# Utilization of interdisciplinary in-hospital early rehabilitation in COVID-19 patients - a multicenter cohort study in the National Pandemic Cohort Network (NAPKON) in Germany

## TL;DR

This study finds that early in-hospital rehabilitation is rarely used for COVID-19 patients in Germany, highlighting a need for better implementation.

## Contribution

The study provides the first multicenter analysis of early in-hospital rehabilitation utilization in hospitalized COVID-19 patients.

## Key findings

- Only 0.79% of hospitalized COVID-19 patients received early in-hospital rehabilitation.
- Among ICU-treated patients, 2.13% received early in-hospital rehabilitation.
- Cardiovascular and neurological/psychiatric diseases were the most common comorbidities in patients receiving early rehabilitation.

## Abstract

Early rehabilitation in acute hospitals aims to prevent immobilization-related complications and improve the functional capacity of patients with severe or critical illness. Early rehabilitation can be a useful concept to improve functioning in COVID-19 patients. However, literature concerning early in-hospital rehabilitation in COVID-19 patients is scarce.

To analyze the utilization of in-hospital interdisciplinary early rehabilitation (IER) in COVID-19 patients and characterize the sample of IER patients.

Prospective cohort study.

Hospitalized COVID-19 patient cases.

This study used data from the National Pandemic Cohort Network (NAPKON) in Germany.

IER utilization rates were retrieved. Demographic and clinical data from hospitalized COVID-19 patients who had received IER during the course of their treatment were evaluated.

Out of the 2,644 patients in the Cross-Sectoral Platform (German abbreviation: SUEP) cohort, 0.79% [95% CI: 0.51% to 1.22%] received IER during their stay in an acute care hospital. Among the subgroup of patients who had previously been treated in intensive care, 2.13% [95% CI: 1.16% to 3.63%] received IER. The most common comorbidities were cardiovascular diseases (66.7%) and neurological/psychiatric diseases (36.1%). The small sample size limited further analyses.

The low rate of early rehabilitation in acute hospitals for COVID-19 patients indicates an unmet need, particularly in severe cases. Structural changes in the health system are needed to close this gap. The WHO and the German Medical Council have recently acknowledged the necessity of early in-hospital rehabilitation and have issued a call for its implementation in acute hospitals.