Of the non-critically ill hospitalized COVID-19 patients, 31.9% received in-hospital rehab services. Electronic medical record data were extracted for 155 patients who received rehab and 162 patients who did not receive rehab for comparison. Demographics, medical insurance status, comorbidities, symptoms, laboratory tests, and vital signs at hospital admission for the rehab and non-rehab groups are summarized in Table 1. The rehab group were older and had fewer Hispanic’s compared to the non-rehab group (p<0.05, Chi square), but there was no sex difference between groups. The majority of non-rehab group (88%) and rehab group (93%) had medical insurance. The rehab group had a higher prevalence of previous hypertension, coronary artery disease, immunosuppression, psychiatric disorders, arrythmia’s, thromboembolic disorders, and hypothyroidism (p<0.05, Chi-square), but lower prevalence of fever, myalgia, and sore throat (p<0.05, Chi-square) compared to the non-rehab group. The rehab group also had fewer smokers than the non-rehab group. The top five most common comorbidities (obesity, hypertension, smoking, diabetes, and coronary artery disease) were similar in both groups. There were more patients with multiple comorbidities in the rehab group compared to the non-rehab group. The majority of the non-rehab (91%) and rehab group (92%) were symptomatic. Of the laboratory tests and vital signs, alanine aminotransferase, brain natriuretic peptide, hematocrit, creatinine, D-dimer, troponin, lactate dehydrogenase, lymphocytes, diastolic blood pressure, SpO2, and heart rate were significantly different between groups (p<0.05, Mann-Whitney U Test)
We evaluated the number of patients needing rehabilitation with respect to pre-admission dependency status and found that in the non-rehab group, 82% were independent, 9% needed partial assistance and 9% were dependent, whereas in the rehab group, 59% were independent, 35% needed partial assistance, and 6% were dependent (Figure 1A). Pair-wise comparison showed that more independent patients did not need rehab (p<0.001, Chi-square), more partial assistance patients needed rehab (p<0.001), and a similar number of dependent patients needed rehab (p>0.05).
Length of stay (LOS) was analyzed with respect to dependency status. Overall, the non-rehab group spent fewer days in the hospital compared to the rehab group (5 [3, 8] vs 9 [5, 16] days, median [IQR], p<0.0001, Mann-Whitney U Test). Figure 1B shows days of hospitalization for three bins. There were a higher percentage of patients who were discharged 0-10 days in the non-rehab group than the rehab group (81% vs 53%, p<0.0001, Chi square), but fewer who were discharged between 10-20 days (17% vs 35%, p<0.05) and 20+ days (2% vs 12%, p<0.05).
Discharge equipment was evaluated for the rehab and non-rehab group. Compared to the non-rehab patients, fewer rehab patients were discharged with no-equipment (38% vs 83% p<0.001), whereas more rehab patients were discharged with a cane or rolling walker (18% vs 1%, p<0.001), and with DME (44% vs 15%, p<0.001 for all, Chi-square, Figure 2A). More rehab patients were discharged with oxygen equipment than the non-rehab group (35% vs 16% respectively, p<0.01, Chi-square, Figure 2B).
We evaluated follow-up referrals in the discharged patients. Overall, comparatively fewer referrals were observed in the non-rehab group. Cardiology, vascular medicine, urology, and gastroenterology follow-up referrals were among the top six recommendations for rehab group (Figure 3A). Cardiology, vascular medicine, endocrinology, pulmonology, and hematology referrals were significantly different between groups (p<0.05, Chi-square). Rehab patients were more likely to have multiple referrals while the non-rehab group was more likely to have no referrals (p<0.001, Chi square, Figure 3B).
Compliance to discharge location and length of stay with respect to discharge locations were analyzed. Most patients adhered to their suggested discharge recommendation (p>0.05, McNemar’s test, Figure 4A). Of those who did not, 38% elected a higher standard of care than suggested and 62% elected a lower standard of care. About half (52%) of the patients were discharged to home with home care, 42% were discharged to rehab facility and <10% were discharged to LTC/hospice.
Patients discharged to homecare spent significantly less time in the hosptial compared to those dicharged to rehab (9.4 vs 13.8 days, p<0.05, ANOVA, Figure 4B). There was no significant difference in LOS between discharge location to rehab and LTC/hospice (p>0.05) or between between discharge location to homecare and LTC/hospice (p>0.05).
Pre-admission domicile was analyzed with respect to discharge locations for the rehab group. (Figure 4C). For patients recommended discharge to homecare or rehab, the majority (96% and 90% respectively) came from private homes, assisted living facilities (ALF), and group homes, while a few came from sub-acute rehab facilities (SAR; 2% and 6%) or skilled nursing facilities (SNF; 1% and 3%). By contrast, for patients recommended discharge to LTC/Hospice, most (80%) came from a SNF. By comparison essentially all patients in the non-rehab group returned to their prior domicile.
Pre-COVID-19 independent status was analyzed with respect to discharge locations for the rehab group (Figure 4D). For survivors recommended homecare, the majority were functionally independent pre COVID-19 (78.8%), some needed partial assistance (18.8%), and very few (2.5%) were dependent. For survivors recommended rehab, similar number of patients were functionally independent (43%) and needing partial assistance (54%), and very few (3%) were dependent. For survivors recommended long term care or hospice, none were functionally independent, and half needed partial assistance (50%) or were dependent (50%).
Functional scores were evaluated with respect to pre-admission dependency status and LOS. Functional scores of rehab patients were below normal (Mental Status Score: 2.72 out of 3, ICU Mobility Scale: 6.87 out of 10, and modified Barthel Index Score: 45.58 out of 75, all p<0.0001 one-sample t-test). Functional scores relied on pre-admission status, with higher scores in patients who were independent pre-admission, followed by those who required partial assistance and were dependent (p<0.0001 for all scores, ANOVA, Figure 5A). Functional scores did not depend on duration of hospitalization (p>0.05, ANOVA, Figure 5B).
Table 2 shows the correlation of Mental Status, ICU Mobility Scale, and modified Barthel Index scores at hospital discharge with demographics, comorbidities, laboratory tests, and vitals. Most of the Barthel scores were significantly negatively correlated with age and hypertension, coronary artery disease, chronic kidney disease, psychiatric disease, and anemia, and neurological disorders (p<0.05, ANOVA), whereas only some mobility and mental status scores were significantly correlated (p<0.05, ANOVA). Functional scores were not significantly correlated with lung disorders, carcinoma, hyperlipidemia, gender, race, or ethnicity.