Objective: COVID-19 presents with varying severities, with about 5% of patients requiring intensive care unit (ICU) admission due to acute respiratory distress syndrome (ARDS). This severe condition often leads to ICU-acquired weakness (ICUAW) and muscle atrophy, affecting long-term functional recovery. Early physical therapy may mitigate these outcomes, though evidence remains inconclusive. This observational study aimed to evaluate functional outcomes at hospital discharge in COVID-19 patients who underwent early rehabilitation post-ICU discharge.

Material and Method: Patients aged ≥18 with COVID- 19-induced ARDS transitioned from ICU to quarantine wards were enrolled from March 2021 to March 2022. Clinical assessments included oxygen saturation, heart rate, blood pressure, muscle strength (MRC Scale). Individualized exercise programs and neuromuscular electrical stimulation (NMES) sessions were administered daily in quarantine wards.

Results: Twenty-one patients (14 males, 7 females; median age 71±15.77 years) were included, undergoing 186 rehabilitation sessions. Muscle strength assessments showed 4 patients with MRC scores <48, indicating significant muscle weakness. By discharge, 12 patients could walk independently,
4 patients could sit without assistance, and others had varying degrees of mobility limitations. Oxygen requirements decreased for most, with 15 patients not needing respiratory support at discharge. Rehabilitation interventions were well- tolerated without significant complications.

Conclusion: Early, tailored rehabilitation, including physical therapy and NMES, significantly improves functional outcomes in COVID-19 ARDS survivors. Findings highlight the importance of individualized rehabilitation programs in enhancing recovery and quality of life. Future research should focus on establishing comprehensive rehabilitation guidelines for critically ill COVID-19 patients.

COVID-19 Acute respiratory distress syndrome ICU-acquired weakness Early rehabilitation Neuromuscular electrical stimulation