Current best evidence for clinical care (more info)
INTRODUCTION: This paper improves the methodology of the first edition of the rapid living systematic review started in April 2020, with the aim to gather and present the current evidence informing rehabilitation of patients with COVID-19 and/or describing the consequences due to the disease and its treatment.
EVIDENCE ACQUISITION: The Cochrane methodology for a rapid living systematic review was applied. Primary research papers, published from 1 January to 30 June 2020, reporting patients' data, with no limits of study design were included. Studies were categorized for study design, research question, COVID-19 phase, limitations of functioning (disability) of rehabilitation interest and type of rehabilitation service involved. Methodological quality assessment was based on the Cochrane Risk of Bias tools, and the level of evidence table (OCEBM 2011) for all the other studies.
EVIDENCE SYNTHESIS: Thirty-six, out of 3703 papers, were included. One paper was of level 2 (RCT), 7 were of level 3 (2 cohort studies, 2 cross-sectional studies and 3 case-control studies), and 28 papers of level 4 (descriptive studies); 61% of papers reported epidemiological data on clinical presentations, 5 investigated natural history/determining factors, 1 searched prevalence, 2 studies reported on intervention efficacy (though not on harms), and 5 studies looked at health service organization.
CONCLUSIONS: Main issues emerging from the review: it is advised to test for COVID-19 people with neurological disorders presenting with symptom changes; dysphagia is a frequent complication after oro-tracheal intubation in COVID-19 patients admitted to the ICU; after discharge, COVID-19 survivors may report persistent restrictive ventilatory deficits regardless of disease severity; there is only sparse and low quality evidence concerning the efficacy of any rehabilitation intervention to promote functional recovery; a substantial increase in resource (staff and equipment) is needed for rehabilitation.
| Discipline / Specialty Area | Score |
|---|---|
| Physical Medicine and Rehabilitation | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
This systematic review shows us how a rapid living report is an important advancement in data extraction concerning the events when the short- and long-term disease sequelae are still growing. The principal advantage is that they use PRISMA guidelines, and guidance from Cochrane group. Evidence is updated monthly. They show the use of phase classification for Covid-19, according to clinical presentation, and natural history. There is no study reported data concerning permanent sequelae or late onset complications of COVID-19 as this is still a undefined period.
Patients with covid-19 infections commonly present with persistent restrictive ventilatory deficits regardless of severity of illness. Patients from the ICU setting commonly have issues with persistent dysphagia. Neurological symptoms are common. Systematic studies are currently not available so cohort and case series indicate the need for further study and rehabilitation.