Abstract
Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.
Highlights
The betacoronavirus severe acute respiratory syndrome (SARS)-CoV-2, discovered in 2019 in China, is one of the six known coronavirus species capable of infecting humans[1,2,3]
Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality
Musculoskeletal disorders and reduced muscle strength have been observed in critically ill patients with prolonged hospitalization due to three main possibilities: 1) muscle hypoxia, in which the inadequate systemic and peripheral muscle perfusion caused by the disease can increase anaerobiosis, raising lactate levels and impairing muscle function; 2) prolonged immobility, common in patients admitted to intensive care units (ICU), which is associated with marked reductions in muscle strength due to loss of functional units from lack of active movement, which in turn leads to postural instability, muscle shortening and contractures9,15,41,44; 3) the use of steroids and neuromuscular blocking agents over a long-term period, which can lead to post-hospitalization polyneuropathy and myopathy[41,44]
Summary
The betacoronavirus SARS-CoV-2, discovered in 2019 in China, is one of the six known coronavirus species capable of infecting humans[1,2,3]. Considering that Covid-19 can affects different physiological systems, with more than 80% of the survivors presenting some long-term functional limitation months after initial symptom onset, several factors can influence the patient's functional capacity after the acute infection and the identification of such factors can help the development of specific rehabilitation strategies for these patients[6,12,13,16].
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