Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19)

Study of the effectiveness of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 pneumonitis

Objective

To determine the effectiveness of the telemedicine-based pulmonary rehabilitation programme in COVID-19 pneumonitis.

Design

Prospective intervention study.

Setting

Rehabilitation outpatient department, Tertiary-Care institute.

Participants

Consecutive sample of patients (N = 50) in recovered COVID-19 infection.

Intervention

Six weeks of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 infection.

Outcome Measures

All patients were clinically assessed by six minutes walk test (6MWT), Modified Medical Research Council Scale (mMRC), 30s-STS and SF 36 at zero week and six weeks post-intervention.

Statistical Analysis

Difference in means of pre- and post-intervention was compared using paired t-test. A P value <0.05 was considered statistically significant.

Results

The 6MWT, mMRC Scale, 30 seconds sit-to-stand test, and WHO QoL scale-SF 36 were assessed and post-rehabilitation sessions, all the patients' showed improvement in the prescribed parameters. After six weeks of respiratory rehabilitation, the distance covered in the 6MWT was significantly longer than that of before the intervention. There was a significant difference between zero and six weeks during the PR intervention. mMRC and 30s-STS results showed a significant difference between zero and six weeks (2.36 ± 0.598, 4.54 ± 1.94. Quality of life improved significantly after six weeks of pulmonary rehabilitation in eight domains of the SF-36.

Conclusion

Six-week pulmonary rehabilitation programme delivered through telemedicine platform improves respiratory function, QoL and anxiety in patients with post-COVID-19 pneumonia during a recovery phase.

Virtual Reality Applications for the Implementation of Domestic Respiratory Rehabilitation Programs for Patients With Long COVID and Post-COVID Condition: Scoping Review

BACKGROUND

Due to a high number of patients affected by long COVID or post-COVID condition, an essential step to address the long-term effects of COVID-19 lies in the development and implementation of flexible and accessible rehabilitation programs. Virtual reality (VR) technologies offer the potential to support traditional therapies with individualized at-home programs.

OBJECTIVE

This study aims to provide an overview of existing scientific evidence on the development and implementation of VR-assisted respiratory rehabilitation programs for patients with long COVID and post-COVID condition and to synthesize the results.

METHODS

We conducted a scoping review of studies from 6 databases. PubMed, CINAHL, Cochrane, ScienceDirect, Web of Science Social Sciences Citation Index, and PEDro were searched using an exploratory search strategy. The search, which was last updated in February 2024, included peer-reviewed studies on immersive VR applications providing respiratory rehabilitation programs for patients with chronic obstructive pulmonary disease and long COVID or post-COVID condition. Exclusion criteria were studies in clinical or inpatient settings, telemedicine, nonimmersive VR applications, and gray literature. Nine publications were included in this review. Findings were extracted and summarized from the studies according to the JBI (Joanna Briggs Institute) method and thematically categorized. Topics covered were study characteristics, physiotherapeutic concept, clinical parameters, as well as usability and acceptability.

RESULTS

The 9 publications included in the qualitative analysis were published in 2019-2023. Eight empirical studies were included: 4 followed a mixed methods design, 3 were qualitative studies, and 1 followed a quantitative method. One scoping review was included in the data analyses. Four of the included studies were on patients with chronic obstructive pulmonary disease. The 9 studies demonstrated that VR-supported respiratory rehabilitation programs result in positive initial outcomes in terms of physical as well as psychological parameters. Particularly noteworthy was the increased motivation and compliance of patients. However, adverse effects and lack of usability are the barriers to the implementation of this innovative approach.

CONCLUSIONS

Overall, VR is a promising technology for the implementation of individualized and flexible respiratory rehabilitation programs for patients with long COVID and post-COVID condition. Nevertheless, corresponding approaches are still under development and need to be more closely adapted to the needs of users. Further, the evidence was limited to pilot studies or a small number of patients, and no randomized controlled trials or long-term studies were part of the study selection. The included studies were performed by 4 groups of researchers: 3 from Europe and 1 from the United States.

Predicting anti-COVID-19 potential: in silico analysis of Mauritine compound from Ziziphus-spina christi as a promising papain-like protease (PLpro) inhibitor

The COVID-19 pandemic caused by the SARS-CoV-2 virus, recognized by the World Health Organization (WHO), has led to 164,523,894 confirmed cases and 3,412,032 deaths globally as of May 20, 2021. SARS-CoV-2 encodes crucial proteases for its replication cycle, including the papain-like protease (PLpro), presenting a potential target for developing COVID-19 treatments. Mauritine, a cyclopeptide alkaloid found in the Ziziphus-spina christi plant, exhibits antiviral properties and was investigated for its affinity and toxicity towards PLpro using molecular docking through MGLTools 1.5.6 with Autodock Tools 4.2. Preceding this, toxicity and ADME prediction were performed via Toxtree 3.1.0 software and SwissADME servers. Results from molecular docking revealed free binding energy values of -8.58; -7.73; -8.36; -6.07; -6.67; -7.83; -7.67; -7.40; and -6.87 Kcal/mol for Mauritine-A, Mauritine-B, Mauritine-C, Mauritine-D, Mauritine-F, Mauritine-H, Mauritine-J, Mauritine-L, and Mauritine-M, respectively. Correspondingly, inhibition constants were 0.51724; 2.14; 0.7398; 35.43; 12.95; 1.83; 2.38; 3.80; and 9.17 µM, respectively. Interactions observed included hydrogen bonds, hydrophobic interactions, and electrostatic interactions between the Mauritine compounds and the receptor. Mauritine-A and Mauritine-C emerged as a promising anti-COVID-19 candidate due to its superior affinity compared to other derivatives, as indicated by research findings. Interestingly, Mauritine-A and Mauritine-C exhibits notable stability as depicted by the RMSD and RMSF graphs, along with a considerable MM-PBSA binding free energy value of -162.431 and -137.500 kJ/mol, respectively.Communicated by Ramaswamy H. Sarma.

Knowledge and perceptions regarding pulmonary rehabilitation amongst Ecuadorian physicians following COVID-19 outbreak

Background

Pulmonary rehabilitation is already an established technique for patients with chronic respiratory disease, aimed at improving breathlessness, exercise capacity, health status, and well-being. The aim of this study was to assess the knowledge and perceptions about pulmonary rehabilitation post-COVID-19 infection among Ecuadorian physicians.

Methods

We conducted a cross-sectional online survey-based study using a 27-item questionnaire to assess the knowledge about specific topics related to pulmonary rehabilitation. The sample comprised Ecuadorian physicians who were currently enrolled to an active medical practice that included care to COVID-19 patients. Descriptive statistics were applied for demographic variables of interest. A chi-square goodness of fit test was used to determine whether the observed frequencies of each of the answers per query were within or outside of the expected frequencies by chance.

Results

In total, 295 participants answered the survey, out of which 57.3% were general practitioners. Most agreed that COVID-19 infected patients must be followed-up with some measurement of respiratory function (81.4%, p=0.000), but only 18.3% (n=54, p=0.000) were aware of specific guidelines related to rehabilitation. 93.6% (n=276, p=0.000) considered that pulmonary rehabilitation provides a benefit, of any kind, to patients with past COVID-19 infection.

Conclusions

Most physicians considered pulmonary rehabilitation beneficial following COVID-19. However, there is uncertainty on how to adequately follow up patients, complementary tests, and specific guidelines outlining rehabilitative interventions.

Effects of Pilates Exercises on Core Stability After Recovery from COVID-19: A Randomized Controlled Trial

Purpose

The primary objective was to investigate the effects of Pilates exercises on CS, and the secondary objective was to assess static trunk balance after recovery from COVID-19.

Patients and Methods

145 recovered COVID-19 university students between the ages of 19 and 25 participated in this single-blinded, randomized controlled trial study. The participants were divided into a Pilates group and a control group, each of which received a home exercise program. Core muscle endurance was measured using the five basic endurance tests and static balance using the Prokin system with open eyes (OE) and closed eyes (CE) at baseline and after three months of treatment.

Results

All measured parameters showed improvement within the groups after treatment. Group comparison revealed a significant increase in the Pilates group in all core endurance tests (P<0.001). The Prokin system results showed improvement in the Pilates group after treatment, while perimeter with OE, CE, and ellipse area with EC decreased (P<0.001), but there was no significant difference in ellipse with OE between the groups.

Conclusion

Pilates exercises positively improved core muscle endurance and trunk balance in people infected with COVID-19, which will be reflected in their quality of movement patterns and quality of life.

Short-term Pulmonary Rehabilitation after Recovering from Severe COVID-19

Background

Patients with severe COVID-19 suffer from various problems such as impaired lung function, decreased exercise capacity, mental disorders, and reduced quality of life. This study aimed to evaluate the effectiveness of short-term pulmonary rehabilitation in patients recovering from severe COVID-19.

Methods

The present study was a retrospective cohort study. This study was conducted in 2021 on 92 patients with severe COVID-19 who met the inclusion criteria. Inter-professional pulmonary rehabilitation sessions were performed for 3 weeks, twice a week (six sessions in total), for this group of patients, which included physical exercises, educational activities, and other health-related services (counseling and psychotherapy). Outcomes assessed included a 6-min walk test, the score of the Hospital Anxiety and Depression Scale, and the SF-12 Quality of Life Questionnaire, which were completed before and after pulmonary rehabilitation. Data analysis was performed using analytical and descriptive statistics.

Results

The statistical analyses showed that 60.86% of patients participating in the study were male and 39.14% were female, and the mean age of patients was 54.9 ± 12.3 years. The findings also showed that the average distance traveled in the 6-min walk test before pulmonary rehabilitation was 289.2174 ± 130.5 m; however, after the intervention, this rate reached 343.0870 ± 103.5 m, which demonstrated a statistically significant difference (P = 0.00). Also, significant changes were observed in anxiety and depression, the ability to perform daily activities, and the physical health of patients before and after the intervention (P < 0.05).

Conclusions

Short-term pulmonary rehabilitation is a safe and useful treatment without side effects that can be effective in reducing anxiety and depression, increasing the ability to perform daily activities and exercise capacity, and consequently, improving the quality of life of patients recovering from severe COVID-19.

Effects of a multi-professional intervention on body composition, physical fitness and biochemical markers in overweight COVID-19 survivors: a clinical trial

Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m2), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol [control group (n = 11); moderate group (n = 17) and severe group (n = 7)]. The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and (p = 0.003), upper-limbs (p = 0.008), maximal isometric lumbar-traction strength (p = 0.04), flexibility (p = 0.0006), and albumin (p = 0.0005), as well as a reduction in the C reactive protein (CRP) (p = 0.003) and fasting glucose (p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength (p = 0.001), higher values of albumin (p = 0.005) and HDL-c (p = 0.002), and lower values of CRP (p = 0.05), and for the control group: an improvement in sit-up repetitions (p = 0.008), and a reduction of CRP (p = 0.01), fasting glucose (p = 0.001) and total cholesterol (p = 0.04) were identified. All experimental groups reduced triglycerides after intervention (p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-4mxg57b.

Efficacy and safety of ultra-short wave diathermy on COVID-19 pneumonia: a pioneering study

Background

The ultra-short wave diathermy (USWD) is widely used to ameliorate inflammation of bacterial pneumonia, however, for COVID-19 pneumonia, USWD still needs to be verified. This study aimed to investigate the efficacy and safety of USWD in COVID-19 pneumonia patients.

Methods

This was a single-center, evaluator-blinded, randomized controlled trial. Moderate and severe COVID-19 patients were recruited between 18 February and 20 April 2020. Participants were randomly allocated to receive USWD + standard medical treatment (USWD group) or standard medical treatment alone (control group). The negative conversion rate of SARS-CoV-2 and Systemic Inflammatory Response Scale (SIRS) on days 7, 14, 21, and 28 were assessed as primary outcomes. Secondary outcomes included time to clinical recovery, the 7-point ordinal scale, and adverse events.

Results

Fifty patients were randomized (USWD, 25; control, 25), which included 22 males (44.0%) and 28 females (56.0%) with a mean (SD) age of 53 ± 10.69. The rates of SARS-CoV-2 negative conversion on day 7 (p = 0.066), day 14 (p = 0.239), day 21 (p = 0.269), and day 28 (p = 0.490) were insignificant. However, systemic inflammation by SIRS was ameliorated with significance on day 7 (p = 0.030), day 14 (p = 0.002), day 21 (p = 0.003), and day 28 (p = 0.011). Time to clinical recovery (USWD 36.84 ± 9.93 vs. control 43.56 ± 12.15, p = 0.037) was significantly shortened with a between-group difference of 6.72 ± 3.14 days. 7-point ordinal scale on days 21 and 28 showed significance (p = 0.002, 0.003), whereas the difference on days 7 and 14 was insignificant (p = 0.524, 0.108). In addition, artificial intelligence-assisted CT analysis showed a greater decrease in the infection volume in the USWD group, without significant between-group differences. No treatment-associated adverse events or worsening of pulmonary fibrosis were observed in either group.

Conclusion

Among patients with moderate and severe COVID-19 pneumonia, USWD added to standard medical treatment could ameliorate systemic inflammation and shorten the duration of hospitalization without causing any adverse effects.Clinical Trial Registration: chictr.org.cn, identifier ChiCTR2000029972.

[Functional parameters and affecting factors in post-COVID period]

Introduction

Post-COVID period is considered to be 12 weeks after the COVID-19 infection. Patients in the post-COVID period may have prolonged or newly developed symptoms. Depending on the prolonged effects of the disease, respiratory and functional parameters may be affected. The aim of the study is to investigate the effect of COVID-19 infection on respiratory and functional parameters in the post-COVID period.

Materials and Methods

A cross-sectional study was conducted to evaluate the functional parameters of patients with COVID-19 in the post-COVID period. Subjects with a history of microbiologically proven COVID-19 infection were evaluated with 6-minute walk test results, Borg, and MRC results at least 12 weeks after COVID-19 infection. The relationship between demographic characteristics, comorbidities, vaccination status, and severity of disease with 6-minute walk test results and dyspnea scales in the post-COVID period was investigated.

Result

Two hundred seventeen patients were included in the study. The mean age of the patients was 48.6 ± 14.9 years and 126 (58.1%) of them were female. 142 (65.4%) of the patients were completely vaccinated against COVID-19 and 75 (34.6%) patients were incompletely vaccinated or unvaccinated. 158 (72.8%) patients had mild disease, 51 (23.5%) patients had moderate disease, and eight (3.7%) patients had severe disease. Those with a history of moderate or severe disease had significantly worsened functional parameters in the postCOVID period compared to those with mild COVID-19. The Borg scale and MRC dyspnea scale values were significantly higher in women (p= 0.008, p= 0.002, respectively). Functional parameters of those who were completely vaccinated against COVID-19 and those who were incompletely or unvaccinated individuals in the post-COVID period were similar.

Conclusions

The functional parameters of people with moderate or severe COVID-19 disease were found to be significantly impaired in the post-COVID period. While the effect of smoking and vaccination status on functional parameters in the post-COVID period could not be demonstrated, disease severity and accompanying comorbidity were found to be effective.

[Segmentation of acute pulmonary embolism in computed tomography pulmonary angiography using the deep learning method]

Introduction

Pulmonary embolism is a type of thromboembolism seen in the main pulmonary artery and its branches. This study aimed to diagnose acute pulmonary embolism using the deep learning method in computed tomographic pulmonary angiography (CTPA) and perform the segmentation of pulmonary embolism data.

Materials and Methods

The CTPA images of patients diagnosed with pulmonary embolism who underwent scheduled imaging were retrospectively evaluated. After data collection, the areas that were diagnosed as embolisms in the axial section images were segmented. The dataset was divided into three parts: training, validation, and testing. The results were calculated by selecting 50% as the cut-off value for the intersection over the union.

Result

Images were obtained from 1.550 patients. The mean age of the patients was 64.23 ± 15.45 years. A total of 2.339 axial computed tomography images obtained from the 1.550 patients were used. The PyTorch U-Net was used to train 400 epochs, and the best model, epoch 178, was recorded. In the testing group, the number of true positives was determined as 471, the number of false positives as 35, and 27 cases were not detected. The sensitivity of CTPA segmentation was 0.95, the precision value was 0.93, and the F1 score value was 0.94. The area under the curve value obtained in the receiver operating characteristic analysis was calculated as 0.88.

Conclusions

In this study, the deep learning method was successfully employed for the segmentation of acute pulmonary embolism in CTPA, yielding positive outcomes.

Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis

AIM

Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients.

DESIGN

Meta-analysis.

METHODS

R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I² . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies.

DATA SOURCES

A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022.

RESULTS

Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks.

CONCLUSIONS

Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks.

IMPACT

These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients.

IMPLICATIONS FOR THE PROFESSION

Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients.

REPORTING METHOD

PRISMA guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Changes in respiratory, physical, and mental conditions in moderate and severe COVID-19 cases at our convalescent rehabilitation ward

Akimoto K, Asano S, Satoh Y, Yokogushi K. Changes in respiratory, physical, and mental conditions in moderate and severe COVID-19 cases at our convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 10-15.

Purpose

This study clarified the changes in respiratory condition, and physical and mental functions pertaining to them, of patients with the coronavirus disease 2019 ("COVID-19") who were admitted to our convalescent rehabilitation ward. It also examined the conditions remaining after the disease (long-COVID).

Methods

We focused on 16 moderate and severe patients with COVID-19 who were transferred to our convalescent rehabilitation ward and discharged home between March and September 2021. We evaluated the patients' respiratory, physical, and mental conditions at the time of admission, four weeks after admission, and at the time of discharge.

Results

We confirmed an improvement in the shortness of breath in those with respiratory conditions, and a significant improvement in the walking distance related to physical function before the time of discharge, but anxiety and depression remained.

Conclusion

Patients with moderate to severe COVID-19 can be discharged home after convalescent rehabilitation. Despite improved dyspnea and walking distance, the patients tend to have incomplete recovery, including physical deconditioning, mood disorders, and other long-COVID conditions at discharge.

Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors: a randomized controlled clinical study

OBJECTIVE

To compare the effects of a home-based pulmonary rehabilitation (PR) program with and without telecoaching on health-related outcomes in COVID-19 survivors.

METHODS

A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale.

RESULTS

In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05).

CONCLUSIONS

A home-based PR program with telecoaching increases social functioning and decreases daily-life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home-based PR program without telecoaching.

[Medical rehabilitation features of patients suffered from new coronavirus infection]

Despite the development and implementation of preventive measures, new coronavirus infection (COVID-19) cases are still being registered among the population.

OBJECTIVE

To describe the methods of recovery treatment, used at different rehabilitation stages of patients suffered from COVID-19.

MATERIAL AND METHODS

An analytical review of rehabilitation methods of patients after COVID-19 was conducted. The literature reviews and original researches from Scopus, Web of Science, PubMed, CyberLeninka and eLibrary electronic databases were studied.

RESULTS AND CONCLUSION

Lungs, heart and vessels, gastrointestinal tract and central nervous system are most commonly affected by COVID-19. Due to this, the article considers key aspect of rehabilitation of patients with revealed disorders. Multidisciplinary approach is the main treatment type of patient with COVID-19. The effective result of comprehensive and multidisciplinary approach can be achieved only by the work of a team of specialists from different disciplines. The early onset, consistency and continuity of rehabilitation activities are important factors in the recovery of patients with post-COVID syndrome.

Home-Based Respiratory Physiotherapy and Telephone-Based Psychological Support for COVID-19 Survivors in Peru: Protocol for a Randomized Controlled Trial

BACKGROUND

Both pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed.

OBJECTIVE

This article presents the design of a trial that aimed to assess whether the participation in a combined rehabilitation program that includes home-based respiratory physiotherapy and telephone-based psychological support is associated with a greater improvement of pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge compared with posthospital usual care provided by a public Peruvian hospital.

METHODS

WAYRA (the word for air in the Quechua language) was an open-label, unblinded, two-arm randomized controlled trial. We recruited 108 participants aged 18-75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 liters/minute of supplemental oxygen during treatment. Participants were randomly assigned at a 1:1 ratio to receive the combined rehabilitation program or usual posthospital care provided by a public Peruvian hospital. The intervention consisted of 12 at-home respiratory rehabilitation sessions and 6 telephone-based psychological sessions. The primary outcome was the 6-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety, and trauma), and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge to assess the difference between arms.

RESULTS

This study was funded by the Peruvian National Council of Science Technology and Technology Innovation in July 2020. Ethics approval was obtained on September 2, 2020. Recruitment and data collection occurred between October 2020 and June 2021. Results are expected to be published by the end of 2022.

CONCLUSIONS

WAYRA was the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scale-up of similar multidisciplinary rehabilitation programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04649736; https://clinicaltrials.gov/ct2/show/NCT04649736.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/36001.

Eccentric Training in Pulmonary Rehabilitation of Post-COVID-19 Patients: An Alternative for Improving the Functional Capacity, Inflammation, and Oxidative Stress

The purpose of this narrative review is to highlight the oxidative stress induced in COVID-19 patients (SARS-CoV-2 infection), describe longstanding functional impairments, and provide the pathophysiologic rationale that supports aerobic eccentric (ECC) exercise as a novel alternative to conventional concentric (CONC) exercise for post-COVID-19 patients. Patients who recovered from moderate-to-severe COVID-19 respiratory distress demonstrate long-term functional impairment. During the acute phase, SARS-CoV-2 induces the generation of reactive oxygen species that can be amplified to a "cytokine storm". The resultant inflammatory and oxidative stress process causes organ damage, particularly in the respiratory system, with the lungs as the tissues most susceptible to injury. The acute illness often requires a long-term hospital stay and consequent sarcopenia. Upon discharge, muscle weakness compounded by limited lung and cardiac function is often accompanied by dyspnea, myalgia, anxiety, depression, and sleep disturbance. Consequently, these patients could benefit from pulmonary rehabilitation (PR), with exercise as a critical intervention (including sessions of strength and endurance or aerobic exercises). Unfortunately, conventional CONC exercises induce significant cardiopulmonary stress and increase inflammatory and oxidative stress (OS) when performed at moderate/high intensity, which can exacerbate debilitating dyspnoea and muscle fatigue post-COVID-19. Eccentric training (ECC) is a well-tolerated alternative that improves muscle mass while mitigating cardiopulmonary stress in patients with COPD and other chronic diseases. Similar benefits could be realized in post-COVID-19 patients. Consequently, these patients could benefit from PR with exercise as a critical intervention.

COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art

Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient’s prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is “a state of complete physical, mental and social well-being”, individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.

The successful rehabilitation of a 75-year-old female with debilitating long COVID: A case report

A 75-year-old previously healthy female became severely ill, functionally dependent, and required long-term home oxygen therapy, after recovery from coronavirus disease 2019 (COVID-19) with acute respiratory failure and extensive pulmonary fibrosis. After two months of respiratory muscle training and a comprehensive cardiopulmonary rehabilitation program, her dyspnea, physical performance, pulmonary function parameters, and activities of daily living rapidly improved. This Case highlights the importance of a timely active rehabilitation program for COVID-19 survivors experiencing the long-term effects of coronavirus (long COVID).

The Possible Impact of COVID-19 on Respiratory Muscles Structure and Functions: A Literature Review

The impact of SARS-CoV-2 infection on respiratory muscle functions is an important area of recent enquiry. COVID-19 has effects on the respiratory muscles. The diaphragm muscle is perturbed indirectly due to the mechanical-ventilation-induced-disuse, but also by direct mechanisms linked with SARS-CoV-2 viral infection. In this sense, a deeper understanding of the possible links between COVID-19 and alterations in structure and functions of the respiratory muscles may increase the success rate of preventive and supportive strategies. Ultrasound imaging alongside respiratory muscle strength tests and pulmonary function assessment are valid approaches to the screening and monitoring of disease, for mild to severe patients. The aim of the present review is to highlight the current literature regarding the links between COVID-19 and respiratory muscle functions. We examine from the pathophysiological aspects of disease, up to approaches taken to monitor and rehabilitate diseased muscle. We hope this work will add to a greater understanding of the pathophysiology and disease management of respiratory muscle pathology subsequent to SARS-CoV-2 infection.

Impact of Physiotherapy on Patients Suffering from COVID-19: An Observational Study

Introduction: COVID-19 was the turning point of 2020, endangering the health of the entire population around the world. Among other therapeutic methods and supportive measures, physiotherapy represents a useful intervention applied on COVID-19 patients suffering from respiratory symptoms, this being supported by recent literature data. Materials and Methods: The study was performed on 45 patients diagnosed with COVID-19 (28 men, 17 women, mean age = 65.03, standard deviation = 14.83). They participated for 2 weeks (the required period of hospitalization) to a series of 14 physiotherapy sessions, which included: position changing, respiratory control, passive joint movements, bed workout, and walking exercises. Depending on the status of the patient, two distinct types of physiotherapy were performed (mild and active). The status of the patients was assessed through a basic assessment of the vital signs, range of motion, degree of dyspnea, and also through the UZ Leuven Start To Move protocol (STMP). The statistical analysis of the data was performed using the Statistica 10 program and included the Spearman correlations (for measuring the strength and direction of association between the ranked variables), the Mann-Whitney test (for measuring the significance of the differences between the groups of patients who undergone light vs. active physiotherapy) and factor analysis (for assessing the changes of the clinical parameters investigated in the study, depending on the type of applied therapy). All differences were considered significant at p < 0.05. Results: The majority of patients (n = 38) benefited from physiotherapy, with the complete disappearance of symptoms met only in the group of patients who followed active physiotherapy. These effects depended on the applied type of physiotherapy (mild vs. active, p = 0.47). In contrast, all patients who were unable to perform physiotherapy (n = 7) remained symptomatic at discharge. Conclusion: The results of this study point out the significant additional role of physiotherapy for a better management of COVID-19 patients. More studies are needed to investigate not only the impact that physiotherapy has on the symptoms of this disease, but also its effects on effort capacity, muscle strength and lung capacity.

Recent Advances in Chest Rehabilitation during COVID-19 Outbreak: A Systematic Review

Background

The current COVID-19 pandemic has brought the entire world to a halt, resulting in illness, death, and changes in individual roles. Physical therapy and chest rehabilitation play a critical role following aftermath of pandemics.

Methods

PubMed, Google Scholar, PEDro, MEDLINE were searched for randomized controlled trials. Methodological quality was assessed independently by two authors using PEDro scale. Data for disability, chest physical functions and adverse effects were analyzed.

Results

A meta-analysis was not possible due to the heterogeneity of the studies included for review. After applying the studies’ inclusion and exclusion criteria, a total of eight articles with 420 patients were included in the study for their detailed analysis. Two independent authors verified and screened the data, with the third author double-checked and searched for additional articles.

Conclusion

Findings revealed that chest rehabilitation approaches influence the clinical condition of people during COVID-19 outbreak resulting in improved condition stabilization and recovery, the consequent reduction in hospitalization period and improved health-related quality of life.

Evaluating the Efficiency of Breathing Exercises via Telemedicine in Post-Covid-19 Patients: Randomized Controlled Study

The aim of the study was to evaluate the effectiveness of breathing exercises given by telemedicine in post-Covid-19 dyspneic individuals. Individuals in the intervention group (n: 26) were asked to perform breathing exercise three times a day for 5 weeks (one session performed via telemedicine each week). Individuals in the control group (n: 26) were given a brochure explaining the exercises. The St George's Respiratory Questionnaire, Pulmonary function tests, and six-minute-walk-tests were administered to all individuals at the beginning and end of the study. The posttest FEV1, FVC, MVV values were significantly higher than the pretest values in the intervention group (p₂ < .001) whereas no significant differences were found in the control group. Six-minute-walk-distance increased by 54.27 m in the intervention group and 4.69 m in the control group. With breathing exercise training applied through telemedicine, improvements were observed in the pulmonary functions, quality of life, and exercise capacities of dyspneic post-Covid-19 individuals.

Exercise Training in Post-COVID-19 Patients: The Need for a Multifactorial Protocol for a Multifactorial Pathophysiology

The battle against COVID-19 has entered a new phase with Rehabilitation Centres being among the major players, because the medical outcome of COVID-19 patients does not end with the control of pulmonary inflammation marked by a negative virology test, as many patients continue to suffer from long-COVID-19 syndrome. Exercise training is known to be highly valuable in patients with cardiac or lung disease, and it exerts beneficial effects on the immune system and inflammation. We therefore reviewed past and recent papers about exercise training, considering the multifactorial features characterizing post-COVID-19 patients’ clinical conditions. Consequently, we conceived a proposal for a post-COVID-19 patient exercise protocol as a combination of multiple recommended exercise training regimens. Specifically, we built pre-evaluation and exercise training for post-COVID-19 patients taking advantage of the various programs of exercise already validated for diseases that may share pathophysiological and clinical characteristics with long-COVID-19.

Rehabilitation at the Time of Pandemic: Patient Journey Recommendations

Purpose

The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020, causing almost 3.5 million coronavirus disease (COVID-19) related deaths worldwide. The COVID-19 pandemic has imposed a significant burden on healthcare systems, economies, and social systems in many countries around the world. The access and delivery of rehabilitation care were severely disrupted, and patients have faced several challenges during the COVID-19 outbreak. These challenges include addressing new functional impairments faced by survivors of COVID-19 and infection prevention to avoid the virus spread to healthcare workers and other patients not infected with COVID-19. In this scoping review, we aim to develop rehabilitation recommendations during the COVID-19 pandemic across the continuum of rehabilitation care.

Materials and Methods

Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched.

Study Selection

We included articles and reports if they were focused on rehabilitation recommendations for COVID-19 survivors or the general population at the time of the COVID-19 pandemic.

Data Extraction

Two of our team members used the pre-tested data extraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

Results

We retrieved 6,468 citations, of which 2,086 were eligible after removing duplicates. We excluded 1,980 citations based on the title and the abstract. Of the screened full-text articles, we included 106 studies. We present recommendations based on the patient journey at the time of the pandemic. We assessed the evidence to be of overall fair quality and strong for the recommendations.

Conclusion

We have combined the latest research results and accumulated expert opinions on rehabilitation to develop acute and post-acute rehabilitation recommendations in response to the global COVID-19 pandemic. Further updates are warranted in order to incorporate the emerging evidence into rehabilitation guidelines.

Effects of Early Physical Therapy and Follow-Up in Acute Severe Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Study

Background

Rehabilitation in subjects with severe coronavirus disease 2019 (COVID-19) pneumonia has been widely recommended. However, data regarding the starting time of rehabilitation, subjects and healthcare workers' safety, as well as rehabilitation program features are limited. We aimed to assess the safety and characterize the effect of early and non-early physiotherapy on severe COVID-19 pneumonia subjects.

Methods

A retrospective cohort study, including a consecutive sample of surviving subjects admitted to an acute care hospital due to severe COVID-19 pneumonia from March 13th to May 15th of 2020, is made. Subjects were separated into three groups: non-physical therapy, early physiotherapy (onset <7 days of admission), and non-early physiotherapy. Subject and therapist safety and length of hospital stay were the main evaluated outcomes.

Results

A total of 159 subjects were included (72% men; median age 62 years). Rehabilitation was performed on 108 subjects (32 early and 76 non-early physiotherapies). The length of hospital stay was 19 [interquartile range (IQR) 36.25] and 34 days (IQR 27.25) (p = 0.001) for early and non-early physiotherapy groups, respectively. No physiotherapist was infected and no subject adverse effect was identified. Multivariate analysis of subjects receiving physiotherapy during admission identified obesity [odds ratio (OR) 3.21; p-value 0.028], invasive mechanical ventilation (OR 6.25; p-value <0.001), and non-early physiotherapy (OR 3.54; p-value 0.017) as independent factors associated with a higher risk of prolonged hospital stay. Survivors' follow-up after hospital discharge at 8 weeks was completed by 54% of subjects.

Conclusion

Rehabilitation in acute severe COVID-19 pneumonia is safe for subjects and healthcare workers and could reduce the length of hospitalization stay, especially in those that may start early.

Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study

Background

Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease. The most common clinical manifestation of severe COVID-19 is acute respiratory failure. Respiratory rehabilitation can be a crucial part of treatment, but data lack for patients with COVID-19. This study investigates the effects of short-term respiratory rehabilitation (i.e., breathing exercises) on respiratory recovery among non-ICU hospitalised patients with COVID-19.

Methods

This was a quasi-experimental, pre-and post-test study. The study recruited 173 patients hospitalised with moderate to severe COVID-19. All the patients received standardised care for COVID-19, and 94 patients in the intervention group also received the intervention of breathing exercises, which included breathing control, followed by diaphragmatic breathing, deep breathing, or thoracic expansion exercise, and huffing (forced expiratory technique) and coughing. Data on the mean values of peripheral oxygen saturation (SpO₂), need for oxygen therapy (litre/min), respiratory rate (breaths/minute), and heart rate (beats/minute) and were collected at baseline, 4 days, and 7 days after the baseline assessment. Analysis of variance on repeated measures was applied to compare the mean value of outcome measures of all the time points.

Results

The mean (± SD) age of the intervention (69.6% men) and control group (62.1% men) were 50.1 (10.5) and 51.5 (10.4) years, respectively. At 4-day of follow-up, SpO2 (96.6% ± 1.9 vs. 90.7% ± 1.8, P < 0.001), need for oxygen therapy (0.8 ± 2.6 vs. 2.3 ± 2.9, P < 0.001), respiratory rate (20.5 ± 2.3 vs. 22.3 ± 2.5, P < 0.001), and heart rate (81.2 ± 9.5 vs. 89.2 ± 8.9, P < 0.001) improved in the intervention group compared to the control group. At 7-day follow-up, differences remained significant concerning the oxygen saturation and the need for oxygen therapy (P < 0.001) between the groups.

Conclusions

Our results indicate that breathing exercise, even for a short period, effectively improves specific respiratory parameters in moderate to severe COVID-19 patients. As a non-invasive and cost-effective respiratory rehabilitation intervention, breathing exercise can be a valuable tool for a health care system overwhelmed by the COVID-19 pandemic. These results should be considered preliminary until they are replicated in larger samples in different settings.

REHABILITATION DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has affected the entire healthcare system, from emergency care, intensive care units, internal medicine wards, outpatient care to home care. The pandemic continues and brings a large number of patients with COVID-19-associated postintensive care syndrome suffering from physical, mental and cognitive impairments that threaten their return to normal life. The complexity and severity of illness in patients recovering from severe COVID-19 requires a coordinated and systematic approach to be applied as early as possible during the recovery phase. Considering the multiorgan dysfunction, debility, pulmonary, neurological, neuromuscular and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with COVID-19. Complications of COVID-19 can be reduced by 1) multidisciplinary rehabilitation, which begins early and continues throughout the hospital stay, 2) providing patient/family education for self-care after discharge from inpatient rehabilitation, and 3) continuing rehabilitation care in the outpatient setting, and at home either in person or with the help of telerehabilitation.

Cardiac Rehabilitation in Patients with Peripheral Artery Disease-A Literature Review in COVID-19 Era

Cardiac rehabilitation (CR) is an integral part of the management of various cardiovascular disease such as coronary artery disease (CAD), peripheral artery disease (PAD), or chronic heart failure (CHF), with proven morbidity and mortality benefits. This article aims to review and summarize the scientific literature related to cardiac rehabilitation programs for patients with PAD and how they were adapted during the COVID-19 pandemic. The implementation of CR programs has been problematic since the COVID-19 pandemic due to social distancing and work-related restrictions. One of the main challenges for physicians and health systems alike has been the management of PAD patients. COVID-19 predisposes to coagulation disorders that can lead to severe thrombotic events. Home-based walking exercises are more accessible and easier to accept than supervised exercise programs. Cycling or other forms of exercise are more entertaining or challenging alternatives to exercise therapy. Besides treadmill exercises, upper- and lower-extremity ergometry also has great functional benefits, especially regarding walking endurance. Supervised exercise therapy has a positive impact on both functional capacity and also on the quality of life of such patients. The most effective manner to acquire this seems to be by combining revascularization therapy and supervised exercise. Rehabilitation programs proved to be a mandatory part of the integrative approach in these cases, increasing quality of life, and decreasing stress levels, depression, and anxiety.

Delivery of Acute Rehabilitation to a Postcoronary Artery Bypass Graft COVID-19 Patient in a Pandemic Environment

During the first wave of the coronavirus disease (COVID-19) pandemic, a 57-year-old COVID-19 male patient was diagnosed with non-ST-elevation myocardial infarction and required urgent coronary artery bypass graft. In-patient cardiac rehabilitation following cardiac surgery was inevitable to limit or prevent various postoperative complications. A routine rehabilitation program was not feasible because of the strict COVID-19 isolation procedures, the high risk of cross infections, and the lack of various resources. Moreover, the detrimental effects of COVID-19 infection on multiple body systems reduced his exercise tolerance, limiting his engagement in physical activity. This case report highlights the various challenges encountered during the rehabilitation of these patients and strategies adopted to overcome them, illustrating the feasibility of a modified rehabilitation program to ensure early functional recovery.

SARS-CoV-2 Post Vaccinated Adverse Effects and Efficacy in the Egyptian Population

Vaccines are the solution to overcome SARS-CoV-2. This study aimed to determine the post-Sinopharm vaccine safety-profile and immunity through antibody titers. Data were collected using a structured questionnaire from Egyptian participants who received two doses of Sinopharm vaccine. Data were divided into three parts, the first and second parts were to detect participants’ post-first and second dose symptoms and practices, and the third for the results of IgG anti spike protein antibodies test and laboratory tests. Pain, redness, swelling at the injection site, headache, fatigue, and lethargy were the most common post-vaccine symptoms for both first and second doses. Most of the participants felt mild or no symptoms after vaccination. The symptoms started mostly during the first day post-vaccination and lasted for no more than two days. Forty-nine percent of the participants resulted in positive antibodies tests on day 18 post-vaccination. The average antibody level for vaccinated participants with past SARS-CoV-2 infection was much higher than that for non-past infected participants. These vaccines’ administration methods need to be reevaluated by changing the dose, dose interval, adding a third dose, or mixing it with other vaccines with different techniques to improve their protection rates. Further studies are required to validate this finding.

Feasibility of the modified 30-second sit-to-stand test in an isolation ward of moderate COVID-19

BACKGROUND The recovery after prolonged immobilization during hospitalization because of COVID-19 is the primary goal of moderate to severe COVID-19 rehabilitation. Lower extremity muscle function assessment after immobilization is needed before starting mobilization. Hence, this study aimed to evaluate the feasibility of the modified 30-second sit-to-stand test (m30STS) as one of the prospective tools of functional capacity assessment in moderate COVID-19. METHODS This cross-sectional study recruited the subjects consecutively. All eligible subjects with oxygen saturation (SaO2) ≥95% with or without oxygen supplementation performed the m30STS following the Bohannon’s guidelines. The score of m30STS was calculated based on the number of stands completed within 30 sec. A higher score of the m30STS indicated better lower extremity function. RESULTS Mean score of m30STS was 13.3. No subjects had oxygen desaturation or increased heart rate, and no fall incidents occurred. CONCLUSIONS The m30STS is feasible and safe to evaluate lower extremity for moderate COVID-19 patients with SaO2 >95%. The absence of oxygen desaturation and increase in heart rate showed no increased oxygen consumption during the test.

Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies

The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase. Depending on the study referred, about 10%-30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19. While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not. Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature. The subtypes are non-severe COVID-19 multi-organ sequelae (NSC-MOS), pulmonary fibrosis sequelae (PFS), myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), post-intensive care syndrome (PICS) and medical or clinical sequelae (MCS). Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.

Coronavirus Disease 2019: Clinics, Treatment, and Prevention

The coronavirus disease 2019 (COVID-19) pandemic, caused by a novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged at the end of 2019 in China and affected the entire world population, either by infection and its health consequences, or by restrictions in daily life as a consequence of hygiene measures and containment strategies. As of September 2021, more than 231,000.000 infections and 4,740.000 deaths due to COVID-19 have been reported. The infections present with varied clinical symptoms and severity, ranging from asymptomatic course to fatal outcome. Several risk factors for a severe course of the disease have been identified, the most important being age, gender, comorbidities, lifestyle, and genetics. While most patients recover within several weeks, some report persistent symptoms restricting their daily lives and activities, termed as post-COVID. Over the past 18months, we have acquired significant knowledge as reflected by an almost uncountable number of publications on the nature of the underlying virus and its evolution, host responses to infection, modes of transmission, and different clinical presentations of the disease. Along this line, new diagnostic tests and algorithms have been developed paralleled by the search for and clinical evaluation of specific treatments for the different stages of the disease. In addition, preventive non-pharmacological measures have been implemented to control the spread of infection in the community. While an effective antiviral therapy is not yet available, numerous vaccines including novel vaccine technologies have been developed, which show high protection from infection and specifically from a severe course or death from COVID-19. In this review, we tried to provide an up-to-date schematic of COVID-19, including aspects of epidemiology, virology, clinical presentation, diagnostics, therapy, and prevention.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review

The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021, found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents. Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed to better understand and mitigate the long-term effects of PASC on individual and population health.

COVID-19: A New Challenge for Pulmonary Rehabilitation?

Coronavirus disease 2019 (COVID-19), currently one of the immense burdens for global healthcare, is often characterized by rapid progression and the occurrence of symptoms particularly affecting the respiratory system. Continuous refinement of treatment protocols improves prognosis; however, COVID-19 survivors are often left with the symptomatic burden of dyspnea and fatigue. Therefore, it is necessary to continue comprehensive treatment including pulmonary rehabilitation. This study aimed to review the available literature on pulmonary rehabilitation in patients diagnosed with COVID-19. The pulmonary rehabilitation programs implemented various forms, i.e., aerobic exercise, breathing exercises, effective cough exercises, diaphragmatic breathing, and respiratory muscle training. Based on the literature review, it was found that pulmonary rehabilitation programs result in an improvement of respiratory function, reduction of fatigue and dyspnea, and improvement in exercise endurance and quality of life after completing both short-term and long-term programs, but depression and anxiety problems did not improve. Pulmonary rehabilitation combined with psychological therapy is crucial for COVID-19 survivors and plays a substantial role in patients’ recovery.

Evaluating Community-Facing Virtual Modalities to Support Complex Neurological Populations During the COVID-19 Pandemic: Protocol for a Mixed Methods Study

Background

The COVID-19 pandemic and concomitant governmental responses have created the need for innovative and collaborative approaches to deliver services, especially for populations that have been inequitably affected. In Alberta, Canada, two novel approaches were created in Spring 2020 to remotely support patients with complex neurological conditions and rehabilitation needs. The first approach is a telehealth service that provides wayfinding and self-management advice to Albertans with physical concerns related to existing neurological or musculoskeletal conditions or post-COVID-19 recovery needs. The second approach is a webinar series aimed at supporting self-management and social connectedness of individuals living with spinal cord injury.

Objective

The study aims to evaluate the short- and long-term impacts and sustainability of two virtual modalities (telehealth initiative called Rehabilitation Advice Line [RAL] and webinar series called Alberta Spinal Cord Injury Community Interactive Learning Seminars [AB-SCILS]) aimed at advancing self-management, connectedness, and rehabilitation needs during the COVID-19 pandemic and beyond.

Methods

We will use a mixed-methods evaluation approach. Evaluation of the approaches will include one-on-one semistructured interviews and surveys. The evaluation of the telehealth initiative will include secondary data analyses and analysis of call data using artificial intelligence. The evaluation of the webinar series will include analysis of poll questions collected during the webinars and YouTube analytics data.

Results

The proposed study describes unique pandemic virtual modalities and our approaches to evaluating them to ensure effectiveness and sustainability. Implementing and evaluating these virtual modalities synchronously allows for the building of knowledge on the complementarity of these methods. At the time of submission, we have completed qualitative and quantitative data collection for the telehealth evaluation. For the webinar series, so far, we have distributed the evaluation survey following three webinars and have conducted five attendee interviews.

Conclusions

Understanding the impact and sustainability of the proposed telehealth modalities is important. The results of the evaluation will provide data that can be actioned and serve to improve other telehealth modalities in the future, since health systems need this information to make decisions on resource allocation, especially in an uncertain pandemic climate. Evaluating the RAL and AB-SCILS to ensure their effectiveness demonstrates that Alberta Health Services and the health system care about ensuring the best practice even after a shift to primarily virtual care.

International Registered Report Identifier (IRRID)

DERR1-10.2196/28267

Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study

The COVID-19 pandemic has caused distress for healthcare providers due to the respiratory problems it causes, among others. In this situation, rehabilitation of the respiratory system has been suggested and implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel program based on breathing exercises through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Forty subjects were randomized in an experimental group, based on pulmonary rehabilitation, and in a control group, of which the subjects did not perform physical activity. Thirty-eight subjects, with nineteen in each group, completed the one-week intervention. We performed measurements using the Six-Minute Walk Test, Multidimensional Dyspnoea-12, Thirty-Second Sit-To-Stand Test, and Borg Scale. Both groups were comparable at baseline. Significant differences were found for all of the outcome measures in favour of the experimental group. Ninety percent adherence was found in our program. A one-week telerehabilitation program based on respiratory exercises is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.

Providing Rehabilitation to Patients Recovering from COVID-19: A Scoping Review

Objective

To synthesize the nature and extent of research on rehabilitation care provision to patients with COVID‐19. Specifically, we aimed to (1) describe the impact of COVID on patients and associated rehabilitation needs, (2) outline the adaptations and preparations required to enable the provision of COVID rehabilitation, (3) describe the types of rehabilitation services and treatments provided to COVID patients, and (4) identify barriers and facilitators to delivering COVID rehabilitation.

Literature Survey

We searched Medline, PsychINFO, Embase, and CINAHL on June 26, 2020 using key words such as “rehabilitation,” “physical medicine,” “allied health professionals,” and variations of “COVID.” The search was updated on October 13, 2020. We included articles published in English and that focused on some aspect of COVID rehabilitation for adults. We excluded articles focused on pediatric populations and those not focused (or minimally focused) on rehabilitation for COVID patients.

Methodology

Data were charted based on article type (ie, primary data, secondary data, guidelines). Key information extracted included (1) COVID sequelae; (2) rehabilitation adaptations; (3) structure, function, and content of rehabilitation services/programs; (4) facilitators and/or barriers to providing COVID rehabilitation; and (5) recommendations for COVID rehabilitation programming. Data were synthesized narratively.

Synthesis

In total, 128 articles were included in the review that reported primary data (n = 33), secondary data (n = 82), and clinical practice/patient self‐management guidelines (n = 13). Evidence begins to suggest that rehabilitation is necessary and valuable for addressing COVID‐related declines in health, function, and well‐being. Most articles recommended that an individualized rehabilitation program be provided across the continuum of care by an interdisciplinary team of professionals and that the nature and extent of rehabilitation be informed by the care setting and COVID severity. Most issues that challenged COVID rehabilitation delivery were directly addressed by the facilitators and adaptations identified.

Conclusions

Future recommendations include a greater emphasis on the psychosocial aspects of COVID rehabilitation, inclusion of families in rehabilitation planning, and the use of qualitative approaches to complement clinical data.

Post-COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and Characteristics of the Initial Patient Cohort

OBJECTIVE

To describe characteristics of a series of patients reporting prolonged symptoms after an infection with coronavirus disease 2019 (COVID-19).

PATIENTS AND METHODS

This study describes the multidisciplinary COVID-19 Activity Rehabilitation Program, established at Mayo Clinic to evaluate and treat patients with post-COVID syndrome, and reports the clinical characteristics of the first 100 patients receiving evaluation and management during the timeframe of June 1, 2020, and December 31, 2020.

RESULTS

The cohort consisted of 100 patients (mean age, 45.4±14.2 years; 68% women; mean body mass index, 30.2 kg/m2; presenting a mean of 93 days after infection). Common preexisting conditions were respiratory (23%) and mental health, including depression and/or anxiety (34%). Most (75%) had not been hospitalized for COVID-19. Common presenting symptoms ware fatigue (80%), respiratory complaints (59%), and neurological complaints (59%) followed by subjective cognitive impairment, sleep disturbance, and mental health symptoms. More than one-third of patients (34%) reported difficulties in performing basic activities of daily living. Only 1 in 3 patients had returned to unrestricted work duty at the time of the analysis. For most patients, laboratory and imaging tests showed no abnormalities or were nondiagnostic despite debilitating symptoms. Most patients required physical therapy, occupational therapy, or brain rehabilitation. Face-to-face and virtual care delivery modalities were feasible.

CONCLUSION

Most of the patients did not have COVID-19-related symptoms that were severe enough to require hospitalization, were younger than 65 years, and were more likely to be female, and most had no preexisting comorbidities before severe acute respiratory syndrome coronavirus 2 infection. Symptoms including mood disorders, fatigue, and perceived cognitive impairment resulted in severe negative impacts on resumption of functional and occupational activities in patients experiencing prolonged effects.

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is presenting as a systemic disease associated with vascular inflammation and endothelial injury. Severe forms of SARS-CoV-2 infection induce acute respiratory distress syndrome (ARDS) and there is still an ongoing debate on whether COVID-19 ARDS and its perfusion defect differs from ARDS induced by other causes. Beside pro-inflammatory cytokines (such as interleukin-1 β [IL-1β] or IL-6), several main pathological phenomena have been seen because of endothelial cell (EC) dysfunction: hypercoagulation reflected by fibrin degradation products called D-dimers, micro- and macrothrombosis and pathological angiogenesis. Direct endothelial infection by SARS-CoV-2 is not likely to occur and ACE-2 expression by EC is a matter of debate. Indeed, endothelial damage reported in severely ill patients with COVID-19 could be more likely secondary to infection of neighboring cells and/or a consequence of inflammation. Endotheliopathy could give rise to hypercoagulation by alteration in the levels of different factors such as von Willebrand factor. Other than thrombotic events, pathological angiogenesis is among the recent findings. Overexpression of different proangiogenic factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-2) or placental growth factors (PlGF) have been found in plasma or lung biopsies of COVID-19 patients. Finally, SARS-CoV-2 infection induces an emergency myelopoiesis associated to deregulated immunity and mobilization of endothelial progenitor cells, leading to features of acquired hematological malignancies or cardiovascular disease, which are discussed in this review. Altogether, this review will try to elucidate the pathophysiology of thrombotic complications, pathological angiogenesis and EC dysfunction, allowing better insight in new targets and antithrombotic protocols to better address vascular system dysfunction. Since treating SARS-CoV-2 infection and its potential long-term effects involves targeting the vascular compartment and/or mobilization of immature immune cells, we propose to define COVID-19 and its complications as a systemic vascular acquired hemopathy.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Telemedicine platform COVIDREHAB for remote rehabilitation of patients after COVID-19

The world's practice has shown the importance of medical rehabilitation, which allows increasing the effectiveness of treatment of patients with COVID-19, and also significantly reduce the risks of developing complications after COVID-19. Moreover, timely medical rehabilitation reduces the frequency of disability retirement. We developed and investigated the effectiveness of the telemedicine platform "COVIDREHAB" in order to enhance the effectiveness of the recovery period during self-isolation, as well as to provide access to rehabilitation for patients residing in remote areas or unable to undergo in-person medical rehabilitation. This pilot open clinical study includes 178 patients (108 women and 70 men) aged 32 to 82 years [mean age 50 (33-56) years] who had a moderate disease of COVID-19. We used the specialised platform COVIDREHAB for remote monitoring of the rehabilitation efficiency of patients who suffered from COVID-19. During the study, the supervising doctor assigned the patient a set of specialised questionnaires, which were filled in online. The questionnaires distributed to the patient included questions specifically designed for the COVIDREHAB remote platform as well as the mMRC (Modified Medical Research Council) questionnaire. Patients who completed the remote rehabilitation programme were found to have positive dynamics of indicators of the respiratory system functional state, and complaints.Pulmonary rehabilitation is an important part of case management for patients with respiratory diseases and plays an active role in improving lung function and general well-being of patients. Patients who completed the comprehensive medical rehabilitation program using the information and analytical system COVIDREHAB, were found to have positive dynamics of indicators of the respiratory system functional state, and complaints. Hence, at the end of the course the shortness of breath severity decreased (from 34.8% to 12.4%, as well as the feeling of lack of oxygen from 32% to 17.4%, p <0.05). We anticipate the online approach to rehabilitation will improve the functioning of the respiratory and cardiovascular systems, restore physical function, reduce anxiety and depression, and restore quality of life. An essential benefit of this program is the prevention of secondary complications and reduction of serious adverse effects of COVID-19 treatment."

Rehabilitation of Patients with Platypnea-Orthodeoxia Syndrome in COVID-19 Pneumonia: Two Case Reports

Platypnea-orthodeoxia syndrome, characterized by dyspnoea and arterial desaturation while upright, is a rare complication of acute respiratory distress syndrome. We report here 2 patients with COVID-19 pneumonia, who were diagnosed with platypnea-orthodeoxia syndrome during commencement of rehabilitation, 18 and 9 days respectively after admission to the intensive care unit. Both patients presented with normocapnic hypoxaemia. One patient required mechanical ventilation with supplemental oxygen during intensive care, while the other required high-flow nasal oxygen therapy. The manifestations of platypnea-orthodeoxia syndrome were most prominent during physiotherapy, when verticalization was attempted, and hindered further mobilization out of bed, including ambulation. This report describes the clinical manifestations of platypnea-orthodeoxia syndrome and the rehabilitative strategies carried out for these 2 patients. The platypnea-orthodeoxia syndrome in these patients resolved after 65 and 22 days respectively from the day of detection. This report highlights this potentially under-recognized phenomenon, which may be unmasked during rehabilitation of patients with COVID-19 pneumonia. Good functional outcomes were achieved with a combination of verticalization training with supplemental oxygen support, respiratory techniques training and progressive endurance and resistance training, whilst awaiting resolution of the platypneaorthodeoxia syndrome.

A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists

The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.

COVID-19, when fourteen days are not enough-A case series of affected healthcare workers

We highlight the need for planning for mass workforce absentees as we prepare for subsequent surges. We suggest a multicomponent intervention including guiding return dates more by symptomatology and fitness for work rather than infectivity status.

Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art

Recent scientific literature has investigated the cardiovascular implications of COVID-19. The mechanisms of cardiovascular damage seem to involve the protein angiotensin-converting enzyme 2 (ACE2), to which severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) binds to penetrate cells and other mechanisms, most of which are still under study. Cardiovascular sequelae of COVID-19 include heart failure, cardiomyopathy, acute coronary syndrome, arrhythmias, and venous thromboembolism. This article aims to collect scientific evidence by exploiting PubMed, Scopus, and Pedro databases to highlight the cardiovascular complications of COVID-19 and to define the physiotherapy treatment recommended for these patients. Exercise training (ET), an important part of cardiac rehabilitation, is a powerful tool in physiotherapy, capable of inducing significant changes in the cardiovascular system and functional in the recovery of endothelial dysfunction and for the containment of thromboembolic complications. In conclusion, due to the wide variety of possible exercise programs that can be obtained by combining intensity, duration, and speed in various ways, and by adjusting the program based on continuous patient monitoring, exercise training is well suited to the treatment of post-COVID patients with an impaired cardiovascular system of various degrees.

Management Challenges in Chronic Obstructive Pulmonary Disease in the COVID-19 Pandemic: Telehealth and Virtual Reality

For the treatment of chronic obstructive pulmonary disease (COPD), early diagnosis and unconditionally correct management at the initial stage of the disease are very important when the symptoms are not yet too worrying. In this way, the progress of the disease can be slowed down, as can the occurrence of late, life-threatening symptoms. Pulmonary rehabilitation is an essential component of the management of COPD. The selection of appropriate exercises, which are determined during the classification of patients into a suitable improvement program, is of key importance in the process of rehabilitation. The coronavirus disease 2019 (COVID-19) pandemic has resulted in major limitations to public health care. Health systems were largely unprepared for an outbreak of this magnitude. Searching for new, attractive technologies that help patients with chronic diseases seems to be justified. This may be driven by telehealth platforms, likewise with the use of virtual reality (VR). Analysis of the available literature indicates promising effectiveness, high patient acceptance, and high motivations to undertake physical activity with the use of such a solution. Thus, the management of patients with COPD during the COVID-19 pandemic should include options for remote delivery of pulmonary rehabilitation, including home-based, telerehabilitation, and computer-based virtual programs.

Corticosteroids and pulmonary rehabilitation reducing long-term morbidity in a patient with post-COVID-19 pneumonitis: A case study

Background

Whilst research efforts have focussed on treatment during the acute phase, little work has focussed on the long‐term sequelae of COVID‐19 infection. This case described a patient who remained symptomatic several weeks after discharge from hospital with what was diagnosed as a COVID‐19 infection. There were significant deficits shown in his functional exercise testing, his pulmonary functions testing and there was evidence of fibrotic changes on his radiology.

Methods

As part of a multidisciplinary clinic, he was started on steroids and a tailored pulmonary rehabilitation course over a course of 6–8 weeks. Thereafter, his exercise testing, pulmonary function tests and radiology were all repeated to see progress.

Results

On completing the course of corticosteroids and concurrent personalised pulmonary rehabilitation, there was a dramatic improvement in the patient's symptom severity, radiology and pulmonary function. The most significant improvement noted was in his exercise testing, namely a 6‐min walk test and 1 min of sit‐to‐stands. Before treatment, he had a Medical Reserch Council (MRC) score of 2, and after it returned to his baseline of 0.

Discussion

Using corticosteroids and exercise training that allowed quantitative evaluation throughout the stages of recovery was a valuable tool to gauge progress and response to treatment. These therapies present opportunity to prevent the development of irreversible pulmonary fibrosis that could prove to be a major breakthrough in reducing long‐term morbidity and improving the quality of life of those affected.

Acute Functional Outcomes in Critically Ill COVID-19 Patients

Background: COVID-19 (Coronavirus Disease 2019) is a global cause of morbidity and mortality currently. We aim to describe the acute functional outcomes of critically ill coronavirus disease 2019 (COVID-19) patients after transferring out of the intensive care unit (ICU).

Methods: 51 consecutive critically ill COVID-19 patients at a national designated center for COVID-19 were included in this exploratory, retrospective observational cohort study from January 1 to May 31, 2020. Demographic and clinical data were collected and analyzed. Functional outcomes were measured primarily with the Functional Ambulation Category (FAC), and divided into 2 categories: dependent ambulators (FAC 0–3) and independent ambulators (FAC 4–5). Multivariate analysis was performed to determine associations.

Results: Many patients were dependent ambulators (47.1%) upon transferring out of ICU, although 92.2% regained independent ambulation at discharge. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (odds ratio 14.02, 95% CI 1.15–171.28, P = 0.039) and a longer length of ICU stay (odds ratio 1.50, 95% CI 1.04–2.16, P = 0.029) were associated with dependent ambulation upon discharge from ICU.

Conclusions: Critically ill COVID-19 survivors have a high level of impairment following discharge from ICU. Such patients should be screened for impairment and managed appropriately by rehabilitation professionals, so as to achieve good functional outcomes on discharge.