Tomoko Sakai , Chisato Hoshino, Reiko Yamaguchi, Masanobu Hirao, Rui Nakahara, Atsushi Okawa
Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan. E-mail: t_sakai.orth@tmd.ac.jp
DOI: 10.2340/16501977-2731

Objective: To describe the effectiveness and risk management of remote rehabilitation for coronavirus disease (COVID-19) patients.
Design: Single-centre, retrospective, observational study.
Patients: COVID-19 patients undergoing rehabilitation (24 April to 24 May 2020).
Methods: All COVID-19 inpatients undergoing rehabilitation in the general ward were assessed. Data were collected on age, sex, physical ability, rehabilitation modality (remote/direct), need for intubation or extracorporeal membrane oxygenation, degree of pneumonia, oxygen therapy from the start of rehabilitation, D-dimer and C-reactive protein levels, and rehabilitation-related complications. Activities of daily living were measured using the Barthel Index.
Results: Out of a total of 43 patients, 14 were initially provided with remote rehabilitation and 29 with direct rehabilitation. Four patients were switched from direct to remote rehabilitation during the study, thus at the end of the study there were 18 in the remote rehabilitation group and 25 in the direct rehabilitation group. Patients in remote rehabilitation were significantly younger than those in direct rehabilitation. Of 12 patients who required intubation, 3 were given remote rehabilitation. One extracorporeal membrane oxygenation survivor underwent direct rehabilitation. All patients on remote rehabilitation were discharged home or to a hotel. Twelve out of 29 patients were transferred to a rehabilitation hospital due to delayed recovery of activities of daily living. No serious adverse events occurred.
Conclusion: Effective and safe remote rehabilitation was performed in 41. 9% of COVID-19 patients in this study, which resulted in improved rehabilitation in COVID-19 zones.

This study assessed the use of remote rehabilitation therapy for coronavirus disease (COVID-19) patients from 24 April to 24 May 2020. A rehabilitation modality was devised that can be applied remotely (from a distance) and over long durations using a mobile terminal. This allowed a final total of 18 out of 43 COVID-19 patients to be treated indirectly by remote rehabilitation. The patients on remote rehabilitation were significantly younger than those undergoing direct rehabilitation. Four patients were switched from direct to remote rehabilitation during the study. Three out of 12 patients who required intubation underwent remote rehabilitation, and 1 extracorporeal membrane oxygenation survivor underwent direct rehabilitation. All patients undergoing remote rehabilitation were discharged home or to a hotel. Twelve out of 29 patients were transferred to a rehabilitation hospital due to delayed recovery of activities of daily living. No serious adverse events were observed. Remote rehabilitation was effective, and safe against the transmission of infection, and could improve delivery of rehabilitation to patients in COVID-19 zones.