e148 Journals of Gerontology: Medical Sciences cite as: J Gerontol A Biol Sci Med Sci, 2022, Vol. 77, No. 4, e148–e154 https://doi.org/10.1093/gerona/glab321 Advance Access publication October 22, 2021 © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Research Article Rehabilitation and In-Hospital Mortality in COVID-19 Patients Anne Felicia Ambrose, MD, 1,2, * Anupama Kurra, MD, 1,3 Lana Tsirakidis, DPT, 3 Kate Collins Hunt, DPT, 3 Emmeline Ayers, MPH, 4 Andrew Gitkind, MD, 1,2 Sandeep Yerra, MD, 2 Yungtai Lo, PhD, 5 Nicole Ortiz, MD, 2 Faraz Jamal, BS, 2,6 Vikram Madan, MPH, 2 Matthew N. Bartels, MD, 1,2,† and Joe Verghese, MBBS 2,4,† 1 Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. 2 Montefore Health Systems, Bronx, New York, USA. 3 White Plains Hospital, White Plains, New York, USA. 4 Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA. 5 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. 6 Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA. *Address correspondence to: Anne Felicia Ambrose, MD, Department of Rehabilitation Medicine, Albert Einstein College of Medicine, 150 E210th Street, Bronx, NY 10467, USA.E-mail: anneambr@montefore.org † Equal senior authors. Received: May 27, 2021; Editorial Decision Date: October 15, 2021 Decision Editor: Lewis  Lipsitz, MD, FGSA Abstract Background: Coronavirus disease 2019 (COVID-19) guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients. Method: A single-center retrospective study, involving 990 COVID-19 patients (42.4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital, was conducted. Association of rehabilitation during hospitalization with in- hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications. Results: Over the 3-month study period, 475 (48.0%) inpatients were referred for rehabilitation. Patients who received rehabilitation were older (73.7 ± 14.0 vs 62.3 ± 17.2). There were 61 hospital deaths (12.8%) in the rehabilitation group and 165 (32.0%) in the nonrehabilitation group. Receiving rehabilitation was associated with an 89% lower in-hospital mortality (odds ratio [OR]: 0.11, 95% confdence interval [CI]: 0.06–0.19) after adjusting for multiple confounders and COVID-19 disease markers. In sensitivity analyses, the results were signifcant in subpopulations defned by age group, sex, race, length of hospitalization, or pulmonary presentations. Each additional rehabilitation session was associated with a 29% lower risk of in-hospital mortality (OR per session: 0.71, 95% CI: 0.64–0.79) in the fully adjusted model. Conclusion: Among hospitalized COVID-19 patients, receiving early rehabilitation was associated with lower in-hospital mortality. Our fndings support implementation of rehabilitation services for COVID-19 patients in acute care settings, but further research from randomized clinical trials is needed. Keywords: COVID-19, Epidemiology, Mortality, Rehabilitation The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with high mortality rates (1–4). As many countries are still struggling with rising numbers of COVID-19 cases and there is as yet no curative treatments, investigation of treatments to reduce in-hospital mortality and improve outcomes is urgently needed. Rehabilitation improves outcomes in acute and chronic respira- tory diseases (5). Meta-analyses report reductions in mortality after Downloaded from https://academic.oup.com/biomedgerontology/article/77/4/e148/6408611 by guest on 10 July 2022