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COVID-19 and functional disability: current insights and rehabilitation strategies
  1. Pasquale Ambrosino1,
  2. Antimo Papa1,
  3. Mauro Maniscalco1,
  4. Matteo Nicola Dario Di Minno2
  1. 1Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
  2. 2Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
  1. Correspondence to Pasquale Ambrosino, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, Pavia 27100, Italy; pasquale.ambrosino{at}

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In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) made the first appearance in Wuhan, China. Despite the attempts to minimise its spread, SARS-CoV-2 gave rise to a public health emergency, finally resulting in the WHO declaration of pandemic in March 2020.

Epidemiologic data indicate that SARS-CoV-2 causes the coronavirus disease 2019 (COVID-19), a condition with a wide spectrum of clinical presentations, ranging from a mild disease with influenza-like symptoms to a severe form with acute respiratory distress syndrome (ARDS), requiring specialised management at intensive care units (ICU).

The long-term consequences of surviving the most severe form of SARS-CoV-2 infection are still largely unknown. However, based on the scientific evidence currently available, some preliminary considerations can be made on this issue.

To date, spirometry indicates a good capacity of recovery in terms of lung function after ARDS. The Toronto ARDS Outcomes Study Group investigated the computed tomography (CT) scans of patients with ARDS at 5-year follow-up, showing a complete resolution of consolidation in all survivors and less than 10% of patients with mild residual CT abnormalities.1

If the lung seems to be an organ with a good capacity of functional recovery, a series of residual limitations in terms of exercise capacity and quality of life have been observed following ARDS and ICU stay, with significant impact on the costs and the need of healthcare services.

Regardless of the underlying pathology, the post-intensive care syndrome (PICS) is a well-known condition, characterised by residual physical and cognitive limitations in ICU survivors. The main clinical manifestations of PICS include fatigue, weakness and exercise intolerance, with different degrees of sexual, sleep, mood and cognitive disorders. As a consequence, family members can be physically and psychologically affected both during ICU stay and after discharge, thus resulting in the PICS-Family (PICS-F). During …

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