Background: Severe SARS-CoV-2 infection often results in prolonged immobilization and intensive care unit–acquired weakness (ICUAW), contributing to delayed functional recovery. Early physical and rehabilitation medicine (PRM) interventions may mitigate neuromuscular decline, yet real-world data integrating kinesitherapy with proprioceptive focal stimulation (PFS) remain limited. This study evaluated the functional impact of early rehabilitation and the role of timing in rehabilitation among critically ill COVID-19 patients. Methods: A transversal observational cohort study included 148 adults with confirmed COVID-19 admitted to the ICU of the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” (June 2020–June 2022). Individualized rehabilitation (kinesitherapy ± PFS) was initiated after hemodynamic stabilization. Outcomes included the Medical Research Council score, the ICU Mobility Scale, the Manchester Mobility Score, and the Glasgow Coma Scale. Statistical analyses used the chi-square, Mann–Whitney U, and Spearman's rank correlation tests. Results: One hundred and eight patients (73.0%) required mechanical ventilation. Intubation was strongly associated with muscular atrophy (p = 7.1×10⁻¹⁰) and lower ICU mobility (p = 1.56×10⁻¹¹). Delayed rehabilitation correlated moderately with poorer mobility at ICU discharge (ρ = −0.397). Conclusion: Early PRM is feasible and associated with better functional outcomes in severe COVID-19. Rehabilitation timing appears critical, particularly in mechanically ventilated patients.
(1) Background: Severe COVID-19 frequently leads to intensive care unit-acquired weakness (ICU-AW), a complex neuromuscular syndrome that may result in enduring disability, delayed functional recovery, and extended mechanical ventilation. Conventional clinical assessment tools capture only a limited scope of this multifactorial condition and often fail to accurately depict the nonlinear dynamics of physiological deterioration and recovery observed in critically ill patients. (2) Methods: This study presents an integrative framework that combines Physical and Rehabilitation Medicine (PRM) with analytical tools derived from nonlinear dynamics and fractal physiology. A prospective observational design and a long-term clinical evaluation were used along with nonlinear signal analysis. Fractal complexity metrics, including Higuchi fractal dimension (HFD) and detrended fluctuation analysis (DFA), were utilized to characterize the dynamics of neuromuscular and cardiorespiratory signals during rehabilitation. Clinical outcomes included the Medical Research Council (MRC) muscle strength score, the Functional Status Score for the ICU (FSS-ICU), and measures of respiratory performance. (3) Results: Early PRM intervention was associated with a consistent increase in neuromuscular strength, functional mobility, and respiratory muscle performance. Fractal analysis showed that physiological complexity was restored at the same time, as shown by large increases in HFD and DFA values. The recovery paths were not linear, and clustering analysis identified three distinct recovery phenotypes. (4) Conclusions: The integration of fractal biomarkers and nonlinear modeling into ICU rehabilitation may enable early risk stratification, improve the monitoring of functional recovery, and strengthen personalized rehabilitation strategies for patients with ICU-acquired weakness following severe COVID-19.
