The Effects of a Pulmonary Rehabilitation Program in Severe and Critical COVID-19 Disease: A Prospective Observational Study

Objective: The pulmonary rehabilitation program has beneficial effects on Coronavirus Disease 2019 (COVID-19). However, the response of each patient is not the same. The aim of this study is to compare the rehabilitation processes of severe and critical patients with COVID-19 infection and investigate the effects of sarcopenia and nutritional parameters on the rehabilitation course.Materials and Methods: Patients with COVID-19 infection who continued to use oxygen were enrolled and classified into severe or critical disease groups. The modified Medical Research Council scale, Borg Rating of Perceived Exertion scale, and Barthel Index were evaluated. A 6-minute walking test, hand grip strength (HGS), and chair stand test were performed. The thickness of the quadriceps muscle was measured by ultrasound to diagnose sarcopenia. Nutrition risk screening and daily protein and calorie intake were computed.Results: Twenty-two patients were included. The oxygen requirement at discharge was reduced compared to those admitted to the rehabilitation unit (p<0.001). Sarcopenia was present in 17 (77.3%) patients in all subjects, 12 (80%) patients in the severe disease group, and in 5 (71.4%) patients in the critical disease group. HGS and the Barthel Index were lower in the critical disease group (p=0.044 and p=0.037, respectively). The duration of rehabilitation was longer in the critical disease group (p=0.044). Daily protein and calorie consumption per kilogram were similar and low in both groups (both p>0.05).Conclusion: Sarcopenia and malnutrition were common in severe and critical COVID-19 disease patients. HGS was lower in critical disease patients, while muscle measurements were similar in both groups.