Safety and feasibility of pulmonary rehabilitation in patients hospitalized with post-COVID-19 fibrosis: A feasibility study

Background: Emerging data suggest a spectrum of pulmonary complications from COVID-19, ranging from dyspnea to difficult ventilator weaning and fibrotic lung damage. Prolonged hospitalization is known to significantly affect activity levels, impair muscle strength and reduce cardiopulmonary endurance.Objective: To assess the feasibility and safety of inpatient pulmonary rehabilitation (PR) and to explore effects on functional capacity, physical performance, fatigue levels, and functional status.Design: A prospective feasibility study.Setting: Inpatient unit of a tertiary care hospital.Participants: Twenty-five hospitalized patients diagnosed with post-COVID-19 fibrosis referred for PR.Intervention: Individualized PR intervention including breathing exercises, positioning, strengthening, functional training, and ambulation twice a day for 6 days a week.Outcome Measures: One-minute sit-to-stand test (STST), Short Physical Performance Battery (SPPB), Fatigue Assessment Scale (FAS), and Post-COVID-19 Functional Status Scale (PCFS).Results: Twenty-five participants (19 males, 6 females) with a mean age of 54.2 +/- 13.4 years were enrolled. Sixteen completed the two-point assessment after undergoing in-patient PR of mean duration 14.8 +/- 9 days. PR led to a significant improvement in all functional outcomes that is, STST (from 7.1 +/- 4.3 repetitions to 14.2 +/- 2.1 repetitions, SPPB (from 5 +/- 2.8 to 9.4 +/- 1.5), FAS (from 33.3 +/- 10.8 to 25.8 +/- 4.7) at the p <=.001, and PCFS (from 3.6 +/- 0.9 to 2.9 +/- 1.2, p <=.05).Conclusion: Early initiation of PR for hospitalized patients with COVID-19 fibrosis was safe, well tolerated, and feasible and may improve functional status.