Rehabilitation Treatment of COVID-19 Patients after Being Discharged from the Hospital

For COVID-19 patients, after relieving the symptoms and achieving the clinical recovery, they may face different dysfunctions and have different needs for rehabilitation after discharge. It is necessary to give corresponding rehabilitation treatment according to their different clinical rehabilitation needs to promote further dysfunction improvement and quality of life.

Most discharged patients with mild and moderate infections have slight or no persistent residual lung function problems. Their hospital stays are shorter and the possibility of physical dysfunction is less, but the adverse psychological effects of the disease on the patient may exist longer. The objective of postdischarge rehabilitation is to restore physical fitness and adjust psychology, principally in the form of home-based rehabilitation under the guidance of professionals. Tire specific content of rehabilitation treatment is based on step-by-step aerobic exercise. Choose the exercise form that patients preferred in the past or choose the appropriate exercise form according to their wishes and realistic conditions. Make an aerobic exercise prescription, pay attention to the scientific nature and implementability of the movement, and gradually help patients recover to the activity level they were at before the onset of the disease and to return to society as soon as possible.

For discharged patients with severe/critically severe disease, it is necessary to make a targeted assessment of the patients lung function impairment and develop a long-term progressive, comprehensive, and personalized respiratory rehabilitation plan in terms of exercise, psychology, nutrition, and other aspects according to the assessment results, with particular emphasis on the evaluation of comprehensiveness, scientificity, and pertinence. Rehabilitation assessment must identify the type and severity of postdischarge disorders in respiratory, physical, daily life, and social participation of COVID-19 patients, and provide a treatment framework for appropriate rehabilitation programs. The assessment project shall be based on the patient’s existing functional impairment, including but not limited to the following aspects.

Perform a detailed examination and assessment of patients’ vital signs, respiratory system signs, breathing patterns, respiratory muscle strength, aerobic activity ability, limb muscle strength, joint mobility, limb circumference, nutritional status, psychological status, and other aspects.

Assess patients’ respiratory symptoms, musculoskeletal symptoms, pain score, balance function, activity function, quality of life, nutritional status, and psychological status through the questionnaire.

Improve supplementary examination based on chest imaging, lung function, and blood biochemical indexes, and arrange auxiliary examination items such as diaphragmatic ultrasound, cardiopulmonary exercise function test, bone density, muscle nuclear magnetic, and other auxiliary examination items according to actual conditions and dysfunction types.

It is important to note that even if the patients are clinically cured, the reinfection possibility is not excluded; therefore, it is imperative that patients strengthen protection, ask them to observe rehabilitation physicians’ medical advice, and pay attention to the prevent ion of colds and other infectious diseases.

Rehabilitation Treatment for Mild/Moderate Discharged Patients

9.3.2.1.1 Objectives of Rehabilitation Treatment

The rehabilitation treatment objectives are to reduce breath shortness, increase athletic endurance, improve and restore respiratory function, prevent recurrence, and restore the patient’s ability of daily activities, occupational adaptability, psychological adaptability, and social participation.

• 9.3.2.1.2 Rehabilitation Treatment Methods
• 1) Patient education: Patients continue to conduct self-health monitoring for 14 days after discharge. They should wear masks and live in well-ventilated single rooms when conditions permit. They should reduce close contact with family members, eat separately, practice good hand hygiene, and avoid going out. They should prevent cold and continue to do an excellent job in self-protection and recurrence prevention.

• 2) Aerobic exercise training: Cross-walking, walking, fast walking, jogging or swimming, and breathing exercises should be done three to five times a week for 20-30 minutes each time. Patients should stop exercise if their Borg score is no more than 3 points or if the patients feel short of breath. It is possible to gradually increase activity intensity to moderate intensity while monitoring blood oxygen.
• 3) Power bicycle: Patients can perform this activity three to five for 20-30 minutes each time. Hie exercise intensity is the same as above.
• 4) Strength training: Patients can perform muscle strength training for target muscle groups three to five times a week.
• 5) Rehabilitation of TCM: Under the condition of eliminating contraindications, for example, limb dysfunction and abnormal consciousness, training such as baduanjin, tai chi chuan, respiratory guidance exercise, and six words breathing exercise can be conducted.
• 6) Activities of daily living (ADL) intervention: For discharged patients with mild disease, their ability to perform daily activities, such as transfer, grooming, toileting, and bathing, must be evaluated to see if there is any impairment caused by pain, dyspnea, and weakness during these daily activities. Within 2 weeks after discharge, possible daily life disorders can be treated with targeted rehabilitation. At the same time, it is necessary to evaluate the patient’s social participation and other higher-level daily activities. Giving targeted treatment to the tool-based daily activities includes shopping, going out, cooking, doing housework, washing clothes, taking medicine, using communication equipment, handling finances, etc. During the treatment process, comprehensively consider patients’ mental and physical abilities in completing these activities. By simulating the actual scene, conduct the training to find out the obstacles of task participation, and carry out targeted intervention under occupational therapists’ guidance.