# Impact of Frailty on the Duration and Type of Speech-Language-Hearing Therapy for Patients With COVID-19

## TL;DR

Frail patients with COVID-19 require more speech-language-hearing therapy time and swallowing exercises compared to non-frail patients.

## Contribution

This study identifies the impact of pre-symptom frailty on the duration and type of speech-language-hearing therapy in non-ventilated COVID-19 patients.

## Key findings

- Frail patients had significantly higher mean and total SLT time compared to non-frail patients.
- Frail patients performed more direct and indirect swallowing exercises during therapy sessions.
- Frailty was associated with higher FOIS scores and increased risk of hospital-acquired pneumonia.

## Abstract

Introduction

This study aimed to explore the standard rehabilitation for patients with COVID-19 who did not receive invasive ventilation treatment and to descriptively clarify the timing and content of speech-language-hearing therapy (SLT), categorizing patients based on the presence or absence of frailty before symptom onset.

Methods

This retrospective observational study included patients aged ≥18 years admitted for COVID-19. SLT was performed at each hospital as per a common protocol. The exposure variable was frailty versus nonfrailty (defined as a clinical frailty scale score of ≥4). Multiple linear analyses adjusted for baseline characteristics were used to determine the link between frailty and mean SLT time. We investigated mean SLT time (min/day), total SLT time, total SLT days, and SLT content per session from weeks one to four.

Results

Of the 254 patients, 207 and 47 were assigned to frail and nonfrail groups, respectively. The mean SLT time in the frail group was significantly higher than that in the nonfrail group. Furthermore, total SLT time, total SLT days, functional oral intake scale (FOIS) score at hospital discharge, incidence of hospital-acquired pneumonia, and discharge to home were significantly longer and higher in the frail group than those in the nonfrail group. The frail group performed considerably more indirect and direct swallowing exercises than the nonfrail group.

Conclusions

Daily SLT time and total SLT days on which SLT was performed were substantially longer in the frail group, with higher rates of direct and indirect swallowing exercises.