HMS Researchers Co-Design COVID-19 Telehealth Rehabilitation Program

Researchers and clinicians from Harvard Medical School designed new telehealth rehabilitation plans for COVID-19 patients discharged from hospitalization in a recently published study.

The study, published Oct. 7 in the scientific journal of the American Academy of Physical Medicine and Rehabilitation, was a collaborative effort between physicians at Spaulding Rehabilitation Hospital, Weill Cornell Medicine, and Columbia University Irving Medical Center.

Ginger R. Polich, lead co-author of the study and an instructor of physical medicine and rehabilitation at Spaulding, said the collaboration began after clinicians in Boston and New York City noticed many patients who recovered from COVID-19 required rehabilitation for pulmonary, cognitive, and mobility issues.

“We both had a series of patients that were critically ill — hospitalized, for the most part, and requiring mechanical ventilation at the hospital,” she said. “We were developing clinical programs that could meet the needs of this population.”

The researchers analyzed results from four categories of discharged patients: those who participated in the telehealth program, those who did home physical therapy, those who did independent breathing, strength, and endurance exercises, and those who did not exercise at all. The study found that strength and endurance in patients who participated in physical therapy virtually improved as much as those who did home-based physical therapy programs.

Alfred C. Gellhorn, principal investigator of the study and a specialist at Weill Cornell Medicine, added that formal physical therapy programs performed “significantly better” than informal and unstructured exercise or no exercise at all.

“The patients who were in the groups that either didn't do any exercise, or just had a sheet of exercises that they were working off of on their own, didn't really improve in terms of their strength and endurance the same way that that the patients who did the virtual [physical therapy] program did,” Gellhorn said.

Gellhorn also said that patients did not suffer from anxiety and depression as much as expected, despite the stressful hospitalization process for COVID-19 patients.

“What my hypothesis was going into the project was that we were gonna see a lot of anxiety, depression, just because being in hospital with COVID is such a scary thing for patients,” Gellhorn said. “In the inpatient setting, most patients did exhibit a lot of mental health problems, the way that they're isolated in the hospital. They don't have family visitors, typically.”

Only about 10 percent of patients in the study experienced ongoing issues with anxiety and depression after hospitalization, Gellhorn added.

Polich said areas of future research might involve a broader subset of COVID-19 patients or compare COVID-19 patients with those recovering from other illnesses. She said that, compared to patients with other severe infections requiring mechanical ventilation during hospitalization, preliminary observations show that COVID-19 patients are doing better than expected.

“There might be a number of reasons behind that,” Polich said. “Maybe some of the people who are getting COVID might have actually fewer medical comorbidities than other people with other disorders who are requiring mechanical ventilation for the same duration of time.”

Joel Stein, chief physiatrist at NewYork-Presbyterian Hospital, said this innovation in telehealth emerged at a fortunate time, as the pandemic limited in-person treatment and rehabilitation.

“With the use of telemedicine, the timing of that was really very opportune,” Stein said. “If this pandemic had come just a few years prior, I don't think we would have been prepared to use these tools, the way we have now.”