Prone Positioning Sequelae in COVID-19-patients and their relevance for Early Rehabilitation - a Retrospective Cohort Study

Background Prone positioning is a therapy option for patients with Acute Respiratory Distress Syndrome. It has become more relevant and common during the COVID-19 pandemic. Among known side effects, pressure ulcers (PU) and peripheral nerve lesions (PNL) are the most relevant Methods In this retrospective cohort study we investigated the prevalence of PU and PNLin COVID-19 patients, who had been treated with prone positioning and had later been referred to an acute rehabilitation unit. Potential determinants for the occurrence of PU and PNL were identified. Potential effects of PU and PNL on the functional outcome of patients after acute rehabilitation were assessed. Results 52 patients were included in this study. 78.8% had typical ventral PU at the time of referral to the acute rehabilitation unit, 10% showed clinical features of PNL. Patients with PNL had diabetes as a preexisting condition more frequently than patients without. The occurrence of PU could not be correlated with any risk factor. On admission to acute rehabilitation patients with PNL were less mobile and less selfsufficent than patients without PNL, however on discharge there were no more differences in mobility and self-sufficency. Patients with PNL needed significantly more aids. PU are very common, mainly affecting the face and neck (56,1%). Conclusion This study shows that complications of BL are common on admission to acute rehabilitation. While mobility is lower on admission of patients with PNL, no such difference can be seen on discharge. Overall, patients with proning sequae don't seem to be impaired in their mobility and ADL performance beyond their time in acute rehabilitation.