Multidisciplinary Inpatient Rehabilitation For Older Adults With COVID-19: A Systematic Review and Meta-Analysis of Clinical and Process Outcomes

McCarthy et al.
BMC Geriatrics (2023) 23:391 BMC Geriatrics

https://doi.org/10.1186/s12877-023-04098-4
RESEARCH Open Access
Multidisciplinary inpatient rehabilitation

for older adults with COVID‑19: a systematic
review and meta‑analysis of clinical and process
outcomes
Aoife McCarthy1*, Rose Galvin2, Frances Dockery3, Kara McLoughlin4, Margaret O’Connor5,6, Gillian Corey5,
Aoife Whiston7, Leonora Carey8, Fiona Steed8, Audrey Tierney2 and Katie Robinson2
Abstract
Background Older adults are at increased risk for disease severity and poorer prognosis following COVID-19 infec-
tion. The aim of this systematic review and meta-analysis is to explore the impact of multidisciplinary rehabilitation in
the acute or post-acute hospital setting for older adults with COVID-19.
Methods The Cochrane library, EMBASE, Cinahl and Medline (via EBSCO), PubMed, and Web of Science were system-
atically searched in June 2022 and a repeat search was completed in March 2023. Screening, data extraction and qual-
ity appraisal were conducted independently by two reviewers. Studies reporting outcomes for older adults following
multidisciplinary rehabilitation (provided by two or more Health and Social Care Professionals) were included. Both
observational and experimental study designs were included. The primary outcome was functional ability. Secondary
outcomes included discharge disposition, acute hospital and rehabilitation unit length of stay, mortality, primary and
secondary healthcare utilisation, and long-term effects of COVID-19.
Results Twelve studies met the inclusion criteria, comprising a total of 570 older adults. Where reported, older adults
stayed in the acute hospital for a mean of 18 days (95%CI, 13.35- 23.13 days) and in rehabilitation units for 19 days
(95%CI, 15.88–21.79 days). There was a significant improvement in functional ability among older adults with COVID-
19 who received multidisciplinary rehabilitation (REM, SMD = 1.46, 95% CI 0.94 to 1.98). The proportion of older adults
who were discharged directly home following rehabilitation ranged from 62 to 97%. Two studies reported a 2%
inpatient mortality rate of older persons during rehabilitative care. No study followed up patients after the point of
discharge and no study reported on long term effects of COVID-19.
Conclusions Multidisciplinary rehabilitation may result in improved functional outcomes on discharge from rehabili-
tation units/centres for older adults with COVID-19. Findings also highlight the need for further research into the long-
term effect of rehabilitation for older adults following COVID-19. Future research should comprehensively describe
multidisciplinary rehabilitation in terms of disciplines involved and the intervention provided.
Keywords Systematic review, Older adults, Rehabilitation, Outcomes, COVID-19
*Correspondence:
Aoife McCarthy
[email protected]; [email protected]
Full list of author information is available at the end of the article
© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
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McCarthy et al. BMC Geriatrics (2023) 23:391 Page 2 of 25
Background comprehensive geriatric assessment, long term follow-

In March 2020, a global pandemic was declared with the up and ongoing monitoring of patients following dis-
emergence of COVID-19, an infectious disease, viral by charge from rehabilitation for COVID-19 is also advised
aetiology and caused by the SARS-CoV-2 virus [1]. As by EuGMS, with suggested time points of 6 weeks and
of the 17th of March 2023, the World Health Organisa- 6 months [28].
tion (WHO) reported 760,360,956 confirmed cases and Studies have evaluated multidisciplinary team (MDT)
6,873,477 deaths globally [2]. Common symptoms of rehabilitation for various groups including adults with
COVID-19 include fever, dry cough, and fatigue; less severe-to-critical illness in intensive care units [29]
commonly people experience headache, dizziness, and those adults post intensive care [30]. Older adults
abdominal pain, nausea, and vomiting [3]. face increased risks for COVID-19 severity and poorer
Older age and male gender place people at higher risk prognosis. While the literature supports multidiscipli-
for disease severity [3–6] and a poorer prognosis [4, 7]. nary rehabilitation for adults hospitalised with COVID-
Those with other underlying health conditions namely 19, little is known yet about how MDT rehabilitation
cancer, obesity, chronic kidney disease, chronic lung in this group impacts outcomes. To date, there are no
disease, cystic fibrosis, dementia, diabetes, people with randomised controlled trials or analytical cohort stud-
disabilities, heart conditions, HIV infection, and those ies published exploring the effect of MDT rehabilitation
who are immunocompromised are also at greater risk of on older adult outcomes following hospitalisation for
severe illness [8–10]. Given that over 50% of those aged COVID-19. However, several observational studies have
over 65 have two or more chronic health conditions [11], described the rehabilitation outcomes of older adults
it would suggest that older persons are at significant risk with COVID-19 following MDT intervention. There is
for COVID-19 disease severity. a need to profile the clinical characteristics, functional
Between 13.9 and 43% of patients infected with and process outcomes of older adults who have under-
COVID-19 develop long term symptoms, with fatigue gone MDT rehabilitation in the acute or post-acute inpa-
and memory difficulties or brain fog amongst the most tient hospital setting to inform the development and
common [12, 13]. Additionally, the quality of life (QOL) response of services in the future and to guide the devel-
of those post COVID-19 is significantly impacted regard- opment of trial studies. This systematic review aims to
less of the time since discharge or recovery and older explore and synthesise the totality of evidence regarding
age and co-morbidities are among the most frequently the outcomes of older adults with COVID-19 who have
reported factors associated with low levels of QOL post undergone MDT intervention in the acute or post-acute
COVID-19 [14]. Worse mobility and functional out- inpatient setting. The author hypothesises that older
comes have also been identified in older adults admit- adults with COVID-19 will have improved function fol-
ted to hospital due to COVID-19 [15] and in older adults lowing completion of MDT rehabilitation.
with mild to moderate COVID-19 who did not require
hospitalisation [16]. Methods
In the early months of the pandemic there was a Study design
dearth of literature describing the rehabilitation needs The conduct and reporting of this systematic review
of people recovering from COVID-19 and the efficacy of of observational studies is in accordance with the
interventions [17]. Since this time, the body of evidence Meta-analysis Of Observational Studies in Epidemi-
has grown significantly to include longitudinal studies ology (MOOSE) guidelines [31], see Additional file 1.
exploring clinical progression, symptoms, and rehabilita- The protocol for this systematic review has been reg-
tion recommendations [18–20]. istered on the PROSPERO register (PROSPERO
The WHO’s living guideline on the clinical manage- ID = CRD42022341365).
ment of COVID-19 recommends screening for rehabili-
tation needs throughout the recovery process [21] and Search strategy
both the WHO guidelines and the National Institute The searches were conducted on the 1st of June 2022 of
for Health and Care Excellence (NICE) guidance docu- the following databases: Cochrane library, EMBASE,
ment for the management of Long Covid [22] recom- Cinahl and Medline (via EBSCO), PubMed, and Web of
mend multidisciplinary input given the virus’ impact Science by the first author. Reference lists of eligible stud-
on several body structures and functions, and its long- ies were also checked. Literature was limited to publica-
term sequelae. These guidelines reflect other COVID- tions from March 2020 to the date of search completion
19 rehabilitation guidelines developed for clinicians of and limited to English language full text. The search was
specific disciplines [23–27] and the European Geriatric completed by AMC, Master of research candidate at the
Medicine Society (EuGMS) guidance [28]. The use of University of Limerick. A repeat search was conducted
on the 17th of March 2023 to identify additional papers Studies were excluded if they met any of the following
published between the initial and repeat search date. criteria:
The following MeSH terms and associated keywords
covering three concepts were used; – Population: Persons with COVID-19 with mean
or median age of < 65 years.
– COVID-19 – Study design: The control arm of experimental or
– Multidisciplinary rehabilitation analytical observational studies where MDT inter-
– Hospital setting vention has not been implemented, and cross-sec-
tional studies.
Appropriate synonyms were compiled to identify all – Intervention: Studies reporting outcomes following
appropriate studies. See Additional file 2 for search terms uni-disciplinary interventions, pulmonary rehabilita-
and synonyms. tion only or papers describing medical interventions
only. Studies reporting outcomes following reha-
Eligibility criteria bilitation only in the Intensive Care Unit were also
Studies meeting the following criteria were included: excluded.
– Population: Older adults (with mean or median age

of 65 or greater) with a diagnosis of COVID-19. Data extraction
– Study design: Prospective and retrospective descrip- Studies obtained through the search strategy were
tive cohort studies, comparison groups of experi- reviewed and duplicates removed in Endnote. Remaining
mental studies including randomized controlled tri- studies were then exported to Rayyan for initial screen-
als, quasi randomized studies or controlled before ing by the first author (AMC). Rayyan is a web-based
after studies, case series (with more than 1 partici- platform that facilitates the methodical and efficient
pant), and the ‘cases’ in case control studies. screening of search results by title and abstract. It allows
– Intervention: multidisciplinary (MDT) rehabilita- researchers to allocate labels to explain reasons for exclu-
tion provided by two or more Health and Social Care sion facilitating transparency in the systematic review
Practitioners (HSCP) including but not limited to the process [33]. One third of included articles were inde-
following disciplines in the inpatient setting: Occupa- pendently reviewed by another author (RG). Following
tional Therapy, Physiotherapy, Speech and Language the initial screening, full text articles were obtained and
Therapy, Human Nutrition and Dietetics, Psychology screened for eligibility by two members of the research
and/or Medical Social Work. team (AMC & RG). Disagreement was resolved through
review by a third review team member (KR). Where
information relating to inclusion and exclusion criteria
Outcomes was ambiguous or not reported in an article, the authors
The primary outcome for the study was any validated were contacted by email to screen for eligibility.
measure of functional ability that reflect activity limita- Data were extracted from included studies by one
tions and participation restrictions in keeping with the reviewer (AMC) using a custom template. The following
International Classification of Functioning e.g., Barthel data were extracted: Author, year of publication, coun-
Index, or Functional Independence Measure. try, methodology/ study design, population (including
Secondary outcomes included: patient demographics and baseline characteristics where
applicable), interventions received, and outcomes meas-
– Discharge disposition e.g., discharge directly home, ured. A quality check of 20% of the data extraction was
long term care, transitional care, and/or to the care of completed by a second independent reviewer (RG).
a family member
– Hospital length of stay (LOS) Quality assessment
– Mortality The methodological quality of included studies was
– Primary/Community and secondary healthcare uti- assessed independently and in duplicate by two reviewers
lisation (unplanned ED return, unscheduled hospital (AMC, RG). The CASP critical appraisal tool for cohort
admission) studies [34] and the JBI critical appraisal tool for case
– Long term effects of COVID-19 i.e. signs and symp- series [35] were applied as appropriate. Disagreements
toms reported during the post COVID-19 phase for regarding bias were resolved by a third reviewer (KR).
example fatigue, headache, attention disorder, hair GRADE analysis was applied to the primary outcome of
loss and dyspnoea [32]. functional ability to evaluate the quality of evidence [36].
Statistical analysis [45, 46], and one study in Canada [47], Romania [48],
Statistical analysis was performed using Review Manager Taiwan [49] and France [50]. Six studies in the review
Software (version 5.4) for meta-analysis. For the primary were published in 2021 [39, 40, 43, 44, 47, 50]. Four
outcome of functional status, the mean and standard were published in 2022 [41, 45, 48, 49]. Two papers were
deviation values for the MDT group were extracted at published in 2023 [42, 46]. The total number of par-
baseline and post MDT rehabilitation. In instances where ticipants from included studies was 570. Nine out of 12
the mean and standard deviation (SD) were not available, studies reported the age of the cohort as a mean (65 to
the median was used as a proxy for the mean and a multi- 85.33 years) [39–42, 44–46, 48, 49]. The remaining three
ple of 0.75 times the interquartile range (IRQ) or 0.25 the studies reported a median age of 65 to 75 [43, 47, 50].
difference in the range [37]. In studies that assessed the Older adults required ICU admission in seven out of 12
same construct but used a different validated outcome studies ranging from 23 to 100% of their total cohort
measure to report the construct, the exposure (MDT [41, 43, 44, 46, 47, 49, 50].
rehabilitation) effect was determined using the standard-
ised mean difference (SMD). In studies that measured the
same outcome using the same scales, the mean difference Rehabilitation programme
(MD) was used. The standard error (SE) was calculated Each paper described MDT rehabilitation which included
using the SD divided by the square root of the number of 2 or more HSCP disciplines including Physiotherapy
values in the data set (n). For all outcomes, the denomi- (PT), Occupational Therapy (OT), Speech and Language
nator in each group was considered as the number of Therapy (SLT), Psychology, Social Work, Clinical Nutri-
participants allocated to that group at baseline. tion and Dietetics and Pharmacy [39–50]. See Table 1 for
We assessed clinical variation across the studies by summary of disciplines provided by study. All 12 papers
exploring the characteristics of participants, the content reported intervention from a PT [39–50]. Nine papers
and duration of the MDT intervention, outcome meas- described intervention from an OT [39–43, 47–50]. Eight
ures administered and timing of outcome assessments. papers described intervention from an SLT [39–41, 44,
Statistical heterogeneity was examined by visual inspec- 46, 47, 49, 50]. Seven papers reported patients received
tion of the forest plots and using the C hi2 statistic and psychological interventions when needed as part of the
the I test. As strict thresholds for interpreting I2 are not
2
MDT intervention [40, 41, 43, 45, 46, 49, 50]. In four
recommended, we interpreted the I2 statistic using the out of seven studies, this intervention was provided by
approximate guide by Deeks and colleagues [38]. Fur- either a Neuropsychologist [40, 41, 43] or Psychologist
thermore, to explore potential explanations of heteroge- [50]. Three of the studies did not report the specific dis-
neity, moderator analysis was conducted where sufficient cipline of psychology providing the service [45, 46, 49].
data was available. For example, random effects meta- In two studies, Social Workers were part of the MDT
regression was conducted when ≥ 10 studies reported a [47, 50]. Clinical Nutrition and Dietetics and pharmacy
continuous moderator variable—age, gender, length of were part of the MDT in only one study [47]. Five out of
stay, and number of health and social care professional 12 papers reported input from a physician alongside the
disciplines. In instances where there was considerable rehabilitation programme [40, 41, 44, 47, 50] including
variation in the results or where there was not enough a rehabilitation physician, medical doctor, hospitalist or
data available to conduct a meta-analysis, we opted for a physiatrist and specialists such as geriatricians and liai-
narrative summary of the outcomes of interest. son psychiatrists.
Intensity of multidisciplinary rehabilitation was not
Results reported in any study. Eight studies presented detailed
Flow of studies in the review information on the nature of rehabilitation intervention
Figure 1 displays the flow of studies in the review. A total [41, 43–46, 48–50]. The description of rehabilitation pro-
of 10,515 studies were identified across the database grammes was heterogenous however domains reported
searches, 9168 were excluded on the basis of title/abstract include respiratory/pulmonary rehabilitation, motor and
screening and 195 full text articles were reviewed. Ulti- strengthening interventions, training in activities of daily
mately 12 articles were deemed eligible for inclusion. living, energy conservation techniques, advice regarding
the home environment and practice of functional mobil-
ity and transfers. Please see Table 2 for characteristics of
Study and patient characteristics included studies for additional information. The remain-
Twelve studies met the criteria for this systematic ing four studies reported only the disciplines that were
review. Four studies were conducted in the United involved in the MDT intervention or the assessment
States [39–42], two in Italy [43, 44], two in Switzerland domains [39, 40, 42, 47].
Fig. 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of included studies
Table 1 Disciplines provided by study

Disciplines OT PT SLT Dietetics MSW Psychology Pharmacy Physician
✓ ✓ ✓
✓ ✓ ✓
Bellinger
✓ ✓ ✓ ✓ ✓ ✓ ✓
Di Pietro
✓ ✓ ✓ ✓ ✓ ✓
Journey
✓ ✓ ✓ ✓ ✓
Piquet
✓ ✓ ✓
Maltser
✓ ✓ ✓
Bertolucci
✓ ✓ ✓
Bompani
✓ ✓
Barbieri
✓ ✓
Cevei
✓ ✓ ✓ ✓
Coakley
✓ ✓ ✓ ✓ ✓
Chuang
Cao
Table 2 Study and patient characteristics

Author/year/ Study Participants Exposure (FITT) Comparison Discharge Outcome measures Results
country design Inclusion/exclusion group disposition
Bellinger Retrospective, Inclusion Frequency None NR Completed on admission 1. IRF PAI:

et al./2021/ descriptive - Positive lab test for C19 5 days per week and discharge from reha- Mean difference of 48.2 points, SD
United States cohort - admission to inpatient Intensity bilitation unit not reported between pre and post
of America rehabilitation upon dis- NR 1. IRF PAI: Subsections for 2. 6MWT:
[39] charge from acute care Time self care and mobility Mean difference of 472.3 ft between
- receipt of a minimum of Average 175.64 min 2. 6MWT pre and post
two out of three therapy per week 3. mBI 3. mBI:
disciplines (PT, OT, and ST) Type 4. Orientation Log and Mean difference of 28.95 between
Exclusion 2 out of 3 disciplines Cognitive Log pre and post
- baseline expressive and/ (OT, PT, SLT) 5. Length of stay (LOS) 4. Orientation Log and Cognitive
or receptive aphasia, Log:
- non-English speakers Orientation- mean difference of 8.6
- readmission to the acute between pre and post
care hospital or leave of Cognitive- mean difference of 4.14
absence of more than between pre and post
3 days from the inpatient 5. Mean LOS = 17.3 days
rehab (SD NR)
- pre-existing illness with (Mdn = 15 days, range: 5–36 days)
a life expectancy of less
than 6 months
- failure to participate
in designated outcome
measures (resulting in a
lack of data availability)
Participants
- N = 35
- Mean age = 68.7
(SD NR)
- Sex (female) = 34%
Di Pietro Retrospective Inclusion Frequency None NR 1. Cumulative illness rating 1. Mean CIRS 1 (severity
et al./2021/ case report/ - Patients who needed, Motor rehabilita- scale (CIRS 1 = Severity index) = 2.2 ± 0.5
Italy [43] case series besides the rehabilitation tion = 6 days per week index and CIRS 2 = co- Mean CIRS 2 (comorbidity
programme, an extensive Occupational morbidity index) index) = 5.6 ± 2.5
neuropsychological evalu- Therapy = frequency NR 2. Admission Barthel index 2. 41.0 ± 29.5
ation during hospital stay Neuropsychology = fre- 3. Discharge Barthel index 3. 78.9 ± 16.8
- These patients, quency NR 4. Delta BI (difference in BI 4. 37.9 ± 31.1
aged > 18 years in stabi- Intensity between admission and 5. 70.3 ± 25.1
lized respiratory condition NR discharge) 6. 95.7 ± 26.0
(PaO2/FiO2 > 300) Time 5. Admission Functional 7. 25.4 ± 21.7
- with previous diagnosis Motor rehabilita- Independence Measure 8. MMSE: descriptive statistics NR
of COVID-19 infection tion = NR 6. Discharge Functional but patients individual scores are
proven by a positive PCR Occupational Independence Measure reported
nasopharyngeal swab Therapy = 150 min per 7. Delta FIM (difference in 9. Neuropsychological assessment
Exclusion week for last 2 weeks FIM between admission and battery:
- patients with delirium of rehabilitation pro- discharge) Mean Forward Digit span
- those receiving antipsy- gramme 8. Mini Mental State 0–9 = 5.13 ± 0.95
chotic therapy Neuropsychology = NR Examination Mean Backward Digit span
Participants Type 9. Complete neuropsycho- 0–9 = 3.94 ± 0.57
N = 12 Motor rehabilitation, logical assessment battery Mean Story test (early recall),
Mean age = 64.0 ± 13.7 Occupational Therapy, (point in time) z = − 0.58 ± 1.11
Median age = 65 (54–73) Neuropsychological (Forward Digit span Mean Story test (late recall),
Sex = NR evaluation Backward Digit span z = 0.24 ± 1.60
Exercises focused on Story test [early recall] Mean TMT-a, score = 32.63 ± 22.41
muscle strengthening Story test [late recall], Mean TMT-b, score = 96.17 ± 55.22
(isotonic and isometric TMT-a Mean FAB, score = 14.58 ± 2.22
exercises) and TMT-b Mean Phonemic verbal fluency
conditioning, and FAB test = 24.10 ± 6.60
bed-to-chair mobility, Phonemic verbal fluency Mean Semantic verbal fluency
wheelchair skills, pre- test test = 38.11 ± 6.97
gait (sit to Semantic verbal fluency Mean Rey–Osterrieth complex
stand), bathroom skills, test figure test = 30.14 ± 7.81
and activities of daily Rey–Osterrieth complex Mean Clock drawing
living (ADL) training figure test test = 12.40 ± 2.70
Clock drawing test) 10. ICU Admission
10. ICU admission (n) and N = 6 (50%)
length of stay ICU stay = mean 26.1 days ± 10.2
11. Normal premorbid state 11. Normal premorbid state = 10 (83%)
12. Symptom duration 12. Symptom duration (days)
(days) Mean = 75.0 ± 42.4
Table 2 (continued)
Journeay Retrospective, Inclusion Frequency None Value, n(%) 1. Single, n (%) 1. 24 (58.5)
et al. /2021/ descriptive - Individuals ≥ 18 years Not reported Home = 35 2. Employed, n (%) 2. 11 (26.8)
Canada [47] cohort - documented COVID- Intensity (85.4) 3. Admitted from home, 3. 37 (90.2)
19-positive diagnosis Not reported Other n (%) 4. 14 (34.1)
- admitted to a designated Time discharge 4. Living alone, n (%) 5. 17 (41.5)
COVID-19 inpatient Not reported destina- 5. Stairs at home, n (%) HTN = 30 (73.2)
recovery unit Type tions = NR 6. Co-morbidities, n (%) Diabetes = 15 (36.6) CNS = 15 (36.6)
Exclusion Rehabilitative care Hypertension 7. 19 (12–31)
- Rehab stay for longer teams consisted of a Diabetes 8. 15 (36.6)
that 12 weeks hospitalist, physiatrist, CNS impairment 9. 16 (13–22)
- those admitted for pallia- nursing, physiothera- 7. Acute care LOS, Median 10. 11 (26.8)
tive care pist, occupational (IQR) 11. 2 (4.9)
Participants therapist, speech 8. ICU stay, N (%) 12. 85 (75–97)
N = 41 language pathologist, 9. Rehab LOS (Median, IQR) 13. 108.5 (103–118)
Median age = 75 social worker, recrea- 10. Ventilator, N (%) 14. 25 (20.75- 25)
(IQR 58- 84) tion therapist, dietitian, 11. Readmissions to acute, Regular = 35 (85.4)
Sex (Male) = 22 (53.7%) pharmacist, ward aides, n (%) Modified = 6 (14.6)
and environmental 12. Admission FIM, Median Regular = 39 (95.1)
services. Specialists (IQR) Modified = 2 (4.9)
available by consulta- 13. Discharge FIM, Median Medically complex = 29 (70.7)
tion included geriatrics (IQR) Pulmonary disorders = 6 (14.6)
and consult liaison 14. Admission MOCA, Stroke/ortho/debility = 6 (14.6)
psychiatry, with internal median (IQR) Neuromusculoskeletal = 30 (73.2)
medicine available 15. Admission Diet, n (%) Cardiovascular, haematological,
16. Discharge Diet, n (%) immunological, respiratory = 27
17. Rehabilitation Client (65.9)
Group, n (%) Mental function = 12 (29.3)
18. Affected body func- Genitourinary and reproductive = 7
tions, n (%) (17.1)
Sensory and pain = 4 (9.8)
Digestive, metabolic, endocrine = 4
(9.8)
Skin and related structures = 3 (7.3)
Voice and speech = 0 (0)
Table 2 (continued)
Piquet Retrospective, Inclusion Frequency None Value, n (%) 1. Background and co- High blood pressure = 48 (48)
et al./2021/ descriptive - Age 18 or older Two physical therapy Home = 75 morbidities, n (%) Age > 70 = 41 (41)
France [50] cohort - The ability and willing- (PT) sessions per day (75) 2. Clinical characteristics at Diabetes = 29 (29) BMI > 30 = 17 (17)
ness to engage in 2 daily 5 days per week Relative’s time of diagnosis, n (%) Renal failure = 13 (13)
PT sessions 5 days per Frequency of OT, SLT home = 4 (4) 3. Barthel Index Coronaropathy = 1 (1)
week and/or Psychology not COVID-free 4. time to perform 10 full Stroke = 9 (9)
Exclusion reported rehabilitation sit-to-stands as quickly as Immunosuppression = 3 (3)
Not reported Intensity unit = 15 possible from a standard- Dyspnea = 79 (79)
Participants Not reported (15) ized 40-cm-height chair, Asthenia = 76 (76)
Value, n (%) Time Acute arms folded over the chest, Fever = 73 (73)
N = 100 Each PT ses- care = 8 (8) with respiratory rate, oxy- Cough = 64 (64)
Sex (male) = 66 (66) sion < 20 min in gen saturation, heart rate, Myalgia = 33 (33)
Median age, IQR = 66 ± 22 duration, and Borg scale of perceived Diarrhea = 25 (25)
OT, SLT and/or Psychol- exertion, recorded before Ageusia = 16 (16)
ogy session time not and after Headache = 14 (14)
reported 5. Hand grip strength Anosmia = 13 (13)
Type 6. Personal assistance Pulmonary embolism = 4 (4)
Motor strengthen- required Thrombosis = 1 (1)
ing and respiratory 7. Deaths, n (%) 3. BI:
rehabilitation 8. Intubation, n (%) Mean pre infection BI = 94.5 ± 16.2
Physical education 9. Nasal O2 at admission to Mean admission BI = 77.3 ± 26.7
group work acute, n (%) Mean discharge BI = 88.8, ± 24.5
2 occupational thera- 10. Nasal O2 at discharge 4. Sit to stand frequency increased
pists, 1 speech from acute, n (%) by 37%
therapist, and 1 psy- 11. Rehab LOS, mean ± SD Post-sit-to-stand test respiration rate
chologist also provided 12. LOS acute care, dropped by
service to ward mean ± SD 9%
A mobile discharge 13. Intensive care, n (%) Borg exertion
team comprising a score after the sit-to-stand test
physical medicine improved by 30%
and rehabilitation phy- 5. Grip strength among right-
sician, a social worker, handed people (92% of patients)
and an occupational increased by 15%
therapist helped detect 6. Personal assistance required:
and solve any social Before C19 = 19 (19)
issues encountered After C19 = 24 (24)
toward returning 7. 2 (2)
home. In 8. 13 (13)
addition, a dedicated 9. 77 (77)
physiotherapist insured 10. 58 (58)
proper execution of 11. 9.8 ± 5.1
the self-rehabilitation 12. 14.4 ± 8.7
exercises by video 13. 23 (23)
consultation
Table 2 (continued)
Maltser Retrospective, Inclusion Frequency Data from Burke 1. GG Scores related to self Burke
et al./2021/ descriptive Burke Daily the Uniform Home = 31 care (GG0130) 1. Change in GG score for self
United States cohort - Demonstrating clinical Intensity Data System (62%) 2. GG scores related to care = mean 15.60 ± 5.20 (SD)
of America recovery of symptoms Not reported (UDS) and Acute mobility (GG0170) (P = 0.0001)
[40] - Have rehabilitation goals Time eRehabData hospital = 8 (scales range from 1 to 6, 2. Change in GG score for mobil-
- < 6L Supplementary O2 3 h per day (1 h OT, 1 h (eRehabData) (16%) where 1 indicates “depend- ity = Mean 27.00 ± 6.99 (SD)
requirements SLT, 1 h PT. If no SLT databases Subacute ent” and (P = 0.0001)
JFK Johnson needs, split between PT for patients rehab = 11 6 indicates “independent.”) 3. 15.56 ± 11.91
- Must be 7 days from and OT) treated for (22%) 3. Rehab LOS, mean ± SD 4. 9.94 ± 10.56
initial symptom onset Type “debility” dur- JFK John- 4. Acute Hospital LOS, 5. White = 25 (50%)
- At least 3 days since OT ing the last son mean ± SD Other = 1 (2%)
fever resolution SLT quarter Home = 46 5. Race/ethnicity, n (%) Asian = 2 (4%)
- Be without fever reduc- PT of 2019 (pre- (92%) Black = 13 (26%)
ing meds Also have access to pandemic) Acute hospi- Hispanic = 9 (18%)
- Have had an improve- recreation therapy and tal = 0 (0) Unknown = 0 (0%)
ment in respiratory neuropsychology as Subacute JFK Johnson
symptoms needed rehab = 4 1. Change in GG score for self
- < or equal 5L supplemen- Information gathered (8%) care = mean 14.04 ± 6.93 (SD)
tary O2 requirements from authors, not P < 0.0001
Participants reported in research 2. Change in GG score for mobil-
Burke article ity = mean 32.68 ± 13.52 (SD)
N = 50 P < 0.0001
Mean = 67.66 ± 12.13 3. 15.72 ± 6.65
Sex (male) = 29 (58%) 4. 29.42 ± 23.45
JFK Johnson 5. White = 14 (28%)
N = 50 Other = 1 (2%)
Mean = 64.54 ± 12.16 Asian = 9 (18%)
Sex (male) = 33 (66%) Black = 15 (30%)
Hispanic = 11 (22%)
Unknown = 0 (0%)
Table 2 (continued)
Bertolucci Prospective, All consecutive patients Frequency None Value, n (%) 1. Cummulative Illness 1. Median index of CIRS comorbid-
et al./2021/ descriptive requiring rehabilitative Daily therapy sessions Home = 38 Rating Scale for medical ity = 1 (which means 1 body appa-
Italy [44] cohort programme due to com- as patients were able (97.44) comorbidity and severity ratus/systems affected by disease
plex disabilities following Intensity Acute 2. Presence of obesity and which requires therapy)
COVID-19 pneumoniae Time hospital = 1 diabetes Median index of CIRS severity = 1.15
referred to the Reha- 2 h of rehabilitation (2.56%) 3. Virological data and clini- 2. Obesity = 14 (35.8%)
bilitation Unit of Versilia per day, as patients cal course Diabetes = 10 (25.6%)
Hospital in Italy between were able 4. Clinical features at No comorbidity = 14 (CIRS score, 0)
March 30 and August 10, Type admission 3. Fifteen out of 39 subjects had
2020 were enrolled pulmonary rehabilita- 5. Clinical features at nasal/throat swabs positivity
Inclusion tion: discharge for SARS-CoV-2 at admission to
- severe respiratory - training for breath 6. Functional measures (BI rehabilitation
failure which required control by abdominal and FAC) 14 had viral clearance by 2 negative
hospitalization in Intensive diaphragmatic direct 7. Rehabilitation LOS nasal/
Care Unit or Medical ward ventilation, chest 8. ICU/Acute ward LOS throat swabs in the previous 48 h
requiring noninvasive expansion, controlled 9. ICU admission, n (%) Re-positive swabs
or invasive ventilation in breathing, diaphrag- after viral clearance was detected in
acute phase matic re-education, 17 patients
- hemodynamics and volume increasing 2 patients were discharged still posi-
respiratory stability at - airways cleaning by tive whilst the others showed two
admission, without bronchus suction and negative swabs at discharge
catecholamine infusion airways unblocking, use Admitted from ICU = 32 (82.05%)
or ventilation, even if of Positive Expiratory Admitted from medical wards = 7
patients needed the deliv- Pressure (PEP) devices (17.95%)
ery of high oxygen flow motor rehabilitation: orotracheal intubation = 28 (71.8%)
with FiO2 up to 60%; - active-assisted and Duration of intubation = range of
- respiratory trend towards active joint mobilization 4–36 days
improvement; of the 4 limbs, also with Prone ventilation = 17 (43.6%)
- sufficient autonomy in mechanical devices Bacterial superinfection at admis-
ADL before infection testi- - muscle strengthening sion = 23 (58.9)
fied by anamnestic Barthel - active postural 4. 8 out of 39 patients had no oxy-
Index (BI) > = 50 changes, readjustment gen supplementation at admission
- presence of actual severe of postural reflexes, Admission mean PaO2/
disability coordination exercises FiO2 = 360,7 ± 122,9
- absence of fever in the for trunk control Tracheostomy at admission = 11
previous 48 h - recovery of standing (28.21%)
- current or past position Dysphagia and fed via Nasogastric
laboratory-confirmed - reconditioning of tube = 7 (17.95%)
SARS-CoV-2 infection walking and effort by Peripheral nervous system impair-
Exclusion interval training and ment = 7 (17.95%)
Not reported continuous training in Rectal colonisation = 28 (71.8%)
Participants order to increase the Corticosteroid use = 19 (48.7%)
N = 39 endurance and pre- Mental confusion—= 17.9%
Mean age = 67.8 ± 10.8 scription of orthosis Antipsychotic drugs = 11 (28.2%)
Sex (female) = 15 (38.46%) Swallowing rehabilita- 5. Without oxygen supplementation
tion: at discharge = 31 (79.4%)
- sensory-motor Tracheostomy removal = 38
stimulation (97.44%)
- postural compensa- Complete oral alimentation = 39
tion (100%)
- change in food Mental confusion = 0 (0%)
consistency Corticosteroid use = 4 (10.2%)
- progressive introduc- Antipsychotics = 5 (12.8%)
tion of foods of differ- Rectal colonisation = 28 (71.8%)
ent consistency Anamnestic BI = Median score of
- oral hygiene 5 (5-5)
Admission BI = Median score of
7.5 (0- 10)
Discharge BI = Median score of 65
(60- 85)
Anamnestic FAC = Median score of
100 (100- 100)
Admission FAC = Median score of
0 (0–0)
Discharge FAC = Median score of
3 (3–4)
7. Mean rehab LOS = 25.5 ± 16.3
8. Mean ICU or acute ward
LOS = 46.4 ± 20.9
9. 32 (82%)
Table 2 (continued)
Bompani Retrospec- Inclusion Frequency None NR 1. FIM at admission (TO) T0 total FIM score: 55.42 ± 25.97
et al./2023/ tive, pre-post For patients with a - Respiratory and and discharge (T1) from (18- 116)
Switzerland intervention severe acute respiratory neuromotor domains: rehabilitation. Reported T1 total FIM score: 93.82 ± 20.83
[46] cohort study syndrome coronavirus Daily as mean, ± SD and range. (38- 125)
2 (SARS-CoV-2)-positive - Psychological inter- Motor, cognitive and total T0 FIM cognitive score:
nasopharyngeal swab: vention: Dependant on scores were calculated 21.37 ± 8.01 (5- 33)
1. a recent chest com- patients needs On admission to rehabilita- T1 FIM cognitive score:
puted tomography scan - Speech and Nutri- tion only: 27.55 ± 5.52 (10- 35)
or X-ray with evidence of tional interventions: 2. Cumulative illness rating T0 FIM motor score:
significant improvement daily for those who scale 34.34 ± 19.84 (13- 85)
versus baseline were mechanically 3. BMI T1 FIM motor score:
2. arterial oxygen partial ventilated 4. Nutritional Risk Screen- 66.27 ± 16.45 (27- 90)
pressure (PaO2)/fractional Intensity ing-2002 (NRS-2002) CIRS severity index (0–56):
inspired oxygen (FiO2) NR system 1.76 ± 0.57 (0–3)
ratio (P/F ratio) > 300 with Time 5. MMSE CIRS comorbidity index (0–12):
FiO2 35% during recovery - Respiratory domain: 6. Digit Span Forward task 7.68 ± 2.35 (3–11)
in the ICU 30–40 min according to 7. Story-Recall test CIRS Psychiatric index (0–4):
3. Apyretic for at least patient’s tolerance 8. Frontal Assessment 1.42 ± 1.84 (0–4)
3 days; - Neuromotor domain: Battery 3. 28.92 ± 6.91 (20–51)
4. 90 mmHg < systolic 30 min 9. Digit Span Backward task 4. 4.58 ± 1.03 (3–7)
blood pressure < dias- - Psychology: NR 10. HADS 5. 25.02 ± 5.84 (3–30)
tolic blood pres- - Speech and nutrition: 11. Chalder Fatigue Scale 6. 5.25 ± 1.23 (3–9)
sure < 90 mmHg 30–45 min according to On discharge only: 7. 12 ± 5.76 (0–24)
For patients with a nega- patients tolerance 12. Rehabilitation Effective- 8. 13.3 ± 1.23 (2–7)
tive nasopharyngeal swab Type ness index (REs) 9. 3.7 ± 1.23 (2–7)
for SARS CoV-2: Respiratory domain: 13. Rehabilitation LOS 10. HADs anxiety:
1. apyretic for at least respiratory exercises, (Days) 5.26 ± 4.18 (0–17)
3 days, and such as deep, slow 14. ICU admission and HADs depression: 4.57 ± 3.49 (0–17)
2. at least two consecutive breathing, and chest mechanical ventilation, 11
negative swabs with an expansion combined n (%) 6.29 ± 2.3 (0–13)
interval of at least 48 h with shoulder expan- 12. 51.88 ± 25.75 (4–94)
between swabs sion in order to reduce 13. 41.83 ± 25.29 (8–146)
Exclusion the spread of droplets. 14. 45 (68.18%)
- Patients who were under Once negative for
psychotropic drugs prior SARS-CoV-2, aerosol
to study inclusion therapy could be
- those with COVID-19 introduced and active
encephalitis breathing, as well as
- patients with signs of training with positive
dementia expiratory pressure,
- patients with pre-COVID were started
19 history of neurological Neuromotor domain:
or psychiatric diagnosis Aimed at preservation
Participants of joint mobility and
N = 66 prevention of muscle
Mean age = 70.14 ± 10.82 wasting
Sex (male) = 39 (59%) Psychology: Aimed at
addressing emotional
and traumatic issues
Speech and nutrition:
Aimed to improve
speech and swallow
skills which may have
been compromised
due to mechanical
ventilation
Table 2 (continued)
Barbieri et al. Quasi experi- Inclusion Frequency None NR 1. FIM at admission (T0) T0 total FIM score:
/2022/ mental Patients admitted to Respiratory and neuro- and discharge (T1) from 74.52 ± 24.28 (21–123)
Switzerland hospital with severe motor domains: daily rehabilitation. Reported T1 total FIM score:
[45] coronaravirus disease Psychological interven- as mean, ± SD and range. 107.16 ± 21.7 (21–126)
For patients with a tion: dependent on Motor, cognitive and total T0 FIM cognitive score:
SARS-CoV-2-positive patient need scores were calculated 28.62 ± 6.62 (8–35)
nasopharyngeal swab: Intensity On admission to rehabilita- T1 FIM cognitive score:
- a recent chest computed NR tion only: 30.86 ± 5.68 (8–35)
tomography or X-ray with Time 2. Cumulative illness rating T0 FIM motor score:
evidence of significant - Respiratory: scale 45.9 ± 19.75 (13–88)
improvement versus 30–45 min depending 3. BMI T1 FIM motor score:
baseline on tolerance 4. Nutritional Risk Screen- 76.3 ± 16.84 (13–91)
- arterial oxygen partial - Neuromotor: 30 min ing-2002 (NRS-2002) CIRS severity index (0–56):
pressure (PaO2)/fractional - Psychological: NR system 1.51 ± 0.48 (0.61–2.61)
inspired oxygen (FiO2) Type 5. 30 s sit to stand test CIRS comorbidity index (0–12):
ratio > 300 with FiO2 35%; Respiratory: aimed at (number of repetitions) 6.69 ± 2.39 (2–12)
- apyretic for 3 days reducing breathing 6. Jamar hand dynamom- 3. 28.92 ± 6.53 (19–54)
- systolic blood pres- difficulties and percep- eter (mean of right and 4. 3.92 ± 1.35 (2–6)
sure < 140 mmHg and tion of dyspnoea, and left as kg) 5. 3.72 ± 3.56 (0–11)
diastolic blood pres- reducing incidence of 7. Perceived pain by VAS 6. 18.82 ± 8.96 (2–41)
sure < 90 mmHg complications On discharge only: 7. 2.0 ± 2.47 (0–8)
For patients with a nega- Patients who remained 8. Rehabilitation Effective- 8. 68 ± 26.06 (0–100)
tive nasopharyngeal swab positive for SARS- ness index (REs) 9. 31.81 ± 20.37 (9–136)
for SARS-CoV-2: CoV-2 underwent a 9. Rehabilitation LOS (days)
- apyretic for 3 days rehabilitative protocol
- at least two consecutive that included respira-
negative swabs with tory exercises such as
at least a 48-h interval deep, slow breathing,
between swabs and chest expan-
Exclusion sion combined with
- Patients under existing shoulder expansion
prescription for psycho- in order to reduce the
tropic drugs spread of droplets.
- those with COVID-19 Breathing exercise
encephalitis helped patients to fully
- or with signs of re-expand the lungs
dementia and to further the
Participants progression of airway
N = 53 secretions from small
Mean age = 67.9 ± 8.73 to large airway, thus
Age range = 49–92 reducing alveolar dead
Sex (male) = 37 (69.8%) space
Once negative for
SARS-CoV-2, aerosol
therapy was introduced
and active breathing,
as well as training with
positive expiratory
pressure, were started
Neuromotor: pro-
gramme to preserve
joint mobility and to
prevent muscle wasting
Psychological: aimed
to address the emo-
tional and traumatic
issues related to the
disease itself and to the
prolonged isolation of
hospitalization
Table 2 (continued)
Cevei et al., Case series Inclusion Frequency None NR Gathered at admission (T0) T0 BI:
2022 Romania Patients admitted to acute Occupational therapy and discharge (T1) from 18.33 ± 23.59
[48] hospital for severe coro- and Physical therapy rehabilitation, reported as T1 BI:
navirus illness requiring twice daily mean ± SD 50.83 ± 36.39
rehabilitation Robotic-assisted gait 1. BI T0 FIM:
- Patients > 80 years old, training and massage 2. FIM 50.67 ± 31.57
previously diagnosed therapy daily 3. Grip strength T1 FIM:
with severe SARS-CoV-2 Intensity 4. CIRS-G 75.00 ± 31.16
infection NR At discharge T0 Right 12.72 ± 3.81
- with no clinical and Time 5. LOS in rehabilitation T0 Left 13.61 ± 5.93
biological signs of acute Physical therapy and hospital T1 Right 18.44 ± 3.38
viral disease, Occupational therapy Hip flexion and manual T1 Left 17.56 ± 5.62
- with loss of autonomy 30 min 2times/day muscle testing were also 4. 16.33 ± 8.68
for activities of daily Robotic assisted gait reported for the cohort but 5. 17 ± 3.79
living 1 month after the training 15–30 min not reported here. Please see
diagnosis per day original paper for details
- musculoskeletal dysfunc- Massage therapy
tion 20 min per day
- inability to walk Type
Exclusion Physical therapy
- Patients with dyspnea Sessions focused on
at rest passive and active
- O2 saturation under 93% joint range of move-
- cardiorespiratory ment, strengthening
instability exercises, transfers
Participants re-education, and co-
N=6 ordination and balance
Mean re-education
age ± SD = 85.33 ± 3.07 Occupational Therapy
Sex (male) = 4 (67%) Sessions focused on
restoration of active
mobility, strength, and
coordination in the
upper and lower body,
acquisition of maxi-
mum degree of func-
tional independence in
self-care, establishing
balance between rest,
occupational, and rec-
reational activities, and
to improve ADLs and
to increase the quality
of life by optimizing
the patient’s home
environment to his/her
individual abilities
Robotic assisted gait
training
Sessions involved
repetitive movements
associated with visual,
auditory, and tactile
feedback
Massage therapy
For the upper body ses-
sions aimed to improve
muscle relaxation,
reduce the severity of
muscle soreness, soften
tender and trigger
points, and to have a
general sedative effect.
For the lower body
sessions targeted cir-
culation improvement,
facilitating an increase
of mobility of the joints
and soft tissues, and
reducing edema
Table 2 (continued)
Coakley Retrospective Inclusion Frequency 1. No Reported as 1. The Boston AM-PAC “6 Pre: 17.1 ± 4.3
et al./2023/ descriptive All adult patients (ages Daily Therapy, No n (%) Clicks” Basic Mobility Inpa- Post: 17.9 ± 4.1
USA [42] cohort study 18 +) admitted to acute Intensity ICU group Home = 36 tient Short Form (reported Mean difference: 1.0 ± 2.3
hospital who tested posi- NR 2. No (68) as mean ± SD) Pre: 17.1 ± 3.9 Post: 16.7 ± 3.7
tive for COVID-19 were Time Therapy, ICU Long term 2. The Boston AM-PAC Mean difference: 0.7 ± 2.0
included in the study. This 3 or more hours per day group care facil- “6 Clicks” Daily Activity Chronic lung disease: 13 (25)
included patients who did Type 3. Therapy, ity = 3 (6) Inpatient Short Form Diabetes: 28 (53)
and did not receive reha- Rehabilitation pro- ICU group Subacute 3. Co-morbidities, n (%) Cardiovascular disease: 46 (87)
bilitation and those who gramme consisted of rehabilita- 4. Hospital LOS, median Renal disease: 12 (23)
did and did not require Occupational Therapy tion = 14 (IQR) Liver disease: 5 (9)
ICU admission. Data were and Physical Therapy. (26) 5. Mortality, n (%) Immunosuppressive co-morbidity:
extracted for those who Nature of interventions Other = 0 (0) 6. ICU, N (%) 4 (8)
received rehabilitation were not described but Neurological co-morbidity: 10 (19)
from the main sample for assessment domains Cancer: 8 (15)
purpose of this review were described in detail Smoker: 4 (8)
Exclusion This included: 4. 6 (3- 9)
NR - proximal strength 5. 1 (2)
Participants - distal strength 6. 0 (0)
N = 54 - cognition
Mean age = 68 ± 16 - sitting and standing
Sex (male) = 26 (48%) balance
- sensation of upper
and lower extremities
- proprioception of upper
- coordination of upper
- activity tolerance
- Functional assessment of
bed mobility, activities of
daily living, and ambulation
Chuang Case series Inclusion Frequency None Home = 4 Gathered at admission (T0) T0 BI: 26 ± 23.82
et al./2022/ - Two consecutive sets 5 days/week for PT, (80%) and discharge (T1) from T1 BI: 71 ± 20.43
Taiwan [49] PCR test with negative OT, SLT Nursing rehabilitation: T0 FAC: 1.6 ± 1.14
results or a cycle threshold As indicated for Psychology home = 1 1. BI T1 FAC: 3.4 ± 0.89
value exceeding 34 within Intensity (20%) 2. FAC T0 FOIS: 4.2 ± 2.95
7 days NR 3. FOIS T1 FOIS: 6.4 ± 0.55
- No oxygen requirement Time 4. BMI T0 BMI: 22.3 ± 6.06
greater than 3 L per Minimum 20 min for each Raw data for the above T1 BMI: 19.56 ± 6.32
minute discipline, as tolerated measures were extracted 5. 17
- Stable vital signs includ- Type from the case series and 6. 5 (100)
ing body temperature, PT the author calculated 7. Median = 17
blood pressure, and Motor strengthening, mean and SD values (mean 22.2 ± 13.74 as calculated
heart rate balance training, aerobic At discharge by this author as raw data was
- Need for multidiscipli- training and ambulation 5. ICU LOS, Median available)
nary rehabilitation training according to 6. ICU, N (%) 8. 2 (20%)
- Clear consciousness and patient ability. Outside 7. Rehab LOS
able to follow up simple treatment sessions, 8. Need for feeding tube,
orders patients were instructed N (%)
Exclusion in individualized, low
NR intensity and multiple
Participants repetition exercises
N=5 with the aid of videos
Mean age = 73.4 or pictures. Breathing
Sex (male) = 4 (80%) exercises to relieve
exertional dyspnea and
control inspiratory/
expiratory rhythm
OT
Therapy to address basic
activities of living, energy
conservation, evaluation of
adaptive devices and envi-
ronmental adaptations
required for discharge
SLT
Swallow assessment
and speech assessment
Psychology
NR
Table 2 (continued)
Cao Retrospective Inclusion Frequency None Group 1: 1. Co-morbidities, n (%) Hypertension: 48 (81.4%)
et al./2022/ cohort study Any patient within the 5- 7 days per week Patients had 2. Complications Type II Diabetes: 23 (40%)
USA [41] hospital or outside the Intensity admission 3. Need for invasive Cardiac dysfunction: 23 (40%)
hospital who met the fol- NR to ICU mechanical ventilation in COPD: 8 (4%)
lowing admission criteria Time Home = 11 ICU, n (%) Kidney disease: 13 (22%)
was considered for admis- 3 h per day (78.6%) For the following Malignance: 5 (8.5%)
sion to the rehabilitation Type Skilled outcomes, the cohort is DVT: 5 (8.5%)
unit: Each patient was nursing reported according to ICU Pulmonary embolism 5 (8.5%)
- Seven days from diagno- assessed on admission facility = 1 admission status: 3. 14 (23.7%)
sis of COVID19 by each member of the (7.1%) 4. Admission and discharge Group 1
- at least 72 h non-febrile MDT; physiatrists and Acute scores for GG Self-Care of Admission: 19 ± 19.2
without taking fever medical consultants, hospital = 2 the Centers for Medicare Discharge: 35 ± 8.3
reducing medication physical therapists, (14.3%) & Medicaid Services Change: 17 ± 7.5
- may have a tracheos- occupational therapists, Group 2: issued IRF-PAI Version 3.0. Group 2
tomy but no need for speech therapists, Patients did (reported as mean ± SD) Admission: 20 ± 5.4
prescribed suction neuropsychologists, not have ICU 5. Pre and post GG Mobility Discharge: 34 ± 9.2
- oxygen need < 5 L at rest respiratory therapists, admission Item of the Centres for Change: 14 ± 6.4
- improving Covid19- and rehabilitation Home = 44 Medicare and Medicaid Group 1
related symptoms and nursing (97.8%) Services issued by IRF-PAI Admission: 27 ± 8.0
in need of rehabilitation, The MDT programme Skilled Version 3.0. (reported as Discharge: 71 ± 22.3
while also considering involved: nursing facil- mean ± SD) Change: 44 ± 21.3
individual psychosocial pulmonary rehabilita- ity = 0 (0%) 6. BMI on transfer to IRF Group 2
needs such as home tion including: Acute (reported as mean ± SD) Admission: 31 ± 12.4
environment and impact - optimization of overall hospital = 1 7. LOS, Median (IQR) Discharge: 72 ± 22.96
on family members medical management (2.2%) a) ICU Change: 41 ± 18.2
- ability to tolerate and - progressive exercise b) Acute care Those ventilated:
participate three hours protocol with closely c) Rehabilitation unit 30 ± 6.4
per day of therapy, monitored vital signs 8. Presence of dysphagia No ventilation
5–7 days per week and pulse oximetry on admission, n (%) 30 ± 7.6
Exclusion - energy conservation 9. Presence of dysphagia Group 1
None techniques on discharge, n (%) a) 9.0 (4.0- 11.8)
Participants - respiratory physi- 10. Oxygen requirement at b) 18 (16- 26)
N = 59 otherapy admission to rehab, n (%) c) 13 (10, 16)
Mean age (SD) = 65 ± 13.2 - Mobility and daily 11. Oxygen requirement on Group 2
Sex (male) = 31 (52.5%) activity functional train- discharge from rehab, n (%) a) N/A
ing activities tailored to 12. Discharge disposition, b) 10 (7- 13)
address the individual’s n (%) c) 12.5 (11- 15.3)
functional deficits Group 1
- For patients with 5 (35.7%)
cognitive impairment, Group 2
cognitive therapy 7 (15.6%)
involved a combina- Group 1
tion of remediation 0 (0%)
through direct training, Group 2
metacognitive strategy 1 (2%)
instruction and use Group 1
of compensatory 6 (42.9%)
techniques Group 2
- All patients were able 21 (46.7%)
to access daily speech/ Group 1
swallow pathology 0 (0%)
and neuropsychology Group 2
service for cognition 2 (4.4%)
assessment and
psychological support
as well, if needed
NR Not reported, LOS Length of stay, ICU Intensive Care Unit, IQR Interquartile range, OT Occupational Therapy, PT Physio/Physical therapy, SLT Speech and Language
Therapy, BI Barthel Index, FAC Functional Ambulation Category, IRF Inpatient Rehabilitation Facility, IRF PAI Inpatient Rehabilitation Facility Patient Assessment Instru-
ment, 6MWT Six Minute Walk Test, m BI Modified Barthel Index, MMSE Mini Mental State Examination, HADS Hospital Anxiety and Depression Scale, CIRS Cumulative
Illness Rating Scale, CIRS-G Cumulative illness Rating Scale Geriatric, VAS Visual analogue scale, FOIS functional oral intake scale
Methodological quality Cohort studies

Table 3 details results of the CASP checklist for cohort All cohort studies in the review addressed a clearly
studies and Table 4 details results of the JBI critical focused question [39–42, 44–47, 50]. In eight out of nine
appraisal tool applied to the case studies included in this studies, the exposure was accurately measured to mini-
systematic review. mise bias [39–42, 44–46, 50]. In eight out of nine studies
McCarthy et al. BMC Geriatrics
(2023) 23:391
Table 3 CASP checklist

CASP item Bellinger Journeay Piquet Maltser Bertolucci Bompani Barbieri Coakley Cao
1 Clearly focused issue/question? Yes Yes Yes Yes Yes Yes Yes Yes Yes
2 Was the cohort recruited in an acceptable way? No No No No No No No No No
3 Was the exposure accurately measured to minimise bias? Yes No Yes Yes Yes Yes Yes Yes Yes
4 Was the outcome accurately measured to minimise bias? Yes Yes Yes Yes Yes Yes Yes Yes Yes
5a Have the authors identified all important confounding factors? No No Yes No No Yes Yes No Yes
5b Have they taken account of the confounding factors in the design No No Yes No No Yes Yes Yes Yes
and/or analysis?
6a Was the follow up of subjects complete enough? No Yes Yes Yes Yes Yes Yes Yes Yes
6b Was the follow up of subjects long enough? No No No No No Yes No No No
9 Do you believe the results? Yes Yes Yes Yes Yes Yes Yes Yes Yes
10 Can the results be applied to the local population? Yes Yes Yes Yes Yes Yes Yes Yes Yes
11 Do the results of this study fit with other available evidence? Yes Yes Yes Yes Yes Yes Yes Yes Yes
Page 16 of 25
Table 4 JBI critical appraisal tool

Question Di Pietro Cevei Chuang
1 Were there clear criteria for inclusion in the case series? Yes Yes Yes
2 Was the condition measured in a standard, reliable way for all participants included in the case series? Yes Yes Yes
3 Were valid methods used for identification of the condition for all participants included in the case series? Yes Yes Yes
4 Did the case series have consecutive inclusion of participants? Yes Yes Unclear
5 Did the case series have complete inclusion of participants? Yes Yes Unclear
6 Was there clear reporting of the demographics of the participants in the study? Yes Yes Yes
7 Was there clear reporting of clinical information of the participants? Yes Yes Yes
8 Were the outcomes or follow-up results of cases clearly reported? Yes Yes Yes
9 Was there clear reporting of the presenting sites’/clinics’ demographic information Yes Yes Yes
10 Was the statistical analysis appropriate? Yes Yes Yes
the follow up of patients was deemed adequate [40–42, the JBI checklist(49). Of relevance to our secondary out-
44–47, 50]. However, all nine studies recruited a con- comes, Di Pietro and colleagues documented an intent
venience sample of patients. Four of the studies identi- to follow up patients at eight to 10 months [43] however
fied all important confounding factors for results[41, 45, the results of this review have not been published to the
46, 50] and five studies took these factors into account authors knowledge. Table 4 details results of the JBI criti-
when designing the methods or completing analysis [41, cal appraisal tool.
42, 45, 46, 50]. In addition, no study followed up patients Table 5 details results of GRADE analysis for the pri-
for long enough evidenced by the absence of follow up mary outcome of functional ability. Analysis discovered
beyond the point of discharge. very low certainty for quality across studies meaning the
true effect is probably markedly different from the esti-
Case study/Case report mated effect.
There were two case report/case series of high quality in
this systematic review satisfactorily meeting all criteria Primary outcome
in the JBI checklist(43, 48). The complete and consecu- Functional ability
tive inclusion of participants by Chuang and colleagues Functional ability was assessed pre and post MDT inter-
was unclear however it met all other quality criteria in vention in all studies. The validated measures used in
Table 5 GRADE assessment of outcome: functional ability

Multidisciplinary rehabilitation for older adults with COVID-19
Patient/population: older adults with COVID-19
Setting: Acute or post-acute hospital setting
Intervention: Multidisciplinary rehabilitation
Comparison: None
Study Design Measurement Risk of Bias Inconsistency Indirectness Imprecision Estimate of Effect Quality
Instrument [95% CI]
- Retrospective -Barthel Index Seriousa Very Serious Serious Not Serious 1.46 [0.94, 1.98] Very Low Certainty
descriptive cohort (N = 5) (I2 = 91%)
(N = 6) -Modified Barthel
-Retrospective case Index (N = 1)
series (N = 1) -Functional Inde-
-Prospective pendence Measure
descriptive cohort (N = 3)
(N = 1) -Boston AM-PAC “6
-Retrospective pre- Clicks” Daily Activity
post intervention Short Form (N = 1)
cohort (N = 1) -US Centres for
-Quasi-experimental Medicare and
(N = 1) Medicaid Services
-Case series (N = 2) mandated section
GG Functional Abili-
ties Score (N = 1)
a
Nine studies recruited a convenience sample, eight studies did not follow up patients for long enough, 4 studies did not account for confounding factors
eleven of the 12 studies for meta-analysis were the Bar- Secondary outcomes
thel Index (BI) [43, 44, 48–50], the Modified Barthel Rehabilitation length of stay
Index (m BI) [39], the Functional Independence Meas- Rehabilitation length of stay was measured across 12
ure (FIM) [45–47], the Boston AM-PAC “6 Clicks” Daily studies. The mean length of stay for older adults in reha-
Activity Inpatient Short Form [42] and the US Centres bilitation units was 19 days (95%CI, 15.88–21.79 days).
for Medicare and Medicaid Services mandated section Heterogeneity was substantial across the pooled studies
GG Functional Abilities score [41]. Figure 2 demon- (p < 0.00001, I2 = 95%). See Fig. 3. Data from 10 of these
strates that there was a statistically significant improve- studies could be pooled to examine the moderating effect
ment in functional ability among older adults with of rehab length of stay on functional outcomes. Meta-
COVID-19 who received multidisciplinary rehabilita- regression showed length of stay did not significantly pre-
tion (REM, SMD = 1.46, 95% CI 0.94 to 1.98). Heteroge- dict functional outcome post-MDT, (p = 0.299).
neity across the studies was significant and considerable
(p < 0.00001, I2 = 91%). However, random effects meta- Acute hospital length of stay
regression showed age (p = 0.747), gender—% males Acute hospital length of stay was measured across six
(p = 0.314), and number of disciplines (p = 0.784) did studies comprising eight cohorts. The mean acute hos-
not moderate functional outcome post-MDT or explain pital length of stay for older adults was 18 days (95%CI,
sources of heterogeneity. See Table 6 for results of 13.35- 23.13 days). Heterogeneity was significant
meta-regression. In the study by Maltser et al., authors (p < 0.00001, I2 = 97%). See Fig. 4. Insufficient number of
reported a statistically significant change in functional studies were available to analyse acute hospital length of
ability measures following their described rehabilita- stay as a moderator on functional outcomes post-MDT.
tion protocol [40]. This change was measured using the
US Centres for Medicare and Medicaid Services man- Discharge disposition
dated section GG Functional Abilities and Goals of the Seven studies reported discharge disposition of older
Improving Post-Acute Care Transformation Act. GG adults. The proportion of older adults who were dis-
scores measure changes related to self-care (GG0130) charged directly home from the acute setting ranged
and mobility (GG0170). from 62 to 97% [40–42, 44, 47, 49, 50]. Other discharge
Fig. 2 Functional ability pre and post MDT rehabilitation in the acute setting
Table 6 Random Effects Meta-Regression

Moderator k Coefficient SE Z value p LL UL
Age 10 -0.021 0.065 -0.323 0.747 -0.148 0.106

Gender (% male) 12 0.038 0.038 1.008 0.314 -0.036 0.113
No. Disciplines 12 0.058 0.211 0.274 0.784 -0.356 0.471
LOS 10 0.028 0.027 1.039 0.299 -0.025 0.080
k Number of samples, SE Standard error, p Significance value of named predictor, LL Lower limit, UL Upper limit
Fig. 3 Rehabilitation length of stay among older adults with COVID-19
Fig. 4 Acute hospital length of stay among older adults with COVID-19
destinations included a relative’s home, COVID-19 free agreed follow-up points in time. Some studies did describe
rehabilitation unit, sub-acute rehabilitation units, skilled patients need for supplementary oxygen [41, 44, 50] on
nursing facilities and return to acute care. discharge, reporting prevalence of 4 and 58%. In addition,
Bertolucci also reported persisting symptoms at the time
Mortality of discharge. The author reports that tracheostomies were
Two studies reported 2% mortality of older persons [42, 50], removed in 97.44% of patients on discharge from rehabilita-
during rehabilitative care. Piquet and colleagues’ patient tion (28.22% of patients had a tracheostomy on admission),
cohort had a mean length of stay in the acute hospital of 100% of patients achieved complete oral alimentation, zero
14.4 days and 9.8 days in rehabilitation and 23% required patients presented with mental confusion, 10.2% of patients
intensive care unit care [50]. Coakley and colleagues had a were continuing to be prescribed corticosteroids and 12.8%
median length of stay of 6 days in the acute setting with 0% were continuing to be prescribed antipsychotics.
admission to ICU [42].
Discussion
Primary/Community and secondary healthcare utilisation This review aimed to describe the clinical characteris-
No studies reported primary and secondary healthcare tics, functional and process outcomes of older adults
utilisation, including unplanned Emergency Department with COVID-19 who received MDT rehabilitation in the
return, or unscheduled hospital admission after dis- inpatient acute or post-acute hospital setting. There was
charge from rehabilitation units. heterogeneity across the 12 included studies with regards
None of the studies reported on long-term effects of to study design, MDT intervention provided, and out-
COVID-19 at discharge from rehabilitation units or at comes measured. There was a significant improvement
in functional ability among older adults with COVID-19 older adults with COVID-19 as it has been shown to ben-
who received MDT rehabilitation, but only two studies efit these outcomes with other older adult populations
had a comparator group [40, 42]. The proportion of older [66, 67].
adults who were discharged directly home from the acute This review included no studies reporting healthcare
setting ranged from 62 to 97%. No studies followed up utilisation following MDT rehabilitation at the point of
patients after discharge or reported on long term effects discharge or at follow up. It is important that intervention
of COVID-19 on discharge from rehabilitation units. studies assess older adults’ healthcare use on discharge
The key finding of our review is that MDT rehabilita- from acute or post-acute hospital settings for COVID-19
tion for older adults with COVID-19 in acute or post- as people discharged from hospital following treatment
acute inpatient hospital setting resulted in statistically for COVID-19 are at significantly higher risk for read-
significant improvement in function. Moreover, this mission to hospital when compared to demographically
improvement in functioning was not moderated by matched controls and people discharged from hospital
length of rehabilitation stay. Our primary outcome, func- following treatment for influenza, suggesting a significant
tion, aligns with the WHO agenda for healthy ageing burden to healthcare services for the cohort [68].
globally [51] which recognises society’s duty to facilitate The 12 included studies in this review consisted of
the rights of the older adult to healthy ageing. Our find- seven descriptive cohort studies, one pre-post inter-
ings support guidelines by the European Geriatric Medi- vention cohort, one quasi experimental study and three
cine Society (EuGMS) [28] and the WHO [21] which case series highlighting a dearth of robust experimental
recommend MDT rehabilitation for older adults hospi- studies or analytical cohort studies describing the effect
talised with COVID-19. of multidisciplinary rehabilitation on the outcomes of
This review found that older adults stayed in hospi- older adults in the acute or post-acute setting follow-
tal for an average of 18 days (95%CI, 13.35- 23.13 days) ing COVID-19 to facilitate systematic review and meta-
and in rehabilitation units for 19 days (95%CI, 15.88– analysis. A quasi-experimental study by Rodriguez and
21.79 days). Mortality was not routinely reported across colleagues aimed to describe the effects of a multimodal
studies, but the incidence was low (2%). Rehabilitation rehabilitation programme in patients with COVID-19
length of stay following COVID-19 has already been admitted to the ICU [69] however this study was ineli-
reported in the literature however in a younger cohort gible for inclusion in our review as the average age of the
of patients, where length of stays ranged from 11 days to intervention cohort was 56.5 years and it was unclear if
44.96 days [30, 52–59]. Most of this evidence represents the intervention was multidisciplinary in nature. A large
patients of high illness acuity with patients described as number of descriptive cohort studies and case series were
having critical illness or severe illness or requiring inten- not included in this review reporting outcomes following
sive care unit treatment [30, 52, 55, 57–59]. This is com- MDT rehabilitation following COVID-19 as their focus
parable to the evidence presented in this review, where was on a younger population [30, 52–59, 70, 71]. GRADE
older adults required ICU admission in seven out of 12 analysis of included studies showed very low certainty
studies [41, 43, 44, 46, 47, 49, 50]. In a study by O’Kelly of evidence which limits the applicability of results and
and colleagues, authors reported patients had a median highlights the importance of future trial studies to deter-
length of stay of 9 days, with 17% requiring ICU admis- mine the effect of rehabilitation for the cohort.
sion, however again patients were younger, with a median Three studies included in this review excluded patients
age of 45 years old [60] and the extent of rehabilitation with a diagnosis of delirium or dementia [43, 45, 46].
services provided, if any, was not reported. Older adults with COVID-19 commonly present with
The long-term sequelae of COVID-19 are well docu- delirium on admission or during the course of their acute
mented [61–63] however we found that none of the illness in hospital [72–74]. Additionally, older adults with
included studies followed up participants after the point an underlying cognitive impairment or dementia pathol-
of discharge and none of the studies reported on residual ogy are at higher risk of delirium incidence [75]. Exist-
COVID-19 symptoms at the point of discharge or follow ing evidence from studies with older adults not specific
up. The long-term effect of multidisciplinary rehabilita- to COVID-19 supports the assertion that older adults
tion is unclear and remains to be investigated rigorously. with cognitive impairment can benefit from rehabilita-
Existing research in the older adult population indicates tion [76, 77]. Exclusion of those with cognitive impair-
decline in function, increases in frailty and a reduction in ment in rehabilitation research, limits the applicability of
quality of life over time following COVID-19 [64, 65]. It outcomes to a significant cohort of older adults seeking
would be valuable to determine through robust experi- acute medical care for COVID-19.
mental research if MDT rehabilitation can impact func- The results of this review must be considered in
tional deterioration and worsening frailty over time in the context of the global progress with the roll out of
COVID-19 vaccination programmes. The European Cen- to facilitate follow up to the appropriate primary care or
tre for Disease Prevention and Control (ECDC) reports a specialist outpatient care setting [28]. None of the stud-
total of 966,099,169 vaccination doses administered as of ies included in this review described a rehabilitation pro-
the 14th of December 2022 [78]. The total number of peo- gramme that addressed all of these domains.
ple who have been vaccinated with at least one dose in the
European Union is reported as 342,182,404 in the total
population, representing 75.5% of the population [78]. It Strengths and limitations
is established that mRNA COVID-19 vaccination greatly The conduct and reporting of this systematic review was
reduces the risk of mortality, disease progression, death in accordance with the MOOSE guidelines [31]. The
and mechanical ventilation [79]. Our review included identification of suitable papers was completed with a
studies in which patients were recruited between March standardised and reproducible search strategy and with
2020 and December 2021 and therefore not all patients clear inclusion and exclusion criteria. A PRISMA flow
could have been vaccinated. Three studies were carried diagram was used to map the flow of information through
out during a time when vaccinations were available to the different phases of the review. Critical appraisal of
older adults [46, 48, 49]. It is possible to deduce that as included papers was completed using the CASP checklist
more people are vaccinated worldwide that fewer adults for cohort studies and the JBI Critical Appraisal Tool to
and older adults will require hospitalisation and rehabili- assess bias. GRADE analysis also assessed the quality of
tation. However, there are cases of unvaccinated cohorts evidence.
internationally due to inequity in vaccine roll out with the A limitation of this review is the heterogeneity of
WHO reporting only 25% of older adults have had a com- rehabilitation programmes with limited reporting of
plete series of vaccines in lower income countries [80]. It the frequency, intensity, time and type of interventions.
has also been reported that COVID-19 patients infected No trial studies were included in this review and criti-
with the Omicron variant have a lower risk of hospitalisa- cal appraisal of the studies included highlight quality
tion compared with patients infected with the Delta vari- deficits which limits the internal and external validity
ant [81, 82]. It is possible that new variants will emerge of the findings.
with unknown associated admission rates to hospital.
Geriatric rehabilitation programmes for patients with Clinical and research Implications
COVID-19 require additional consideration for the This review highlights the need for experimental studies
physical environment, equipment, resources and staff- exploring the effect of multidisciplinary rehabilitation on
ing in order to minimise the impact of infection con- older adults with COVID-19. The ethical challenge this
trol measures on patient experience and outcomes [28]. poses to the research community must be considered
The multi-organ involvement of COVID-19 requires however as experimental studies would place patients
an interdisciplinary approach to address the numerous into control and experimental groups.
complications associated with COVID-19 infection [83] This review highlights the need for greater attention
provided by an interdisciplinary team including, Physi- to long term follow up in studies with older adults post
cians, Nurses, Physiotherapists, Occupational Therapists, COVID-19 to assess function, ongoing symptoms, and
Dietitians, Speech and Language Therapists, Psychologists healthcare utilisation to determine the long-term effect of
and Social Workers [28]. In this systematic review, each multidisciplinary rehabilitation. Long term outcomes and
study met the criteria for MDT rehabilitation however ongoing symptoms should be explored objectively by meas-
team composition varied. PT, OT, SLT and Psychology ures designed for the population and health states in ques-
were the most prevalent disciplines. Few studies reported tion such as the COVID-19 Yorkshire Rehabilitation Scale
Dietitians as part of the MDT despite the high prevalence (C-19 YRS) [86] which is recommended by the United
of malnutrition in COVID-19 hospitalised patients [84, Kingdom’s National Health Service [87] and the National
85]. Heterogeneity of rehabilitation programmes and lim- Institute for Health and Care Excellence [22].
ited reporting of rehabilitation programmes were evident Given the heterogeneity of rehabilitation pro-
in this systematic review however seven papers described grammes in this review, future experimental research
their rehabilitation programme in sufficient detail [41, 43– should describe a defined and reproducible rehabilita-
46, 49, 50]. It is recommended that geriatric rehabilitation tion programme using the TIDieR checklist [88]. An
for COVID-19 should address frailty, malnutrition, cog- economic evaluation of multidisciplinary rehabilita-
nition, activities of daily living and participation, mood, tion in this population could explore the financial
pain and symptom management, retraining of mobility, implications to our health care systems. It is estimated
strengthening exercises, psychological disturbances, and that COVID-19 rehabilitation costs twice that of
speech and swallow impairments with discharge planning other rehabilitation units due to the complexity of its
presentation, the heterogenous complications and the Authors’ contributions

A.MC., K.R. and R.G. were major contributors in writing the manuscript. A.MC.,
infection control measures required [89] however exact K.R. and R.G. designed the overall study and critically appraised the included
figures do not exist. studies. A.MC., R.G. and A.W. completed the meta-analysis. A.MC,. K.R., R.G., A.T.,
G.C., F.D., K.M., M.O’C., L.C., A.W., and F.S. participated in critically appraising and
editing the manuscript. A.MC., K.R., R.G., A.T., G.C., F.D., K.M., M.O’C., L.C., A.W.,
Conclusion and F.S. read and approved the final manuscript. K.R. is the guarantor of the
This review demonstrates that multidisciplinary rehabili- review. The corresponding author attests that all listed authors meet author-
tation may result in improved functional outcomes on dis- ship criteria and that no others meeting the criteria have been omitted.
charge from acute or post-acute hospital settings for older Funding
adults with COVID-19. There is a need for robust and No funding was required.
experimental research into the long-term effect of reha-
Availability of data and materials
bilitation for older adults following COVID-19. Future The authors declare that the data supporting the findings of this study are
research should comprehensively describe MDT rehabili- available within the article and its supplementary information files.
tation in terms of disciplines involved and the interven-
tion provided using a standardised method of reporting. Declarations
Ethics approval and consent to participate
Abbreviations Not applicable.
6MWT Six Minute Walk Test
ADL Activities of daily living Consent for publication
BI Barthel Index Not applicable.
C-19 YRS COVID-19 Yorkshire Rehabilitation Scale
CASP Critical appraisal skills programme Competing interests
CI Confidence interval The authors declare that they have no competing interests.
ECDC European Centre for Disease Prevention and Control
EuGMS European Geriatric Medicine Society Author details
1
FAC Functional Ambulation Category School of Allied Health, Faculty of Education and Health Sciences, Post Gradu-
FEM Fixed effects model ate Member HRI, University of Limerick, Limerick, Ireland. 2 School of Allied
FIM Functional independence measure Health, Faculty of Education and Health Sciences, Ageing Research Centre,
HSCP Health and social care practitioner Health Research Institute, University of Limerick, Limerick, Ireland. 3 Depart-
ICU Intensive Care Unit ment of Geriatric and Stroke Medicine, and Integrated Care Team for Older
IQR Interquartile range People North Dublin, Beaumont Hospital, Dublin, Ireland. 4 Department
IRF PAI Inpatient Rehabilitation Facility Patient Assessment Instrument of Occupational Therapy, Beaumont Hospital, Dublin, Ireland. 5 Department
LOS Length of stay of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
6
mBI Modified Barthel Index School of Medicine, Faculty of Education and Health Sciences, University
MDT Multidisciplinary team of Limerick, Limerick, Ireland. 7 Post Doctoral Researcher, Ageing Research Cen-
NICE National Institute for Health and Care Excellence tre, University of Limerick, Limerick, Ireland. 8 UL Hospitals Group, University
NR Not reported Hospital Limerick, Limerick, Ireland.
OT Occupational Therapy
PT Physiotherapy Received: 25 January 2023 Accepted: 8 June 2023
QOL Quality of life
REM Random effects model
SE Standard error
SLT Speech and language therapy
SMD Standardised mean difference References
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McCarthy et al.

BMC Geriatrics (2023) 23:391 BMC Geriatrics

RESEARCH Open Access

Multidisciplinary inpatient rehabilitation

Background comprehensive geriatric assessment, long term follow-

– Population: Older adults (with mean or median age

Table 1 Disciplines provided by study

Table 2 Study and patient characteristics

Bellinger Retrospective, Inclusion Frequency None NR Completed on admission 1. IRF PAI:

Methodological quality Cohort studies

Table 3 CASP checklist

Table 4 JBI critical appraisal tool

Table 5 GRADE assessment of outcome: functional ability

Table 6 Random Effects Meta-Regression

Age 10 -0.021 0.065 -0.323 0.747 -0.148 0.106

Fig. 3 Rehabilitation length of stay among older adults with COVID-19

presentation, the heterogenous complications and the Authors’ contributions

87. National Health Service. National Commissioning Guidance for post

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