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8. The association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID‐19 outcomes.

Author

Abramoff, Benjamin A., Hentschel, Claudia, Dillingham, Ingram A., Dillingham, Timothy, Baraniecki‐Zwil, Gwen, Williams, Asha, and Pezzin, Liliana E.

Subjects
POST-acute COVID-19 syndrome, SPINAL cord injuries, BRAIN injuries, DISABILITIES, MULTIPLE sclerosis, COVID-19
Abstract

Background: Although persons with disabilities are a high‐risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes. Objective: To examine the severity of acute SARS‐CoV‐2 infection and post‐COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI). Methods: This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID‐19‐positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID‐19‐positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID‐19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post‐COVID sequelae within 6 months following a COVID‐19 diagnosis. Results: There were 388,297 laboratory‐confirmed COVID‐19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID‐19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03–1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19–2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17–2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38–2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea. Conclusions: Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID‐19. However, associations between these diagnoses and postacute COVID‐19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Inpatient Rehabilitation Outcomes After Severe COVID-19 Infections

Author

Abramoff, Benjamin A., Dillingham, Timothy R., Caldera, Franklin E., Ritchie, Marylyn D., and Pezzin, Liliana E.

Subjects
Inpatients, Long COVID, Frailty, Postacute Sequelae of SARS-CoV-2 Infection, COVID-19, Rehabilitation Centers, Patient Discharge, CME Article . 2021 Series . Number 12, Policy, Post-ICU Syndrome, Inpatient Rehabilitation, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Humans, Retrospective Studies
Abstract

Supplemental digital content is available in the text., Objective The aim of the study was to describe the characteristics and functional outcomes of patients undergoing acute inpatient rehabilitation after hospitalization for COVID-19. Design Using a retrospective chart review, patients were identified who were admitted to inpatient rehabilitation after COVID-19. Patient information collected included sociodemographic characteristics, comorbidities, length of stay, discharge disposition, self-care, mobility, and cognitive functioning. These patients were compared with patients (controls) without COVID-19 with similar impairment codes treated at the same facility before the COVID-19 pandemic. Results There were 43 patients who were admitted to the inpatient rehabilitation hospital after COVID-19 infection and 247 controls. Patients who had COVID-19 were significantly more likely to be African American and to have been admitted to a long-term acute care hospital. They also had a longer length of rehabilitation stay. The groups did not differ by age, sex, or insurance. Functionally, although presenting with significantly worse mobility, self-care, and motor scores, the patients previously infected with COVID-19 had similar functional outcomes at time of discharge to the control group. Conclusions Although patients with a history of COVID-19 had worse function at time of admission to acute rehabilitation, inpatient rehabilitation significantly improved their function to comparable levels as patients who did not have COVID-19. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Identify how characteristics of patients with COVID-19 admitted to acute rehabilitation differ from those with similar admission codes but without COVID-19; (2) Describe changes in functional measures at admission and discharge of COVID-19 patients compared with patients without COVID-19; and (3) Recognize how inpatient rehabilitation may help reduce inequities in outcomes after severe COVID-19 infection. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Published
2021

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