Associations Between COVID-19 Symptoms & Amounts of PT & OT in COVID-19 Patients in a Skilled Nursing Facility

PURPOSE: Nursing home (NH) patients with COVID-19 need occupational (OT) and physical therapy (PT) to prevent functional decline. While most residents can tolerate moderate or high intensities, some are unable to tolerate these rehabilitation amounts (Canter et al, 2023). It is unknown if COVID-19 symptoms are related to amounts (minutes) and intensity (minutes/sessions) of OT and PT in older adults. We explored associations between COVID-19 symptoms and OT and PT intensities and amounts in NH patients with COVID-19.

DESIGN: Retrospective cohort study of 125 COVID-19 NH patients who had OT or PT within 30 days post-COVID-19 diagnosis.

METHOD: OT and PT durations and symptoms were extracted from patient charts. Multivariate linear regressions analyzed relationships between common symptoms in patients (Boockvar et al., 2021) and OT and PT amount and intensity.

RESULTS: Patients with delirium received significantly fewer minutes of OT (β=-138.347, p=.005) but not PT. Delirium was not associated with OT or PT intensity (p>.05). Cough was associated with increased OT amount (β=98.977, p=.027) but not OT or PT intensity, or PT amount. Pain was associated with increased PT intensity (β=6.472, p=.013), but not OT intensity. Pain was not associated with OT or PT amount. Appetite loss, lethargy, fever, and shortness of breath were not associated with OT nor PT amount or intensity. Increased dehydration (BUN/creatinine ratio) was associated with lower OT (β=-4.855, p=.034) and PT minutes (β=-4.508, p=.050) but not intensity.

CONCLUSION: Patients with delirium may be unable to tolerate intensive OT and PT. Other than delirium, associations between clinical symptoms of COVID-19 and rehabilitation intensity/amount were small. It is unlikely symptoms impacted OT or PT tolerance. Impact Statement: OT and PT is a key part of rehabilitation of residents with COVID-19 and can be prescribed in moderate amounts to COVID-19 NH patients without delirium, regardless of other symptoms.

References

Canter, B. E., Raschen, L., Reinhardt, J. P., Weerahandi, H., Mak, W., Burack, O. R., ... & Boockvar, K. S. (2023). Characteristics of Physical, Occupational, and Speech Therapy Received by COVID-19 Patients in a Skilled Nursing Facility: A Retrospective Cohort Study. Journal of the American Medical Directors Association, 24(4), 459–461. https://doi.org/10.1016/j.jamda.2023.01.010

Boockvar, K. S., Mak, W., Burack, O. R., Canter, B. E., Reinhardt, J. P., Spinner, R., ... & Weerahandi, H. (2021). Co-occurring dehydration and cognitive impairment during COVID-19 in long-term care patients. Journal of the American Medical Directors Association, 22(11), 2270–2271. https://doi.org/10.1016/j.jamda.2021.09.002