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Principal Investigator: Kristine Mace Erlandson
Organization: UNIVERSITY OF COLORADO DENVER
Fiscal Year: 2020
Award: $523,492
Funding agency: National Institute on Aging
PROJECT SUMMARY/ABSTRACT
Older adults and adults with comorbidities or disability are at highest risk for morbidity and mortality from
COVID-19, although many healthy middle-aged adults without underlying risk factors also experience severe
disease, likely driven by a profound and exaggerated inflammatory response. Those who develop severe
COVID-19 with acute respiratory distress syndrome often require prolonged mechanical ventilation and have
limited contact with hospital personnel, including rehabilitation providers, due to infectivity and shortages of
adequate personal protective equipment. Even patients with less severe COVID-19 who do not require
intensive care unit (ICU) care often experience prolonged fatigue, myalgias, and activity-limiting dyspnea.
While the long-term consequences of COVID-19 are not yet known, the combination of immobility, limited in-
hospital interventions, and heightened inflammation may have detrimental effects on physical function lasting
well beyond that seen with other critical illness. The overarching hypothesis is that both older adults with
multimorbidity and healthy middle-aged adults who experience the `accelerated aging' effects of profound
inflammation associated with COVID-19 will experience significant ongoing physical and neuropsychological
impairment. Novel, scalable interventions that can overcome many of the barriers imposed by COVID-19 are
urgently needed to reverse physical and neuropsychological impairments and prevent the long-term functional
consequences. Aim 1 will determine predictors of improved post-hospitalization recovery of adults recently
hospitalized with COVID-19. Aim 2 will investigate the feasibility and initial efficacy of a multicomponent tele-
rehabilitation program during COVID-19 recovery. This study will enroll 300 adults recently hospitalized due to
COVID-19 and follow these individuals for 16 weeks post-discharge using telehealth; Aim 2 will enroll a subset
of 40 individuals from Aim 1 who required ICU care for at least 24 hours, who will be compared to similar
controls in Aim 1. Significance of the proposed work is based on the great need to identify predictors of
multisystem recovery and long-term health in survivors of COVID-19, and to deliver safe and effective
rehabilitative care to medically complex patients even, and especially, when they face post-hospitalization
barriers to in-person care. This work will directly translate to other medically complex populations who will
benefit from innovative tele-rehabilitation, which has not yet been applied to medically complex patients. This
study will contribute immediately to our knowledge of the course of recovery for survivors of COVID-19 and
predictors for prolonged impairment during COVID-19 recovery. Furthermore, it will advance the feasibility of
tele-rehabilitation as a more generally useful intervention in medically complex patients lacking access
(distance, availability, mobility) to standard rehabilitative services. Developing safe and effective tele-
rehabilitation programs as alternatives to in-person rehabilitation for medically complex populations could
transform post-hospital care for medically complex patients including, but not limited to, those with COVID-19.
Terms: <2019 novel coronavirus><2019-nCoV><21+ years old><65+ years old><ARDS><Access to Care><Accounting><Aching muscles><Acute><Acute Respiratory Distress><Acute Respiratory Distress Syndrome><Address><Adult><Adult ARDS><Adult Human><Adult RDS><Adult Respiratory Distress Syndrome><Age><Aged 65 and Over><Aging><Breathlessness><C-reactive protein><COVID><COVID-19><COVID19><Caring><Cessation of life><Characteristics><CoV disease><Cognition><Complex><Computer Software Tools><Computerized Medical Record><Critical Illness><Critically Ill><Da Nang Lung><Data><Death><Development><Disease><Disease Surveillance><Disorder><Dyspnea><Education Module><Educational Module><Elderly><Electronic Medical Record><Enrollment><Equipment><Exposure to><Face><Fatigue><Funding><Gustation><Health><Health Services Accessibility><Home><Home environment><Hospital Admission><Hospital Personnel><Hospitalization><Hospitals><Hour><Impairment><Individual><Inflammation><Inflammatory Response><Injury><Intensive Care Units><Intervention><Intervention Strategies><Lack of Energy><Learning Module><Marble><Measures><Mechanical ventilation><Medical><Medical Rehabilitation><Moods><Morbidity><Morbidity - disease rate><Muscle discomfort><Muscle pain><Muscle pain/fibrositis><Muscle sorenesss><Myalgia><Myalgic><Myodynia><Myoneuralgia><Myosalgia><NHLBI><National Heart, Lung, and Blood Institute><Neuropsychologies><Neuropsychology><Olfaction><Outcome><Outcome Measure><Participant><Patients><Persons><Physical Function><Population><Prone Position><Proteins, specific or class, C-reactive><Provider><Quarantine><Recovery><Rehabilitation><Rehabilitation therapy><Research Resources><Resources><Risk Factors><SARS-CoV-2><SARS-CoV2><SARS-associated coronavirus 2><SARS-coronavirus-2><SARS-related coronavirus 2><Sedation procedure><Severe acute respiratory syndrome coronavirus 2><Shock Lung><Smell><Smell Perception><Software Tools><Standardization><Stiff lung><Stress><Subgroup><Survivors><Symptoms><Taste><Taste Perception><Teaching Module><Testing><Time><Translating><Uncertainty><Work><Wuhan coronavirus><access to health services><access to services><access to treatment><accessibility to health services><adulthood><advanced age><age 65 and greater><age 65 and older><aged><aged 65 and greater><aged ≥65><ages><availability of services><base><biobehavior><biobehavioral><care access><co-morbid><co-morbidity><comorbidity><corona virus disease><corona virus disease 2019><coronavirus disease><coronavirus disease 2019><cost><developmental><disability><doubt><elders><enroll><exercise program><experience><faces><facial><fitness program><geriatric><gustatory perception><gustatory processing><gustatory response><health service access><health services availability><high risk><human old age (65+)><improved><injuries><innovate><innovation><innovative><interventional strategy><isolation/quarantine><late life><later life><mechanical respiratory assist><mid life><mid-life><middle age><middle aged><midlife><mortality><multimorbidity><multiple chronic conditions><neuropsychologic><novel><odor perception><older adult><older person><olfactory perception><pandemic><pandemic disease><post-traumatic stress symptoms><post-traumatic symptoms><posttraumatic stress symptoms><posttraumatic symptoms><prevent><preventing><programs><prospective><recruit><rehab therapy><rehabilitation care><rehabilitation service><rehabilitative><rehabilitative care><rehabilitative therapy><sedation><senior citizen><service availability><taste processing><taste response><tele-rehabilitation><telehealth><telerehab><telerehabilitation><treatment access><virtual><wet lung>