Simpson R, Robinson L. In response to a Letter to the Editor of the American Journal of Physical Medicine & Rehabilitation. Am J Phys Med Rehabil. 2020 May 26 :10.
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