This study describes an established multi-disciplinary COVID-19 Activity Rehabilitation Programme (CARP) at Mayo Clinic, which serves to evaluate and manage patients with post-COVID syndrome. The paper depicts their first cohort of 100 patients (mean age, 45.4 ± 14.2 years; 68% women), with a mean of 93 days (range 28–159) following acute infection. Within the cohort, the most common symptoms were fatigue (80%), respiratory problems (59%), neurological complaints (59%), as well as subjective cognitive impairment and sleep disturbance. CARP interventions were delivered from 4 weeks after symptom onset or positive PCR, beginning with an initial evaluation to assess the individual’s symptoms, as well as the goals for their care. Interventions were directed at fulfilling the clinic’s 3 primary aims. Firstly, they aimed to detect any evidence of deterioration during the early recovery phase, as previous research has shown a higher mortality within the first 60 days of discharge for those hospitalised with COVID-19 (e.g., due to thromboembolic events). The second objective was to improve function, as 34% of patients reported ongoing difficulties in performing activities of daily living. By utilising physiotherapy and occupational therapy, an individually paced programme for general rehabilitation and conditioning could be developed in response to a patient’s initial assessment. Other therapies included brain rehabilitation. Finally, CARP aimed to facilitate a safe return to work, as only one-third of patients had been able to return to full time employment. Routine laboratory work did not reveal significant abnormalities or aid diagnosis for the majority of patients. Autonomic reflex screens were performed in many patients in response to labile vital signs and symptoms, such as persistent tachycardia. 15 patients had completed autonomic reflex testing, and 12 tests indicated abnormalities. These patients were referred to neurologists and, where appropriate, managed with treatments such as propranolol, increased hydration and salt intake, and compression garments.
Comment: It has been hypothesised that autonomic dysfunction, including orthostatic intolerance and sudomotor dysfunction, could contribute to various Long-COVID symptoms, such as fatigue and other neurocognitive features. Furthermore, up to 25% of patients with postural orthostatic hypotension syndrome can be found to have raised ANA titres. Whilst a vital part of managing those with Long-COVID includes a multi-disciplinary team approach including physiotherapy and occupational therapy, it may also be relevant to assess for autonomic dysfunction in addition and manage accordingly. There is a significant reduction in quality of life for those affected by Long-COVID, emphasising the importance of planning for effective rehabilitation services. Guidelines for service referral will be imperative to prevent overwhelming services and this is likely to become even more important as the effect of the emerging variants on Long-COVID is yet to be determined.
Vanichkachorn et al. (2021) Mayo Clin Proc. 96(7):1782–1791.