Examination of the Presence of COVID-19 Encephalopathy on Inpatient Acute Rehabilitation Outcomes and Disability

Research Objectives: The objective of the current study was to investigate the impact of COVID-19 encephalopathy on acute inpatient rehabilitation outcome.

Design: This retrospective study assessed functional ability pre-intervention (admission) and post-intervention (discharge) among COVID-19 patients who received acute inpatient rehabilitation between April 2020 and March 2021.

Setting: Participants received care in a dedicated COVID unit at a freestanding acute inpatient rehabilitation facility.

Participants: 161 inpatients were divided into two groups according to COVID-encephalopathy status: 87 negative (CE-) and 74 positive (CE+). Encephalopathy status was determined based on Chart-Based Delirium Identification Instrument using electronic medical records. The sample was 61% male / 39% female, 62% White, 14% Black, 8% Hispanic, 4% Asian, 12% Other/declined. Mean age was 62 (SD=15.2) and mean education was 13 years (SD=3.9).

Interventions: Rehabilitation interventions utilized a medically-based, multidisciplinary approach. All participants received a minimum of three hours of physical, occupational and/or speech therapy five days / week during inpatient stay.

Main Outcome Measures: The total raw score from the self-care and mobility section of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) was used to assess overall functional ability at admission and discharge. The Brief Interview for Mental Status was utilized to assess orientation.

Results: At admission, encephalopathy groups did not differ in overall ability. In contrast, at discharge overall ability was significantly higher with encephalopathy and IRF-PAI change per day trended higher with encephalopathy. Finally, at discharge orientation was associated with overall ability in the CE+ group.

Conclusions: Following inpatient rehabilitation CE+ patients had less overall disability than CE- patients but residual problems with cognitive functioning were associated with severe overall disability in the CE+ group. Findings highlight the complexity of COVID-19 symptom manifestation and persistent physical and cognitive deficits during the course of a COVID-19 infection and recovery.

Author(s) Disclosures: The authors have no conflicts of interest to declare nor any financial or non-financial interests to disclose.