PCORI Biweekly COVID-19 Scan: Cognitive Rehabilitation Therapy, Tele-rehabilitation Programs (May 13-26, 2021)
The Briefing provides an at-a-glance view of some important developments in the information universe surrounding COVID-19. The views presented here are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders.
The increasing probability that SARS-CoV-2, the virus that causes COVID-19, will become a seasonal infection risk marks the first time that we will document the path of a coronavirus from pandemic to endemic. Disease control is likely, but there is no clear evidence of how severe seasonal COVID outbreaks might be.
A partnership between Colorado Mesa University and the Broad Institute of MIT and Harvard demonstrates how 3 key strategies—symptom- and contact-tracing apps, COVID-19 testing, and wastewater surveillance—while perhaps not effective in isolation, can create a strong preventive net when applied together. Future use of these strategies might help US officials both monitor and mitigate seasonal COVID outbreaks and any emerging risk from coronavirus variants.
Meanwhile, investigations of the causes of long COVID and how to care for patients with long COVID continues. A recent study at a London, UK, hospital brings promising news that children who had multisystem inflammatory syndrome (MIS-C) caused by COVID are not experiencing long-term debilitation. In the United States, the Pediatric Heart Network will follow 600 children over 5 years to be sure that this is the case. Also in the United States, several programs are making it easier for adults with long COVID to get treatment for specific symptoms (see Topics to Watch).
ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.
Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.
Cognitive Rehabilitation Therapy to Treat Post-COVID Cognitive Symptoms
At a Glance
- Cognitive rehabilitation therapy (CRT) is typically used to treat patients who have cognitive deficits from a concussion, traumatic brain injury, or stroke. Cognitive deficits might occur after COVID-19, too, and can persist for months. About one-third of patients are diagnosed with neurologic and psychiatric conditions within 6 months after a COVID-19 diagnosis.
- Some institutions (eg, Mayo Clinic, Yale, and Johns Hopkins) are referring patients experiencing post-COVID cognitive symptoms (executive dysfunction and difficulty with thinking, concentrating, and memory) for treatment at CRT programs.
- CRT includes memory training, speech therapy, and cognitive exercises, as well as psychological support. It can be implemented both before discharge from the hospital or in the outpatient setting.
- Early intervention of COVID-19 cognitive impairment might be an important defense against potentially lifelong impairments to a patient’s overall health and quality of life.
Cognitive rehabilitation therapy (CRT) is typically used to treat patients who have cognitive deficits due to concussion, traumatic brain injury, or stroke. Recently, institutions including Mayo Clinic, Yale University, and The Johns Hopkins University have started referring patients experiencing post-COVID cognitive symptoms for treatment at CRT programs. Research suggests that one-third of patients are diagnosed with neurologic and psychiatric conditions within 6 months after a COVID-19 diagnosis.
Cognitive symptoms, including executive dysfunction and long COVID symptoms of difficulty thinking, concentrating, and remembering, are commonly reported and can persist for months. CRT might help treat post-COVID cognitive symptoms by providing memory training, speech therapy, and cognitive exercises, as well as offering psychological support. It can be implemented both before discharge from the hospital or in the outpatient setting.
CRT is an established therapy being used to treat post-COVID cognitive symptoms. It might mitigate neuropsychiatric fallout from the COVID-19 pandemic by treating lingering cognitive symptoms requiring intervention, with vast implications for patient health and quality of life.
Early feedback from ECRI internal stakeholders suggested that improving cognitive function has important implications for patients’ brain and mental health in the short and long term, as well as on quality of life. CRT might allow more patients to regain previous levels of functioning in work, relationships, and other activities. Reducing cognitive symptoms might help decrease rates of anxiety, depression, posttraumatic stress disorder, and substance abuse, which have increased during the pandemic.
Improved cognitive reserve might protect against the onset of neurodegeneration, including dementia later in life. CRT might help reduce health disparities considering that mental status and cognitive changes are more common in hospitalized COVID-19 patients than in outpatients.
CRT is likely to increase post-COVID treatment costs, which might limit access. Increased demand for CRT for people with post-COVID cognitive symptoms might also reduce access for other patients with cognitive complaints, including those with a concussion, traumatic brain injury, or stroke.
- Category: Systems and management
- Areas of potential impact: Patient outcomes, population health, health care disparities, health care costs
Tele-rehabilitation Programs to Treat Post-COVID Pulmonary Symptoms
At a Glance
- Some patients in post-COVID recovery have lingering pulmonary complications, including shortness of breath and fatigue. Health care systems are developing clinical infrastructures to address the continued needs of these patients.
- Pulmonary rehabilitation, typically used for managing patients with chronic obstructive pulmonary disease (COPD), is being investigated and used to treat patients with post-COVID symptoms. However, program availability remains limited.
- Virtual rehabilitation programs consisting of medically supervised virtual exercise training and health education might address this gap by delivering physical therapy sessions via secure telehealth platforms to improve strength and cardiopulmonary endurance.
- Patients consult with a pulmonary physician for an initial evaluation and are then treated according to individual needs by a multidisciplinary care team. Early adopters of this intervention include the medical center at the University of California, Davis and UPMC.
Although the pathophysiology of post-COVID recovery is still under investigation, lingering pulmonary complications (eg, shortness of breath, fatigue) can occur in patients after recovering from COVID-19. Health care systems are developing clinical infrastructures to address the continued needs of these patients.
Pulmonary rehabilitation, an intervention typically used to help patients who have COPD, is being investigated and used to treat patients with post-COVID symptoms. However, programs will need to meet the potentially high demand. One such program showed that virtual rehabilitation programs can address this gap by delivering sessions via secure Health Insurance Portability and Accountability Act–compliant telehealth platforms. Patients in this program received virtual physical therapy 1 to 2 times per week and showed improvements in strength and cardiopulmonary endurance.
The medical center at UC Davis Health and UPMC have also adopted tele-rehabilitation, which includes medically supervised virtual exercise training and health education. Patients consult with a pulmonary physician for an initial evaluation and then are treated by a care team made up of doctors, nurses, respiratory therapists, and physical therapists. This multidisciplinary, individual-needs approach might help patients continue their recovery journey.
Tele-rehabilitation programs might reduce post-COVID pulmonary symptoms and improve patients’ quality of life. These medically supervised interventions might increase awareness about the benefits of rehabilitation for individuals with long COVID and allow health care professionals to refine treatment approaches for post-COVID illness. It might also reduce community transmission of SARS-CoV-2 as a result of virtual therapy sessions. If widely adopted, these tele-rehabilitation programs might change the standard of care for other chronic pulmonary illnesses in the postpandemic era.
Early feedback from ECRI internal stakeholders suggested that virtual pulmonary rehabilitation programs might improve population health outcomes by preventing long-term disability. The programs might also reduce barriers to access for those with transportation issues. However, such programs might increase disparities for those without a stable or secure broadband connection.
These multidisciplinary programs might accelerate patients’ physiological and psychosocial recovery via physical therapy and health education. However, stakeholders noted that the effectiveness of tele-rehabilitation could be limited by the lack of standardized training and resources for providers engaged in these programs.
- Category: Systems and management
- Areas of potential impact: Clinician learning curve, costs, disparities, infrastructure, patient health outcomes, patient management, treatment models, understanding
Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.
The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.
In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.
The HCHSS COVID-19 supplement produces 3 main outputs:
- Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
- Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
- High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.
Commentary in this COVID-19 Scan reflects preliminary views of ECRI Horizon Scanning and internal ECRI stakeholders.
The information contained in this document has not been vetted by other stakeholders.
We welcome your comments on this Scan. Send them by email to [email protected].
Posted: June 9, 2021
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