Clinical Implications of Mask Wearing for Special Populations in an Inpatient Rehabilitation Setting during COVID-19 Global Pandemic

RESEARCH OBJECTIVES: To describe the clinical implications of wearing a mask among special populations in inpatient rehabilitation. DESIGN: Narrative Review. SETTING: Inpatient rehabilitation. PARTICIPANTS: Patients undergoing acute inpatient rehabilitation. INTERVENTIONS: Mask wearing. MAIN OUTCOME MEASURES: Effect of mask wearing on exercise outcomes, including perceived exertion, shortness of breath, and patient perception; clinical implications for the interdisciplinary team. RESULTS: Five trials which observed exercise outcomes after mask wearing were identified and summarized. Findings for the effect of face masks on exercise and vital signs varied due to heterogeneity of exercise protocols and outcome measures. Relevant findings show that patients who wore masks had higher ratings of perceived exertion, increased shortness of breath, and feelings of claustrophobia while wearing a face mask during exercise. Wearing masks affected physical and mental outcomes despite exercise intensity (low, moderate, or high). CONCLUSIONS: Moderate-to-high intensity exercise is needed for neuroplasticity. This type of exercise may not be possible in neurological populations, who do not have normal oxygen consumption at rest or with exercise, and may be further affected by wearing masks. Clinicians should their patients' mask wearing into consideration, and change the frequency, intensity, timing and types of exercises when patients are wearing a face mask. Frequent measurement of vital signs and fatigue symptoms are critical to maintain patient safety, and adjustments should be made as necessary. Other neurological challenges to monitor include impaired cognitive function, limited communication, reduced mood, and interactions with medications. These can affect the patients' ability to accurately determine and state their perceived effort or may hinder physiological and autonomic responses. Lastly, interdisciplinary teams should communicate patient findings related to mask wearing at team conferences, huddles and include discussion for ways to increase patients' participation and how to optimize health outcomes. AUTHOR(S) DISCLOSURES: None.