Rehabilitation Outcomes and Infection Control in the Early Stage of the COVID-19 Pandemic
Abstract
Introduction: Understanding how infection control measures were devised and the outcomes of rehabilitation in the early stage of an emerging infectious disease pandemic is important. This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on inpatient rehabilitation, and to determine the effectiveness of the original infection control measures implemented for the rehabilitation team. Material and Methods: In this single-center, retrospective, observational study, we calculated multiple rehabilitation indices of patients discharged from our rehabilitation ward between February 28 and May 25, 2020 when Hokkaido was initially affected by COVID-19, and compared them with those calculated during the same period in 2019. Fisher’s exact test and the Mann-Whitney U test were used for statistical analysis. We also verified the impact of implementing the original infection control measures for the rehabilitation team on preventing nosocomial infections. Results: A total of 93 patients (47 of 2020 group, 46 of 2019 group) were included. The median age was 87 and 88 years, respectively, with no differences in age, sex, and main disease between the groups. Training time per day in the ward in 2020 was significantly lower than that in 2019 (p = 0.013). No significant differences were found in the qualitative evaluation indices of Functional Independence Measure (FIM) score at admission, FIM gain, length of ward stay, FIM efficiency, and rate of discharge to home. None of the patients or staff members had confirmed COVID-19 during the study period. Conclusions: Early COVID-19 pandemic affected the quantitative index for inpatient rehabilitation but not the qualitative indices. No symptomatic nosocomial COVID-19 infections were observed with our infection control measures.
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Doi: 10.28991/SciMedJ-2021-03-SI-6
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References
Hui, D. S., Azhar, E. I., Madani, T. A., Ntoumi, F., Kock, R., Dar, O., ... & Petersen, E. (2020). The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China. International journal of infectious diseases, 91, 264-266. doi:10.1016/j.ijid.2020.01.009.
World Health Organization: WHO Director-General's opening remarks at the media briefing on COVID-19. 11 March, 2020. Available online: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (accessed on March 2020).
Yuki Furuse, Yura K Ko, Mayuko Saito, Yugo Shobugawa, Kazuaki Jindai, Tomoya Saito, Hiroshi Nishiura, Tomimasa Sunagawa, Motoi Suzuki, National Task Force for COVID-19 Outbreak in Japan. Epidemiology of COVID-19 Outbreak in Japan, January–March 2020. Jpn J Infect Dis 2020. doi:10.7883/yoken.JJID.2020.271.
Shunji Edagawa, Fumiko Kobayashi, Fumihiro Kodama, Masayuki Takada, Yuki Itagaki, Akira Kodate, Keisuke Bando, Keisuke Sakurai, Akio Endo, Hisako Sageshima, Atsushi Nagasaka. Epidemiological features after emergency declaration in Hokkaido and report of 15 cases of COVID-19 including 3 cases requiring mechanical ventilation. Global Health & Medicine 2020; 2, 112-117. doi:10.35772/ghm.2020.01024.
Mun-Keat Looi. Covid-19: Japan ends state of emergency but warns of “new normalâ€. BMJ 2020; 369: m2100. doi:10.1136/bmj.m2100.
Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994). The structure and stability of the Functional Independence Measure. Archives of physical medicine and rehabilitation, 75(2), 127-132. doi:10.1016/0003-9993(94)90384-0.
Kanda Y. Investigation of the freely-available easy-to-use software “EZR†(Easy R) for medical statistics. Bone Marrow Transplant 2013:48,452–458. doi:10.1038/bmt.2012.244.
Information for Public. Q&A on Coronavirus Disease 2019 (COVID-19). Ministry of Health, Labor and Welfare.2020. Available online: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/dengue_fever_qa_00014.html (accessed on March 2020).
WHO Expert Committee on Disability Prevention and Rehabilitation & World Health Organization. (‎1981)‎. Disability prevention and rehabilitation: report of the WHO Expert Committee on Disability Prevention and Rehabilitation (‎meeting held in Geneva from 17 to 23 February 1981)‎. World Health Organization. Available online: https://apps.who.int/iris/handle/10665 /40896 (accessed on December 2020).
S Bachmann, C Finger, A Huss, M Egger, AE Stuck, and KM Clough-Gorr. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 2010;340:c1718. doi:10.1136/bmj.c1718.
Ribeiro DKMN, Lenardt MH, Lourenço TM, Betiolli SE, Seima MD, Guimarães CA. The use of the functional independence measure in elderly. Rev Gaúcha Enferm 2017; 38(4): e66496. doi:10.1590/1983-1447.2017.04.66496.
M. Tokunaga, S. Mita, Keiichi Tashiro, M. Yamaga, Y. Hashimoto, R. Nakanishi, H. Yamanaga. Methods for comparing Functional Independence Measure improvement degree for stroke patients between rehabilitation hospitals. Int J Phys Med Rehabil 2017;5:2. doi:10.4172/2329-9096.1000394.
Centers for Disease Control and Prevention. Operational Considerations for the Identification of Healthcare Workers and Inpatients with Suspected COVID-19 in non-US Healthcare Settings. Available online: https://www.cdc.gov/coronavirus/ 2019-ncov/hcp/non-us-settings/guidance-identify-hcw-patients.html (accessed on May 2020).
Turolla, A., Rossettini, G., Viceconti, A., Palese, A., & Geri, T. (2020). Musculoskeletal physical therapy during the COVID-19 pandemic: is telerehabilitation the answer?. Physical therapy, 100(8), 1260-1264. doi:10.1093/ptj/pzaa093.
Centers for Disease Control and Prevention. (2020). Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19). Available online: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html (accessed on March 2020).
Ferretti, L., Wymant, C., Kendall, M., Zhao, L., Nurtay, A., Abeler-Dörner, L., ... & Fraser, C. (2020). Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science, 368(6491). doi:10.1126/science.abb6936.
Leung, N. H. (2021). Transmissibility and transmission of respiratory viruses. Nature Reviews Microbiology, 1-18. doi:10.1038/s41579-021-00535-6.
Centers for Disease Control and Prevention. Protecting Healthcare Personnel. Available online: https://www.cdc.gov/hai/prevent/ppe.html (accessed on May 2020).
Xiaoquan Lai, Minghuan Wang, Chuan Qin, Li Tan, Lusen Ran, Daiqi Chen, Han Zhang, Ke Shang, Chen Xia, Shaokang Wang, Shabei Xu, Wei Wang. Coronavirus Disease 2019 (COVID-2019) Infection among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China. JAMA Netw Open. 2020 May 1; 3(5):e209666. doi:10.1001/jamanetworkopen.2020.9666.
Christopher M Petrilli, Simon A Jones, Jie Yang, Harish Rajagopalan, Luke O'Donnell, Yelena Chernyak, Katie A Tobin, Robert J Cerfolio, Fritz Francois, Leora I Horwitz. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020; 369:m1966. doi:10.1136/bmj.m1966.
Temet M McMichael, Dustin W Currie, Shauna Clark, Sargis Pogosjans, Meagan Kay, Noah G. Schwartz, James Lewis, Atar Baer, Vance Kawakami, Margaret D. Lukoff, Jessica Ferro, Claire Brostrom-Smith, Thomas D. Rea, Michael R. Sayre, Francis X. Riedo, Denny Russell, Brian Hiatt, Patricia Montgomery, Agam K. Rao, Eric J. Chow, Farrell Tobolowsky, Michael J. Hughes, Ana C. Bardossy, Lisa P. Oakley, Jesica R. Jacobs, Nimalie D. Stone, Sujan C. Reddy, John A. Jernigan, Margaret A. Honein, Thomas A. Clark, Jeffrey S. Duchin, for the Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med 2020 May 21; 382(21):2005-2011. doi:10.1056/nejmoa2005412.
Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal masking in hospitals in the COVID-19 Era. N Engl J Med 2020;382:e63. doi:10.1056/nejmp2006372.
Lindsley WG, Noti JD, Blachere FM, Szalajda JV, Beezhold DH. Efficacy of face shields against cough aerosol droplets from a cough simulator. J Occup Environ Hyg 2014; 11(8):509–518. doi:10.1080/15459624.2013.877591.
Mayar Al Mohajer, Kristen M. Panthagani, Todd Lasco, Bradley Lembcke, Vagish Hemmige. Association between universal face shield in a quaternary care center and reduction of SARS-COV2 infections among healthcare personnel and hospitalized patients. Int J Infect Dis. 2021 Apr; 105: 252–255. doi:10.1016/j.ijid.2021.02.060.
Perencevich EN, Diekema DJ, Edmond MB. Moving personal protective equipment into the community: face shields and containment of COVID-19. JAMA 2020;323(22):2252–2253. doi:10.1001/jama.2020.7477.
Michael A Johansson, Talia M Quandelacy, Sarah Kada, Pragati Venkata Prasad, Molly Steele, John T Brooks, Rachel B Slayton, Matthew Biggerstaff, Jay C Butler. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA Netw Open. 2021 Jan 4;4(1):e2035057. doi:10.1001/jamanetworkopen.2020.35057.
Escalon, M. X., & Herrera, J. (2020). Adapting to the Coronavirus Disease 2019 Pandemic in New York City. American Journal of Physical Medicine & Rehabilitation, 99(6), 453–458. doi:10.1097/phm.0000000000001451.
Paolo Boldrini, Carlotte Kiekens, Stefano Bargellesi, Rodolfo Brianti, Silvia Galeri, Lucia Lucca. First impact on services and their preparation. "Instant paper from the field" on rehabilitation answers to the Covid-19 emergency. Eur J Phys Rehabil Med 2020 Jun;56(3):319-322. doi:10.23736/s1973-9087.20.06303-0.
Qian Liu, Dan Luo, Joan E Haase, Qiaohong Guo, Xiao Qin Wang, Shuo Liu, Lin Xia, Zhongchun Liu, Jiong Yang, Bing Xiang Yang. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health 2020 Jun;8(6):e790-e798. doi:10.1016/S2214-109X(20)30204-7.
DOI: 10.28991/SciMedJ-2021-03-SI-6
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