Aftercare trajectories following hospital admission

Can we further develop the aftercare trajectories following a hospital admission as a consequence of COVID-19? We are investigating that in the regions Rotterdam, Rijnmond and Delft.

At the beginning of the pandemic, when we started our study, patients were either in the ICU or treated in the hospital ward. Depending on their residual symptoms – physical, cognitive or psychological – they are referred to an aftercare program. We enrolled 650 people for this study. We follow them for two years after hospital discharge at four times: after three months, six months, after one year and after two years. This gives us insight into the recovery of people, and into the quality of the aftercare process.

Primary, medical specialist and geriatric rehabilitation

There are several aftercare trajectories. Following hospital admission – whether or not to intensive care – some people return home without extra care. Others receive primary care from, for example, a physiotherapist or an occupational therapist, usually on a monodisciplinary basis. If people have been more seriously affected, then they are referred to a rehabilitation centre, for example. There they receive intensive supervision from several disciplines, for example a physiotherapist, an occupational therapist or the psychologist, always under the supervision of a rehabilitation physician. Finally, there is an aftercare trajectory for geriatric rehabilitation in a nursing home under the supervision of a geriatric medicine specialist.

Physical recovery

We already have the results of the measurements up to and including one year after hospital discharge. These reveal that, in general, the physical recovery is reasonable to good. That is great news. This mainly applies to people who underwent intensive rehabilitation. They started the aftercare trajectory with a considerable loss of muscle strength and physical condition. But after one year, they have achieved the same levels as people who were far less seriously ill due to a COVID-19 infection and did not receive any rehabilitation.

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We already have the results of the measurements up to and including one year after hospital discharge. These reveal that, in general, the physical recovery is reasonable to good.
Rita van den Berg-Emons
Movement scientist, Department of Rehabilitation Medicine, Erasmus MC and associate professor of Fitness and Lifestyle

Anxiety, depression and PTSS

There is also a group that suffers from symptoms of anxiety, depression or PTSS (post-traumatic stress symptoms). Imagine: it is 2020. You have been admitted to an IC or hospital ward with a COVID-19 infection and you are possibly receiving artificial respiration. Care personnel dress in protective clothing to be able to take care of you. Family and friends are not allowed to come and visit you. Nobody knows what the consequences of the virus infection are. Every news or current affairs programme talks about COVID-19. That can have had a lot of impact on patients. This is one of the reasons why we are also measuring these aspects.

Increasingly better-aligned care

The rehabilitation care for COVID-19 was quickly set in motion at the start of the pandemic. There was very little known about the virus and what the consequences of an infection would be. At the start of the pandemic, the treatment trajectories were therefore mainly based on expert opinion. In our study, it is important that we evaluate that care: What have we learned from it so far? Once we have completed all the measurements, we can also examine the underlying mechanisms in more detail. Perhaps that will enable us to better predict who will develop which Long COVID symptoms and to better match follow-up care with patients’ needs. It may enable us to offer people with Long COVID more'.

Author: Riëtte Duynstee
Photo: private collection  Rita van den Berg-Emons