Date Presented 04/01/2022
Two hundred forty-eight patients in a large urban skilled nursing facility (SNF) were studied, examining intensity of rehabilitation services among individuals with coronavirus disease 2019 (COVID-19). Of the population, 58.1% participated in OT and physical therapy services and 13.3% participated in speech therapy services. Significantly higher intensities of rehabilitation services were noted in the 71 patients who were postacute care. More research is needed to determine the most efficacious intensities for geriatric patients with COVID-19, which may vary on the basis of rehabilitation type and patient characteristics.
Primary Author and Speaker: Benjamin E. Canter
Contributing Authors: Himali Weerahandi, Orah Burack, Joann Reinhardt, Kenneth Boockvar, Lauren Siconolfi
PURPOSE: The purpose of this study was to examine the intensity of rehabilitation services in COVID-19 patients at a skilled nursing facility (SNF). Potential associations between type of care (long-term vs post-acute) and type of therapy (eg: occupational therapy, physical therapy, speech therapy) and rehab intensity were also explored.
DESIGN: This was a retrospective descriptive cohort study. All participants at the participating SNF who tested positive for COVID-19 between March and May 2020 were recruited for this study.
METHOD: Data were abstracted from electronic medical records at a SNF in NYC. Residents with a positive COVID-19 PCR test from March to May 2020 were included and followed for 30 days. Rehab intensity was defined by number of minutes. T-tests and Chi-squared tests examined associations in rehab intensity with patient characteristics.
RESULTS: Of the 248 individuals enrolled in the study, 58.1% of patients engaged in occupational (OT) and physical therapy (PT) for an average of 406.4±248.7 and 402.5±242.6minutes and 9.4±5.8 and 9.6±5.9 sessions respectively over the 30-day post-symptom onset window, only 13.3% of patients attended speech therapy (ST), with a intensity of 226.4±156.4 minutes over 5.0±3.3 sessions. 33.9% of patients did not attend any rehabilitation. 19.4% attended low levels of rehabilitation (<400 total minutes over the thirty days). Another 19.0% attended rehabilitation at moderate intensities (400-799 minutes). The remaining 27.8% received high-intensity rehabilitation, (≥800) or more total minutes during the 30-day window. Individuals in post-acute care (n = 71) were significantly more likely receive rehabilitation at higher intensities than those in long-term care in OT (p<.001), PT (p<.001), and ST (p<.01).
CONCLUSION: At a SNF, the majority of COVID-19 patients, specifically post-acute patients, qualified for and could tolerate moderate/high rehabilitation intensities during the duration of their COVID-19 illness. This may have been a result of increased tolerance to rehabilitation intensity. ST was utilized far less often and at lower amounts than PT and OT. While it is typical for ST to be used at lower intensities than OT and PT in those recovering from respiratory illnesses, it is notable how few individuals utilized ST at all. During COVID-19 rehospitalization played a role in delayed discharge for many patients (Weerahandi et al, 2021). More research is needed into the most efficacious intensities of these different types of rehabilitation in geriatric COVID-19 patients during illness to prevent rehospitalization and thus delayed discharge.
Weerahandi, H., Mak, W., Burack, O. R., Canter, B. E., Reinhardt, J. P., & Boockvar, K. S. (2021). Discharge Processes in a Skilled Nursing Facility affected by COVID-19. Journal of the American Geriatrics Society.
Weerahandi, H. M., Mak, W., Burack, O., Canter, B., Reinhardt, J., & Boockvar, K. (2021, April). Discharge Practices in Skilled Nursing Facilities affected by COVID-19. Journal of the American Geriatrics Society, 69, S215.