# Early physical rehabilitation dosage in the IntensiveCare Unit predicts hospital outcomes after criticalCOVID-19

## TL;DR

Early physical rehabilitation in the ICU improves hospital outcomes for critical COVID-19 patients.

## Contribution

A novel method to quantify rehabilitation dosage is introduced and linked to patient outcomes.

## Key findings

- Rehabilitation dosage is moderately and positively associated with physical function at discharge.
- Mechanical ventilation and early mobility scores predict physical function at discharge.
- Higher rehabilitation exposure in the ICU correlates with better post-hospital physical outcomes.

## Abstract

to examine the relationship between physical rehabilitation parameters including a novel approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.

Retrospective practice analysis from March 5, 2020, to April 15, 2021.

Intensive care units (ICU) at four medical institutions

n = 3,780 adults with ICU admission and diagnosis of COVID-19

We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: 1) mortality; 2) discharge disposition; and 3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24=greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital).

The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n=1739) required mechanical ventilation. For 2191 patients with complete data, rehabilitation dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2= 0.68, p <0.001) demonstrates mechanical ventilation (β = −0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p <0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS.

Greater physical rehabilitation exposure early in the ICU is associated with physical function at hospital discharge.