RESUMEN
OBJECTIVE: To investigate predictive factors and outcomes in those admitted to post-acute rehabilitation (PAR) versus those that discharged home following multi-level spinal decompression and fusion surgery. METHODS: Retrospective case review study of adults that underwent multi-level spinal decompression and fusion surgery between 2016 and 2022 at an academic institution. Preoperative, perioperative, postoperative, and outcomes variables were compared between those discharged home versus PAR. Finally, multiple logistic regression was used to determine factors contributing to PAR admission. RESULTS: Of 241 total patients, 89 (37%) discharged home and 152 (63%) discharged to PAR. Among home discharge patients, 45.9% used an assistive device, while among PAR patients, 61.5% used 1 (P = 0.041). Mean pre-operative Oswestry Disability Index score was significantly lower in the home discharge group compared to the PAR discharge group (40.3 vs. 45.3 respectively, P = 0.044). Females were 2.43 times more likely to be discharged to PAR compared to males (95% CI: 1.06, 5.54, P = 0.04). Patients with a mood disorder had 2.81 times higher odds of being discharged to PAR compared to those without (95% CI: 1.20, 6.60, P = 0.02). Other variables evaluated were not statistically significant. CONCLUSIONS: Female sex and presence of a mood disorder increase the likelihood to PAR discharge following multi-level spinal decompression surgery.
Asunto(s)
Descompresión Quirúrgica , Fusión Vertebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Resultado del Tratamiento , Alta del Paciente/estadística & datos numéricos , AdultoRESUMEN
OBJECTIVE: The aim of this study is to determine the effects of enhanced external counterpulsation (EECP) in patients with long COVID and objectively assessed cognitive impairment. DESIGN: A retrospective evaluation of long COVID patients referred for EECP, with cognitive sequela, and having completed an objective digital assessment before and after therapy. Patients had either cognitive impairment or no cognitive impairment at baseline. We assessed changes in composite score using multifactor analysis of variance. Multiple linear and logistic regression analyses were conducted to evaluate several independent variables. RESULTS: Eighty long COVID patients (38 cognitive impairment vs. 42 no cognitive impairment) were included for analyses. All baseline characteristics were well matched. There was significant improvement in composite score post EECP in those with objective cognitive impairment at baseline. There were no notable documented safety concerns. CONCLUSIONS: This is the first study showing that EECP led to significant improvement in cognitive functioning of long COVID patients with objectively defined cognitive impairment. Although a lack of a negative control group is a limitation of this study, EECP seems to be highly safe and effective with the potential for widespread application.
Asunto(s)
COVID-19 , Disfunción Cognitiva , Contrapulsación , Humanos , Masculino , COVID-19/complicaciones , Femenino , Estudios Retrospectivos , Contrapulsación/métodos , Disfunción Cognitiva/terapia , Disfunción Cognitiva/rehabilitación , Disfunción Cognitiva/etiología , Anciano , Persona de Mediana Edad , SARS-CoV-2 , Síndrome Post Agudo de COVID-19 , CogniciónRESUMEN
Professional or governmental agencies and organizations have developed guidelines to define the problem and evaluate and manage patients with Post-Acute Sequelae of SARS CoV-2 (PASC). Multidisciplinary models largely exist in academic centers and larger cities; however, most care for PASC patients is provided by the primary care providers. The American Academy of Physical Medicine and Rehabilitation has been in the forefront in releasing consensus statements as a part of the long COVID collaborative.
Asunto(s)
COVID-19 , Prestación Integrada de Atención de Salud , Medicina Física y Rehabilitación , Humanos , Síndrome Post Agudo de COVID-19 , Consenso , SARS-CoV-2 , Progresión de la EnfermedadRESUMEN
Severe acute respiratory syndrome coronavirus 2-also known as COVID-19-is primarily known for respiratory illness. Although it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extrapulmonary involvement. This report will summarize key nonpulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.