CRITIQUE REVIEW

Adults with multiple organ dysfunction syndrome are very prone to severe COVID-19 symptoms.

MODS is defined as altered organ function in an acutely ill patient involving 2 or more organ systems

among the respiratory, cardiovascular, renal, hepatic, gastrointestinal, haematological, endocrine and

central nervous system. Other research cited that SARS-CoV2 are associated with multiorgan failure

(Histol 2020 “COVID-19 and multiorgan failure: A narrative review on potential mechanisms”). Corona

virus disease is caused by severe acute respiratory syndrome. As MODS is one of the worst possible

manifestations of covid along with respiratory failure, neurological symptoms, septic shock, or a

combination of all. In this article “Effectiveness of Rehabilitation Interventions in Adults with Multi-

Organ Dysfunction Syndrome: A Rapid Review” by Arienti, Lazzarini, Pollini, Patrini, Kiekens, and

Negrini, examined the effectuality of rehabilitation for persons with MODS. Researchers believe that

rehabilitation interventions could cover an essential role in the accomplishment of functional recovery of

patients specially those with multiorgan failures and can be a great help to the increasing mortality

problems due to covid. The rapid review made by the researchers aims to portray the effectiveness of

rehabilitations interventions for patients specially elderly patients with multiorgan failure. Setting their

goal as to provide preliminary findings on how to increase the recovery of critically ill patients in

correlation to SARS-CoV-2.

Researchers used randomized controlled trials (RCTs) supporting their studies involving adults

with 2 or more organ dysfunctions diagnosed with SOFA (Sequential Organ Failure Assessment) and

comparing rehabilitation interventions with any other type of interventions or with no intervention. In

similar to the research of Ferrándiz et al (May 2021) “Effectiveness of a Functional Rehabilitation

Program for Upper Limb Apraxia in Postroke Patients: A Randomized Controlled Trial who used A

randomized controlled trials to support their studies. This type of method is used to prevent the skewing

or deliberate manipulation of results and for the researchers and participants not to influence the result.

Similarly to the article mentioned above, it is best to use randomized controlled trials on this type of study
to achieve more accurate result by testing different groups or control. In this study, they examined a total

of 90 critically ill patients with MODS and admitted to the intensive care unit (ICU) for at least 48 hours

using neuromuscular electrical stimulation (NMES) and some are combined with whole-body vibration

(WBV). The population used in the study are 26 patients with admission scores Acute Physiology and

Chronic Health Evaluation II of 13 or higher, 14 incubated patients with baseline APACHE II and SOFA

scores of 20 and 50 participants with sepsis at admission and a median SOFA score of 14.

The review included studies addressing rehabilitation interventions as defined by Cochrane

Rehabilitation as all interventions provided or prescribed by rehabilitation professionals to enable people

with disabilities to attain, or maintain, their maximum independence; all interventions provided by

rehabilitation professionals to prevent secondary health conditions or complications arising from a

primary health conditions, and all physical modalities, manual therapies, exercise therapies, prosthetics

and orthotic interventions and adaptive technologies for disabilities. These interventions are aiming to

maintain or prevent worsening of the clinical conditions such as electrical simulation or patient

positioning. The search was preformed by an information specialist on November 30, 2020. The aim was

to improve muscle strength and physical performance at first awakening and ICU discharge. The overall

quality of evidences shows low due to high risk of bias and due to small population being used in the

study that only includes 90 participants. As a result of their study, the effectiveness of interventions

compared with no treatment or standard physiotherapy reported a positive effect of NMES on muscle

mass measurements and strength and stated that rehabilitation interventions might deliver tangible

improvements in several aspects in the recovery from MODS and other pathologies causing similar

impairments such as covid 19. In addition to that, the authors concluded that NMES may be a potential

rehabilitation intervention for preventing muscle volume loss and improving muscle strength and function

in critically ill patients with MODS and can recommend the high recovery of patients with severe cases.

Based on World Health Organizations (WHO), an estimated of 2.4 billion people are currently living with
a health condition that benefits from rehabilitation (Shimizu 2021). With this being said, authors have

identified that rehabilitations for patients with MODS are effective.

However, authors stated that no firm conclusion can be drawn to their studies due to lack of

evidence on the effectiveness of rehabilitation intervention in improving or maintaining the clinical

condition of patients with critically ill patients with multiorgan dysfunction symptoms. With this method

being used, there are still limitations on the studies as to differences of the facility used of the researchers

and also the patient’s condition. The facilities of hospitals may also affect the efficacy of this study,

especially those rural hospitals may not provide better facilitation for critically ill patients. The expertise

of healthcare providers can also be a barrier for this study. Facility and expertise of healthcare sector has a

great impact on taking care of patients. According to some report, rehab hospitals may harm some

patients. In the article written by Marsh Allen (2016), 29 percent of patients in rehab facilities suffered a

medication error, bedsore, infection or some other type of harm as a result of the care they received. It is

also important to acknowledge the capacity of hospitals and healthcare units in providing rehab programs

to patients. The researches should also indicate the quality or type of facility being used and the expertise

of healthcare providers.

Due to the increasing rate of morbidity and mortality due to the current pandemic, it is very

important to find solutions to control the worsening effect of Covid-19 for every country. Healthcare

sectors are now looking for solutions on how to decrease the number of deaths for covid cases and to

increase the recovery rate of covid patients with severe symptoms. Adding to this, healthcare sectors are

finding quality implementations on how to provide better service on the health industry. This study may

help healthcare sectors to provide an alternative or concrete solutions for the current outbreak and gives

an idea on how to control the increasing rate of mortality due to covid. According to some studies,

rehabilitations have a great impact on patients to improve the condition of patients and to avoid the worst

cases on not having proper treatment for patients. (“Benefits of Rehabilitation” Duhan and O’Reilly).

Therea are lots of benefits that can be given to patients during rehabilitation period as it provides
improvement on health condition of patients by properly attending the needs of patients and providing

proper treatment on their illness. There are also studies prior to pandemic that shows the effectiveness and

efficiency of in-patient rehabilitation services. (SAGE Journals 2016). With proper rehabilitation

interventions, critically ill patients specially those with MODS will be given complete treatment and

provide proper care during hospitalization that will help the patients to improve their conditions. Proper

measurements will be given by healthcare sectors for patients with severe symptoms with complete set of

equipment if needed compare to home treatment with no proper knowledge in treating critically ill

patients. With the help of expert healthcare providers and with great facilities of hospitals, people with

multiorgan dysfunction may rely on hospital rehabilitations for proper treatment. As a result, the survival

of patients with multiorgan failures amid covid is very high with the help of hospital rehabilitation.

However, due to the increasing number of cases of COVID-19, hospitals nowadays are jampacked or now

crowded with covid patients. Here in the Philippines, almost hundreds of hospitals are near full capacity

as virus cases continue to increase. (Reuters – Aug 9, 2021). Of the 1,291 hospitals here in the

Philippines, 236 have reached “critical level” of over 85% occupancy, because of this, hospitals will have

difficulty attending to each and every patient and having difficulty in accommodating incoming patients.

Lots of hospitals cannot accommodate the increasing number of patients every day, there are reports and

news stating that hospitals have no other choice but to decline some patients and just recommend other

hospitals because they cannot accommodate more patients as of the moment. With this current situation, it

is so hard for healthcare sectors to provide proper rehabilitation on patients with MODS. Hospitals must

filter their patients accordingly to provide much better service for those really who need hospital

treatment. In addition to this, the lack of nurses in Philippines will also be a problem in attending this

situation. Reports shows that there are now shortage of nurses and also a threat of mass resignation amid

covid surge in the Philippines. By this, the ratio of nurses attending patients is not balance. This will

result to tiredness of nurses and adding the un even work compensation for health care workers that may

lead them in not fulfilling their proper duties. By this, patients under rehabilitation may not given a proper

treatment and care. Even though families of patients with MODS wants to admit their patient to hospitals
for proper treatment and rehabilitations, due to this situation, they have nothing to do but to do house

treatment instead.

REFERENCES:

1. Ariente, Lazzarani, Pollini, Patrini, Kiekens, & Negrini (May 2021) “Effectiveness of

Rehabilitation Interventions in Adults with Multi-Organ Dysfunction Syndrome: A Rapid

Review

2. Histol, J Mol (October 4, 2020) “COVID-19 and multiorgan failure: A narrative review on

potential mechanisms” Nature Public Health Emergency Collection: 1-16

doi: 10.1007/s10735-020-09915-3

3. María Encarnación Aguilar-Ferrándiz et al. Arch Phys Med Rehabil. (2021 May)

“Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke

Patients: A Randomized Control Trial” doi: 10.1016/j.apmr.2020.12.015

4. Marsh Allen (July 21, 2016) “Rehab Hospitals May Harm A Third of Patients, Report Finds”

Rehab Hospitals May Harm A Third Of Patients, Report Finds : Shots - Health News : NPR

5. Duhan, Neha and O’Reilly, Naomy “Benefits of Rehabilitation”. Physiopedia. Benefits of

Rehabilitation - Physiopedia (physio-pedia.com)

6. Shimizu Yoshi (July 16, 2021) “World Health Organizations: Rehabilitation” Rehabilitation

(who.int)

7. SAGE Journals (February 17, 2016) “The Effectiveness and Efficiency of Inpatients

Rehabilitation Services in Thailand: A Prospective Multicenter Study”

https://doi.org/10.4137/RPO.S34816

8. Reuters Plus (August 9, 2021) “Hundreds of Philippine Hospitals near full capacity as virus

cases Surge) ( Hundreds of Philippine hospitals near full capacity as virus cases surge |

Reuters )