Predictors of Recovery and the App-Facilitated Tele-Rehabilitation (AFTER) Program for COVID Survivors

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PROJECT SUMMARY/ABSTRACT Older adults and adults with comorbidities or disability are at highest risk for morbidity and mortality from COVID-19, although many healthy middle-aged adults without underlying risk factors also experience severe disease, likely driven by a profound and exaggerated inflammatory response. Those who develop severe COVID-19 with acute respiratory distress syndrome often require prolonged mechanical ventilation and have limited contact with hospital personnel, including rehabilitation providers, due to infectivity and shortages of adequate personal protective equipment. Even patients with less severe COVID-19 who do not require intensive care unit (ICU) care often experience prolonged fatigue, myalgias, and activity-limiting dyspnea. While the long-term consequences of COVID-19 are not yet known, the combination of immobility, limited in- hospital interventions, and heightened inflammation may have detrimental effects on physical function lasting well beyond that seen with other critical illness. The overarching hypothesis is that both older adults with multimorbidity and healthy middle-aged adults who experience the `accelerated aging' effects of profound inflammation associated with COVID-19 will experience significant ongoing physical and neuropsychological impairment. Novel, scalable interventions that can overcome many of the barriers imposed by COVID-19 are urgently needed to reverse physical and neuropsychological impairments and prevent the long-term functional consequences. Aim 1 will determine predictors of improved post-hospitalization recovery of adults recently hospitalized with COVID-19. Aim 2 will investigate the feasibility and initial efficacy of a multicomponent tele- rehabilitation program during COVID-19 recovery. This study will enroll 300 adults recently hospitalized due to COVID-19 and follow these individuals for 16 weeks post-discharge using telehealth; Aim 2 will enroll a subset of 40 individuals from Aim 1 who required ICU care for at least 24 hours, who will be compared to similar controls in Aim 1. Significance of the proposed work is based on the great need to identify predictors of multisystem recovery and long-term health in survivors of COVID-19, and to deliver safe and effective rehabilitative care to medically complex patients even, and especially, when they face post-hospitalization barriers to in-person care. This work will directly translate to other medically complex populations who will benefit from innovative tele-rehabilitation, which has not yet been applied to medically complex patients. This study will contribute immediately to our knowledge of the course of recovery for survivors of COVID-19 and predictors for prolonged impairment during COVID-19 recovery. Furthermore, it will advance the feasibility of tele-rehabilitation as a more generally useful intervention in medically complex patients lacking access (distance, availability, mobility) to standard rehabilitative services. Developing safe and effective tele- rehabilitation programs as alternatives to in-person rehabilitation for medically complex populations could transform post-hospital care for medically complex patients including, but not limited to, those with COVID-19.