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Gregory A, Ender J, Shaw AD, Denault A, Ibekwe S, Stoppe C, Alli A, Manning MW, Brodt JL, Galhardo C, Sander M, Zarbock A, Fletcher N, Ghadimi K, Grant MC. ERAS/STS 2024 Expert Consensus Statement on Perioperative Care in Cardiac Surgery: Continuing the Evolution of Optimized Patient Care and Recovery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00399-9. [PMID: 39004570 DOI: 10.1053/j.jvca.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Alexander Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heartcenter Leipzig GmbH, Leipzig, Germany
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH
| | - André Denault
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Stephanie Ibekwe
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Christian Stoppe
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Ahmad Alli
- Department of Anesthesiology & Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto CA
| | - Carlos Galhardo
- Department of Anesthesia, McMaster University, Ontario, Canada
| | - Michael Sander
- Anesthesiology and Intensive Care Medicine, Justus Liebig University Giessen, University Hospital Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Nick Fletcher
- Institute of Anaesthesia and Critical Care, Cleveland Clinic London, London, UK
| | | | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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He X, Song Y, Cao Y, Miao L, Zhu B. Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention. Heliyon 2024; 10:e31278. [PMID: 38803859 PMCID: PMC11128526 DOI: 10.1016/j.heliyon.2024.e31278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.
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Affiliation(s)
- Xiaofang He
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuwei Song
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuchun Cao
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Liying Miao
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, Jiangsu, China
| | - Bin Zhu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
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McGrath RL, Shephard S, Parnell T, Verdon S, Pope R. Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review. Physiother Theory Pract 2023:1-31. [PMID: 38009858 DOI: 10.1080/09593985.2023.2284823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope. OBJECTIVE To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress. METHODS A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically. RESULTS 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management. CONCLUSION While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Sarah Verdon
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Rodney Pope
- Department of Rural Health, University of Melbourne, Shepparton, Australia
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Eaton TL, Taylor SP. Health system approaches to providing posthospital care for survivors of sepsis and critical illness. Curr Opin Crit Care 2023; 29:513-518. [PMID: 37641522 DOI: 10.1097/mcc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. RECENT FINDINGS Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face. Health systems can leverage existing care models such as primary care or invest in specialty programs to deliver postdischarge care. Qualitative and implementation science studies provide insights into important contextual factors for program success. Several studies demonstrate successful application of telehealth to improve reach of postdischarge support. Research is beginning to identify subtypes of survivors that may respond to tailored intervention strategies. SUMMARY Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.
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Affiliation(s)
- Tammy L Eaton
- National Clinician Scholars Program (NCSP); VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan Department of Systems, Populations and Leadership, University of Michigan School of Nursing
| | - Stephanie Parks Taylor
- Division of Hospital Medicine, Michigan Medicine; & Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Hanada M, Tanaka T, Kozu R, Ishimatsu Y, Sakamoto N, Orchanian-Cheff A, Rozenberg D, Reid WD. The interplay of physical and cognitive function in rehabilitation of interstitial lung disease patients: a narrative review. J Thorac Dis 2023; 15:4503-4521. [PMID: 37691666 PMCID: PMC10482628 DOI: 10.21037/jtd-23-209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/04/2023] [Indexed: 09/12/2023]
Abstract
Background and Objective Interstitial lung disease (ILD) encompasses several diverse pulmonary pathologies that result in abnormal diffuse parenchymal changes. When prescribing rehabilitation, several additional factors need to be considered as a result of aging, polypharmacy, and comorbidities manifested in ILD patients. This review aims to discuss issues related to frailty, skeletal muscle and cognitive function that limit physical activities in ILD patients. It will also highlight exercise training and propose complementary strategies for pulmonary rehabilitation. Methods A literature search was performed in MEDLINE, CINAHL (inception to October 19th, 2022) using search terms based on concepts of: idiopathic pulmonary fibrosis or interstitial lung disease; frailty; muscular atrophy; skeletal muscle dysfunction; cognitive dysfunction; sleep quality; sleep disorders; anxiety disorders; or depressive disorders. After eligible texts were screened, additional references were included from references cited in the screened articles. Key Content and Findings Frailty and skeletal muscle dysfunction are common in ILD. Weight loss, exhaustion, and anti-fibrotic medications can impact frailty, whereas physical inactivity, aging, corticosteroids and hypoxemia can contribute to sarcopenia (loss of muscle mass and function). Frailty is associated with worse clinical status, exercise intolerance, skeletal muscle dysfunction, and decreased quality of life in ILD. Sarcopenia appears to influence wellbeing and can potentially affect overall physical conditioning, cognitive function and the progression of ILD. Optimal assessment tools and effective strategies to prevent and counter frailty and sarcopenia need to be determined in ILD patients. Even though cognitive impairment is evident in ILD, its prevalence and underlying neurobiological model of contributing factors (i.e., inflammation, disease severity, cardiopulmonary status) requires further investigation. How ILD affects cognitive interference, motor control and consequently physical daily activities is not well defined. Strategies such as pulmonary rehabilitation, which primarily focuses on strength and aerobic conditioning have demonstrated improvements in ILD patient outcomes. Future incorporation of interval training and the integration of motor learning could improve transfer of rehabilitation strategies to daily activities. Conclusions Numerous underlying etiologies of ILD contribute to frailty, skeletal muscle and cognitive function, but their respective neurobiologic mechanisms require further investigation. Exercise training increases physical measures, but complementary approaches may improve their applicability to improve daily activities.
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Affiliation(s)
- Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takako Tanaka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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Ravara B, Giuriati W, Maccarone MC, Kern H, Masiero S, Carraro U. Optimized progression of Full-Body In-Bed Gym workout: an educational case report. Eur J Transl Myol 2023. [PMID: 37358234 PMCID: PMC10388607 DOI: 10.4081/ejtm.2023.11525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023] Open
Abstract
People suffering from fatigue syndromes spend less time exercising each day, thus aggravating their motor difficulties. Indeed, muscles and mobility deteriorate with age, while exercising muscles is the only sure countermeasure. It is useful to offer a safe and toll-free rehabilitation training: Full-Body In-Bed Gym, easy to learn and performe at home. We suggest a 10-20 min daily routine of easy and safe physical exercises that may improve the main 200 skeletal muscles used for every-day activities. Many of the exercises can be performed in bed (Full-Body In-Bed Gym), so hospital patients can learn this light workout before leaving the hospital. The routine consists of series of repetitions of 15 bodyweight exercises to be performed one after the other without time breaks in between. Alternating sequences of arm and leg exercises are followed by moving body parts in lying and sitting positions in bed. These are followed by series of tiptoeing off the bed. Progressive improvements can be tested by a series of push-ups on the floor. Starting from 3-5, number of repetitions are increased by adding 3 more every week. To maintain or even shorten total daily time of workout each movement is weekly speeded up. The devoted time every morning (or at least five days a week) to train all the major muscles of the body can remain under 10 minutes. Because there are no breaks during and between sets, the final push-ups become very challenging: at the end of the daily workout heart rate, depth and number of ventilations and frontal perspiration increase for a few minutes. We here provide an example of how to implement the progression of the Full-Body In-Bed Gym presenting an educational Case Report of a trained 80-year old person in stable pharmacological managements. In addition to strengthening the main muscles, including the ventilatory muscles, Although performed in bed, Full-Body In-Bed Gym is a resistance training equivalent to a short jog.. Started in early winter and continued regularly throughout spring and summer, Full-Body In-Bed Gym can help maintain independence of frail people, including those younger persons suffering with the fatigue syndrome related to the viral infection of the recent COVID-19 pandemic.
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Affiliation(s)
- Barbara Ravara
- Department of Biomedical Sciences, University of Padova, Padua, Italy; CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; A&C M-C Foundation for Translational Myology, Padua.
| | - Walter Giuriati
- Department of Biomedical Sciences, University of Padova, Padua.
| | - Maria Chiara Maccarone
- Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Helmut Kern
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten, Austria; Institute of Physical Medicine and Rehabilitation, Prim. Dr. H Kern GmbH, Amstetten.
| | - Stefano Masiero
- CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Padua, Italy; CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; A&C M-C Foundation for Translational Myology, Padua.
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Cao N, Barcikowski J, Womble F, Martinez B, Sergeyenko Y, Koffer JH, Kwasniewski M, Watanabe T, Xiao R, Esquenazi A. Efficacy of Early Inpatient Rehabilitation of Post-COVID-19 Survivors: Single-Center Retrospective Analysis. Am J Phys Med Rehabil 2023; 102:498-503. [PMID: 36282676 PMCID: PMC10184709 DOI: 10.1097/phm.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to understand the demographic, clinical characteristics, and effectiveness of early inpatient rehabilitation of post-COVID survivors. DESIGN A single-center retrospective chart review analysis of 100 patients admitted to a newly created acute COVID rehabilitation unit (CORE+) from April to December 2020 was conducted. RESULTS The demographic and clinical characteristics and complications of 100 post-COVID patients were reviewed. Functional outcomes of GG Self-care and Mobility Activities Items (Section GG0130 and GG0170) of the Centers for Medicare & Medicaid Services of the Inpatient Rehabilitation Facility Patient Assessment Instrument (Version 3.0) at admission and discharge, prevalence of oxygen requirement, the need for cognitive and neuropsychology support by discharge, and dispositions after completion of inpatient rehabilitation facility stay were analyzed. The functional outcomes of 59 primary pulmonary manifestations of COVID patients were further analyzed based on the presence of intensive care unit stay before transfer to the COVID rehabilitation unit. Most patients demonstrated significant functional gains after completion of inpatient rehabilitation facility stay; however, a considerable number of patients continued to require cognitive support by discharge. CONCLUSION The data suggested the benefit of early rehabilitation for hospitalized post-COVID patients. Services need to be geared to include patients' cognitive deficits.
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Lijo M, Hamilton A, Russell ME, Wren N. Acute inpatient rehabilitation for COVID-19 survivors: A retrospective case series. Physiother Theory Pract 2023:1-10. [PMID: 37184416 DOI: 10.1080/09593985.2023.2213773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patients with Coronavirus Disease 2019 (COVID-19) who required mechanical ventilation and had prolonged hospital stay present with medical instability and functional impairments after the acute hospitalization. OBJECTIVE To present the rehabilitation outcome of three patients with COVID-19 admitted to an inpatient rehabilitation unit using a case series method. METHODS Subjects included three consecutive male patients admitted to the rehabilitation unit with a diagnosis of deconditioning and critical illness myopathy. On admission, patients were evaluated by a multidisciplinary team using outcome measures such as 6-min walk test (6 MWT), 10-m walk test (10 MWT), berg balance scale (BBS), and dynamometry. Each patient received daily therapy with a minimum of 900 min per week during their rehabilitation stay. Treatment strategies included fatigue management, training of mobility and activities for daily living tasks, muscle strengthening, and cognitive retraining. RESULTS All patients showed significant improvements across all the outcome measures, specifically, the 6MWT (minimal clinically identifiable difference (MCID) range: 14-30.5 m) and the 10MWT (MCID range: 0.10-0.20 m/s) which exceeded the MCID for all three patients. The BBS also demonstrated significant improvement, surpassing the minimum detectable change of 5-7 points. Of the three patients, two were able to be discharged at an independent level, while one required supervision for safety. CONCLUSION Patients with COVID-19, who experienced prolonged hospital stay present with severe impairments in muscle strength, functional mobility, and participation in daily living tasks. Inpatient rehabilitation may have the potential to reduce impairments and accelerate the recovery process while managing ongoing medical issues.
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Affiliation(s)
- Mithu Lijo
- Rehabilitation Services, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ashley Hamilton
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
| | - Mary E Russell
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
| | - Nicole Wren
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
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Polastri M, Sepúlveda MI. Rehabilitative insights on intensive care unit–acquired weakness and post–intensive care syndrome: same setting, different conditions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Gregory AJ, Noss CD, Chun R, Gysel M, Prusinkiewicz C, Webb N, Raymond M, Cogan J, Rousseau-Saine N, Lam W, van Rensburg G, Alli A, de Vasconcelos Papa F. Perioperative Optimization of the Cardiac Surgical Patient. Can J Cardiol 2023; 39:497-514. [PMID: 36746372 DOI: 10.1016/j.cjca.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/06/2023] Open
Abstract
Perioperative optimization of cardiac surgical patients is imperative to reduce complications, utilize health care resources efficiently, and improve patient recovery and quality of life. Standardized application of evidence-based best practices can lead to better outcomes. Although many practices should be applied universally to all patients, there are also opportunities along the surgical journey to identify patients who will benefit from additional interventions that will further ameliorate their recovery. Enhanced recovery programs aim to bundle several process elements in a standardized fashion to optimize outcomes after cardiac surgery. A foundational concept of enhanced recovery is attaining a better postsurgical end point for patients, in less time, through achievement and maintenance in their greatest possible physiologic, functional, and psychological state. Perioperative optimization is a broad topic, spanning multiple phases of care and involving a variety of medical specialties and nonphysician health care providers. In this review we highlight a variety of perioperative care topics, in which a comprehensive approach to patient care can lead to improved results for patients, providers, and the health care system. A particular focus on patient-centred care is included. Although existing evidence supports all of the elements reviewed, most require further improvements in implementation, as well as additional research, before their full potential and usefulness can be determined.
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Affiliation(s)
- Alexander J Gregory
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Christopher D Noss
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rosaleen Chun
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Gysel
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Prusinkiewicz
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Webb
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Meggie Raymond
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | | | - Wing Lam
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gerry van Rensburg
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ahmad Alli
- Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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The Effect of Pulmonary Rehabilitation on Pain, Respiratory Functions and Activities of Daily Living in COVID-19 Patients. JOURNAL OF CONTEMPORARY MEDICINE 2023. [DOI: 10.16899/jcm.1227489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) requires a multidisciplinary approach owing to its multisystem involvement. Pulmonary rehabilitation may be required in patients with COVID-19. In our study, we aimed to examine the effect of the pulmonary rehabilitation program applied after the acute period of back pain in patients with severe pulmonary involvement, dyspnea and health profiles of the patients.
Method: In our retrospectively planned study, 50 patients with advanced pulmonary involvement who were treated for COVID-19 and discharged from the hospital and who were diagnosed with shortness of breath, back pain and difficulties in daily living activities in the 1st month chest diseases polyclinic controls and who were given a pulmonary rehabilitation program for a period of
1 month were included in our study. Before and 1 month after the pulmonary rehabilitation program, back pain was evaluated with the VAS, respiratory functions were evaluated with the Modified Medical Research Council Scale, and activities of daily living were evaluated with the Notthingham scale.
Results: A statistically significant difference was found between the beginning and the end of the pulmonary rehabilitation program in the Modified Medical Research Council Scale scores (p
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Incidence of and risk factors for post-intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study. Aust Crit Care 2022:S1036-7314(22)00096-0. [PMID: 36104256 DOI: 10.1016/j.aucc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients transferred from the respiratory intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients. OBJECTIVES This study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS. METHODS This cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients' general information and disease-related information. RESULTS Fifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05). CONCLUSION The PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.
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Orendáčová M, Kvašňák E. Effects of vaccination, new SARS-CoV-2 variants and reinfections on post-COVID-19 complications. Front Public Health 2022; 10:903568. [PMID: 35968477 PMCID: PMC9372538 DOI: 10.3389/fpubh.2022.903568] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Post-COVID-19 complications involve a variety of long-lasting health complications emerging in various body systems. Since the prevalence of post-COVID-19 complications ranges from 8-47% in COVID-19 survivors, it represents a formidable challenge to COVID-19 survivors and the health care system. Post-COVID-19 complications have already been studied in the connection to risk factors linked to their higher probability of occurrence and higher severity, potential mechanisms underlying the pathogenesis of post-COVID-19 complications, and their functional and structural correlates. Vaccination status has been recently revealed to represent efficient prevention from long-term and severe post-COVID-19 complications. However, the exact mechanisms responsible for vaccine-induced protection against severe and long-lasting post-COVID-19 complications remain elusive. Also, to the best of our knowledge, the effects of new SARS-CoV-2 variants and SARS-CoV-2 reinfections on post-COVID-19 complications and their underlying pathogenesis remain to be investigated. This hypothesis article will be dedicated to the potential effects of vaccination status, SARS-CoV-2 reinfections, and new SARS-CoV-2 variants on post-COVID-19 complications and their underlying mechanisms Also, potential prevention strategies against post-COVID complications will be discussed.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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14
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Collaborative integration of palliative care in critically Ill stroke patients in the neurocritical care unit: A single center pilot study. J Stroke Cerebrovasc Dis 2022; 31:106586. [PMID: 35667164 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients admitted to the Neurocritical Care Unit (NCCU) with moderate-to-severe acute strokes, along with their surrogate decision makers, have the potential for unrecognized or unmet emotional and psychological needs. Our primary objective was to determine if early integration of palliative care consultations within this cohort was feasible and would impact understanding, decision-making and emotional support to patients and their surrogate decision makers. Our secondary objective was to evaluate the long-term impact of early palliative care assessment on the development of post-traumatic stress disorder (PTSD). METHODS This was a single center prospective pilot study. Patients with moderate-to-severe ischemic and hemorrhagic strokes were randomized into two arms. The control arm received standard intensive care and the intervention arm received an additional early palliative care consultation within 72 hours of hospitalization. Study assessments with the participants were obtained on day 1-3, and day 5-7 of care with comparisons of total scores on the Questionnaire on Communication (QOC), Decisional Conflict Scale (DCS), and Hospital Anxiety and Depression Scale (HADS). Furthermore, comparisons of HADS and PTSD DSM-5 (PCL- 5) scores were completed at 3 months. Linear mixed effects models were conducted to examine the association between intervention and participant's scores. RESULTS A total of 22 participants were enrolled between February 2019 and April 2020. Statistically significant improvement in scores was seen in the total HADS score (p=0.043) and PCL5 score (p=0.033) at 3 months following intervention. CONCLUSION Collaboration between the intensive care and palliative care team with early palliative assessment may be beneficial in lowering anxiety, depression and PTSD symptoms in critically ill stroke patients and their caregivers. Further research is needed to validate these findings.
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15
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Souza TSD, Aleluia ÍRS, Pinto EB, Pinto Junior EP, Pedreira RBS, Fraga-Maia H, Pinto JM. Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2133-2142. [PMID: 35649003 DOI: 10.1590/1413-81232022276.00752022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.
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Affiliation(s)
- Thiago Santos de Souza
- Escola Bahiana de Medicina e Saúde Pública. Av. Dom João VI 275, Brotas. 40290-000 Salvador BA Brasil. .,Rede CoVida. Salvador BA Brasil
| | - Ítalo Ricardo Santos Aleluia
- Rede CoVida. Salvador BA Brasil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus BA Brasil
| | - Elen Beatriz Pinto
- Rede CoVida. Salvador BA Brasil.,Departamento de Ciências da Vida, Universidade do Estado da Bahia. Salvador BA Brasil.,Programa de Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública. Salvador BA Brasil
| | - Elzo Pereira Pinto Junior
- Rede CoVida. Salvador BA Brasil.,Centro de Integração de Dados e Conhecimentos para a Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz-Bahia. Salvador BA Brasil
| | | | - Helena Fraga-Maia
- Rede CoVida. Salvador BA Brasil.,Departamento de Ciências da Vida, Universidade do Estado da Bahia. Salvador BA Brasil
| | - Juliana Martins Pinto
- Rede CoVida. Salvador BA Brasil.,Departamento de Fisioterapia, Universidade Federal do Triângulo Mineiro. Uberaba MG Brasil
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16
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Adapt and Fear Less. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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John KJ, Mishra AK, Ramasamy C, George AA, Selvaraj V, Lal A. Heart failure in COVID-19 patients: Critical care experience. World J Virol 2022; 11:1-19. [PMID: 35117968 PMCID: PMC8788216 DOI: 10.5501/wjv.v11.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with heart failure (HF) may be at a higher risk of coronavirus disease 2019 (COVID-19) infection and may have a worse outcome due to their comorbid conditions and advanced age. In this narrative review, we aim to study the interaction between COVID-19 and HF from a critical care perspective. We performed a systematic search for studies that reported HF and critical care-related outcomes in COVID-19 patients in the PubMed and Medline databases. From a total of 1050 papers, we identified 26 that satisfied the eligibility criteria for our review. Data such as patient demographics, HF, intensive care unit (ICU) admission, management, and outcome were extracted from these studies and analyzed. We reported outcomes in heart-transplant patients with COVID-19 separately. In hospitalized patients with COVID-19, the prevalence of HF varied between 4% and 21%. The requirement for ICU admission was between 8% and 33%. HF patients with COVID-19 had an overall mortality rate between 20% and 40%. We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients, and patients with HF were more likely to require ventilation, ICU admission and develop complications. Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction, and HF with preserved ejection fraction. COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.
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Affiliation(s)
- Kevin John John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla 689103, India
| | - Ajay K Mishra
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Chidambaram Ramasamy
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Vijairam Selvaraj
- Division of Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Mayo Clinic, Rochester, MN 55902, United States
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18
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Kumar A, Roy I, Warren M, Shaibi SD, Fabricant M, Falvey JR, Vashist A, Karmarkar AM. Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs After Joint Replacement Surgery. Phys Ther 2022; 102:6506306. [PMID: 35079829 PMCID: PMC9190306 DOI: 10.1093/ptj/pzab313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models. METHODS A secondary analysis of Medicare fee-for-service claims was conducted for beneficiaries 65 years of age or older who underwent hip and knee replacement surgery from 2016 to 2017. Independent variables were hospital participation in value-based programs categorized as: (1) BPCI, (2) CJR, and (3) non-BPCI/CJR; and total minutes per day of hospital-based rehabilitation services categorized into tertiles. The primary outcome variable was discharged to the community versus discharged to institutional post-acute care settings. The association between rehabilitation amount and community discharge among BPCI, CJR, and non-BPCI/CJR hospitals was adjusted for patient-level clinical and hospital characteristics. RESULTS Participation in BPCI or CJR was not associated with community discharge. This analysis found a dose-response relationship between the amount of rehabilitation services and odds of community discharge. Among those who received a hip replacement, this relationship was most pronounced in the BPCI group; compared with the low rehabilitation category, the medium category had odds ratio (OR) = 1.28 (95% CI = 1.17 to 1.41), and the high category had OR = 1.90 (95% CI = 1.71 to 2.11). For those who received a knee replacement, there was a dose-response relationship in the CJR group only; compared with the low rehabilitation category, the medium category had OR = 1.21 (95% CI = 1.15 to 1.28), and the high category had OR = 1.56 (95% CI = 1.46 to 1.66). CONCLUSION Regardless of hospital participation in BPCI or CJR models, higher amounts of rehabilitation services delivered during acute hospitalization is associated with a higher likelihood of discharge to community following hip and knee replacement surgery. IMPACT In the era of value-based care, frontloading of rehabilitation care is vital for improving patient-centered health outcomes in acute phases of lower extremity joint replacement.
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Affiliation(s)
- Amit Kumar
- Department of Physical Therapy, Phoenix Biomedical Campus, College of Health and Human Services, Northern Arizona University, Phoenix, Arizona, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Meghan Warren
- Department of Physical Therapy, Phoenix Biomedical Campus, College of Health and Human Services, Northern Arizona University, Phoenix, Arizona, USA
| | - Stefany D Shaibi
- Department of Physical Therapy, Phoenix Biomedical Campus, College of Health and Human Services, Northern Arizona University, Phoenix, Arizona, USA
| | - Maximilian Fabricant
- Department of Physical Therapy, Phoenix Biomedical Campus, College of Health and Human Services, Northern Arizona University, Phoenix, Arizona, USA
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Sciences, School of Medicine, University of Maryland, Baltimore, Maryland, USA,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | | | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA,Sheltering Arms Institute, Richmond, Virginia, USA,Address all correspondence to Dr Karmarkarat at:
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19
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Arbillaga-Etxarri A, Lista-Paz A, Alcaraz-Serrano V, Escudero-Romero R, Herrero-Cortina B, Balañá Corberó A, Sebio-García R, Vilaró J, Gimeno-Santos E. [Respiratory physiotherapy in post-COVID-19: a decision-making algorithm for clinical practice]. OPEN RESPIRATORY ARCHIVES 2022; 4:100139. [PMID: 38620962 PMCID: PMC8507569 DOI: 10.1016/j.opresp.2021.100139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023] Open
Abstract
The outbreak of COVID-19 has posed a great challenge for the healthcare system which has been later aggravated by the need of managing clinical manifestations and potential sequelae in COVID-19 survivors. In this context, respiratory Physiotherapy emerges as a cornerstone in the interdisciplinary management warranted in this population. Given that the implementation and resources available for the interdisciplinary therapeutic interventions in Spain is scarce, it is essential to perform a comprehensive, exhaustive and personalised assessment. This will allow us to establish more accurate selection criteria in order to optimise the use of existing human and material resources. To this end, we propose here a decision-making algorithm for clinical practice to assess the clinical manifestations in people recovered from COVID-19 based on well-established, validated tests and assessment tools. This algorithm can be used at any clinical practice environment (primary care/community or hospital-based), combined with a patient-centered model and the use of community and e-Health resources and its application to improve the Physiotherapy care of these patients in the COVID-19 era.
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Affiliation(s)
- Ane Arbillaga-Etxarri
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Deusto, Gipuzkoa, España
| | - Ana Lista-Paz
- Facultad de Fisioterapia, Universidade da Coruña, A Coruña, España
| | - Victoria Alcaraz-Serrano
- Fundación Clínic para la Investigación Biomédica, Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, España
- Facultad de Ciencias de la Salud Blanquerna, Universidad Ramon Llull, Barcelona, España
| | | | - Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
- Universidad San Jorge, Campus Universitario, Zaragoza, España
| | - Ana Balañá Corberó
- Facultad de Ciencias de la Salud Blanquerna, Universidad Ramon Llull, Barcelona, España
- Servicio de Neumología, Hospital del Mar-IMIM, Barcelona, España
| | - Raquel Sebio-García
- Servicio de Rehabilitación, Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Investigaciones Biomédicas Agustí Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Jordi Vilaró
- Facultad de Ciencias de la Salud Blanquerna, Universidad Ramon Llull, Barcelona, España
- Global Research on Wellbeing (GRoW), Universidad Ramon Llull, Barcelona, España
| | - Elena Gimeno-Santos
- Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, España
- Facultad de Ciencias de la Salud Blanquerna, Universidad Ramon Llull, Barcelona, España
- Servicio de Rehabilitación, Hospital Clínic de Barcelona, Barcelona, España
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20
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Parker AM, Brigham E, Connolly B, McPeake J, Agranovich AV, Kenes MT, Casey K, Reynolds C, Schmidt KFR, Kim SY, Kaplin A, Sevin CM, Brodsky MB, Turnbull AE. Addressing the post-acute sequelae of SARS-CoV-2 infection: a multidisciplinary model of care. THE LANCET. RESPIRATORY MEDICINE 2021; 9:1328-1341. [PMID: 34678213 PMCID: PMC8525917 DOI: 10.1016/s2213-2600(21)00385-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
As of July 31, 2021, SARS-CoV-2 had infected almost 200 million people worldwide. The growing burden of survivorship is substantial in terms of the complexity of long-term health effects and the number of people affected. Persistent symptoms have been reported in patients with both mild and severe acute COVID-19, including those admitted to the intensive care unit (ICU). Early reports on the post-acute sequelae of SARS-CoV-2 infection (PASC) indicate that fatigue, dyspnoea, cough, headache, loss of taste or smell, and cognitive or mental health impairments are among the most common symptoms. These complex, multifactorial impairments across the domains of physical, cognitive, and mental health require a coordinated, multidisciplinary approach to management. Decades of research on the multifaceted needs of and models of care for patients with post-intensive care syndrome provide a framework for the development of PASC clinics to address the immediate needs of both hospitalised and non-hospitalised survivors of COVID-19. Such clinics could also provide a platform for rigorous research into the natural history of PASC and the potential benefits of therapeutic interventions.
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Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Emily Brigham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna V Agranovich
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael T Kenes
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Kelly Casey
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia Reynolds
- Sydney and Lois Eskenazi Health Critical Care Recovery Center, Indianapolis, IN, USA
| | - Konrad F R Schmidt
- Institutes of General Practice & Family Medicine, Charité University Medicine, Berlin, Germany; Institute of General Practice & Family Medicine, Jena University Hospital, Jena, Germany
| | - Soo Yeon Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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21
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Mohamed Hussein AA, Saad M, Zayan HE, Abdelsayed M, Moustafa M, Ezzat AR, Helmy R, Abd-Elaal H, Aly K, Abdelrheem S, Sayed I. Post-COVID-19 functional status: Relation to age, smoking, hospitalization, and previous comorbidities. Ann Thorac Med 2021; 16:260-265. [PMID: 34484441 PMCID: PMC8388571 DOI: 10.4103/atm.atm_606_20] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 04/08/2021] [Indexed: 01/30/2023] Open
Abstract
RATIONAL: Recently, a new “Post-COVID-19 Functional Status (PCFS) scale” is recommended in the current COVID-19 pandemic. It is proposed that it could be used to display direct retrieval and the functional sequelae of COVID-19. AIM OF THE STUDY: The aim of the study was to assess the PCFS and to evaluate if age, gender, smoking, hospitalization, and comorbidities have any effect on functional limitations in recovered COVID-19 patients. METHODS: A total of 444 registered confirmed COVID-19 patients were included. They were interviewed in our follow-up clinics and filled an Arabic translated PCFS scale as well as their demographic and clinical data. RESULTS: Eighty percent of COVID-19 recovered cases have diverse degrees of functional restrictions ranging from negligible (63.1%), slight (14.4%), moderate (2%), to severe (0.5%) based on PCFS. Furthermore, there was a substantial variance between the score of PCFS with age (P = 0.003), gender (P = 0.014), the duration since the onset of the symptoms of COVID-19 (P < 0.001), need for oxygen supplementation (P < 0.001), need for intensive care unit (ICU) admittance (P = 0.003), previous periodic influenza vaccination (P < 0.001), smoking status (P < 0.001), and finally, the presence of any comorbid disorder (P < 0.001). CONCLUSIONS: Most of the COVID-19 recovered cases have diverse degrees of functional restrictions ranging from negligible to severe based on PCFS. These restrictions were affected by age, gender, periodic influenza vaccination, smoking, duration since symptoms onset, need for oxygen or ICU admittance, and finally the presence of coexisting comorbidity.
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Affiliation(s)
| | - Mahmoud Saad
- Faculty of Medicine, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hossam E Zayan
- Department of Gastroenterology and Infectious Disease, Assiut University Hospitals, Assiut, Egypt
| | | | | | | | - Radwa Helmy
- Faculty of Pharmacy, Asswan University, Aswan, Egypt
| | - Howaida Abd-Elaal
- Faculty of Medicine, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Karim Aly
- Department of Cardiology, Assiut University Hospitals, Assiut, Egypt
| | | | - Islam Sayed
- Faculty of Medicine, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt
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22
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Hsu YT, Turner K, Lee SP. Post-acute physical therapy for a patient with critical illness associated with COVID-19: A case report. Physiother Theory Pract 2021; 38:3226-3232. [PMID: 34455906 DOI: 10.1080/09593985.2021.1972499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND : The COVID-19 pandemic is expected to bring a surge of survivors in need of post-acute rehabilitation. Preliminary research and clinical guidelines suggest patients recovering from critical illness associated with COVID-19 will present compromised function similar to acute respiratory distress syndrome (ARDS) and ICU-acquired weakness (ICUAW). However, information regarding physical therapy and progressions of physiological and functional outcomes is currently limited. This case report describes the course of recovery of a patient without significant preexisting medical conditions. CASE DESCRIPTION : The patient RW (male, age 56) tested positive for COVID-19, and was admitted to ICU for 29 days. After weaning off mechanical ventilation after 2 months of hospitalization, he was transferred to our post-acute rehabilitation facility to recover from the residual effects. Physical therapy evaluation showed that while the patient was cognitively alert, he exhibited impaired general strength and activity intolerance due to severe exertional dyspnea. The patient received physical therapy aimed at improving his functional capacity. During his 16-day stay, the patient was able to significantly improve his capacities (i.e. 600% increase in 30-second chair stand test, 69.5% improvement in walking distance in 6-minute walk test, and 132.4% longer time to exhaustion during level ground ambulation). Dyspnea remained the main factor that limited his activities. DISCUSSION : This case demonstrated that post-acute physical therapy appeared to be effective and safe in improving function after critical illness due to COVID-19 for this patient. Physical therapists are encouraged to closely monitor respiratory parameters such as heart rate, oxygen saturation, and levels of dyspnea during treatment for patient response and decisions regarding activity progression.
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Affiliation(s)
- Ya-Ting Hsu
- Encompass Health Rehabilitation Hospital of Henderson, Henderson, NV, USA
| | - Kristen Turner
- Encompass Health Rehabilitation Hospital of Henderson, Henderson, NV, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA.,Department of Physical Therapy, Asia University, Wufeng, Taichung, Taiwan
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23
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Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, Engelbert RHH, van der Schaaf M. Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study. Crit Care 2021; 25:279. [PMID: 34353341 PMCID: PMC8339801 DOI: 10.1186/s13054-021-03709-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home. METHODS A mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline. RESULTS 43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions. CONCLUSIONS This study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy. Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792 , registered 7-06-2019.
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Affiliation(s)
- Mel E Major
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daniela Dettling-Ihnenfeldt
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Stephan P J Ramaekers
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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24
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Skeletal muscle weakness in older adults home-restricted due to COVID-19 pandemic: a role for full-body in-bed gym and functional electrical stimulation. Aging Clin Exp Res 2021; 33:2053-2059. [PMID: 34047931 PMCID: PMC8160559 DOI: 10.1007/s40520-021-01885-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
Persons suffering with systemic neuromuscular disorders or chronic organ failures, spend less time for daily physical activity, aggravating their mobility impairments. From 2020, patients at risk are also older adults, who, though negative for the SARS-Cov-2 infection, suffer with a fatigue syndrome due to home restriction/quarantine. Besides eventual psycological managements, it could be useful to offer to these patients a rehabilitation workouts easy to learn and to independently repeat at home (Full-Body In-Bed Gym). Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation (FES), we suggest for this fatigue syndrome a 10–20 min long daily routine of easy and safe physical exercises that may recover from muscle weakness the main 400 skeletal muscles used for every-day activities. Leg muscles could be trained also by an adjunctive neuro-muscular electrical stimulation (NMES) in frail old persons. Many of the exercises could be performed in bed (Full-Body in-Bed Gym), thus hospitalized patients can learn this light training before leaving the hospital. Full-Body in-Bed Gym is, indeed, an extension of well-established cardiovascular-ventilation rehabilitation training performed by patients after heavy surgery. Blood pressure readings, monitored before and after daily routine of Full-Body in-Bed Gym, demonstrate a transient decrease in peripheral resistance due to increased blood flow to major body muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the fatigue syndrome related to the restrictions/quarantine imposed to the general population during the COVID-19 pandemic.
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Kotani T, Sugiyama M, Matsuzaki F, Kubodera K, Saito J, Kaneki M, Shono A, Maruo H, Mori M, Ohta S, Kasai F. Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study. J Clin Med 2021; 10:jcm10132941. [PMID: 34209010 PMCID: PMC8267911 DOI: 10.3390/jcm10132941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate the prevalence of persistent symptoms three months after discharge from the intensive care unit by checking the medical records. All patients received an early mobilization program. Four out of 13 patients (31%) had postintensive care syndrome. No patients had muscle weakness, and 11 patients (85%) returned to their previous work. However, psychiatric disorder, such as anxiety (23%) and posttraumatic stress disorder (15%), were observed. Eleven patients claimed persistent symptoms, including fatigue and numbness in the extremities. Our results suggest that the implementation of an early rehabilitation program plays some role in preventing muscle weakness and that decreasing psychiatric disorders should be a next target of patient care in the intensive care unit.
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Affiliation(s)
- Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
- Correspondence: ; Tel.: +81-3-3784-8575
| | - Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
| | - Fumika Matsuzaki
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Kota Kubodera
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Jin Saito
- Graduate School of Nursing and Rehabilitation Sciences, Showa University, Yokohama 226-8555, Japan;
| | - Mika Kaneki
- Department of Nutrition, Showa University Hospital, Tokyo 142-8666, Japan;
| | - Atsuko Shono
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Hiroko Maruo
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Maiko Mori
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Shin Ohta
- Department of Internal Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan;
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
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26
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Webber SC, Tittlemier BJ, Loewen HJ. Apparent Discordance Between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review. Phys Ther 2021; 101:6307339. [PMID: 34160029 PMCID: PMC8420624 DOI: 10.1093/ptj/pzab155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many survivors of COVID-19 experience ongoing signs and symptoms affecting multiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages. METHODS MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. Select questions from the Appraisal of Guidelines for Research and Evaluation instrument were used to evaluate the quality of consensus guidelines. RESULTS Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, activities of daily living and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation. CONCLUSION There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self-management and access to rehabilitation specialists in multidisciplinary teams. IMPACT Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.
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Affiliation(s)
| | - Brenda J Tittlemier
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
| | - Hal J Loewen
- Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
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27
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Jesus TS, Arango-Lasprilla JC, Kumar Kamalakannan S, Landry MD. Growing physical rehabilitation needs in resource-poor world regions: secondary, cross-regional analysis with data from the global burden of disease 2017. Disabil Rehabil 2021; 44:5429-5439. [PMID: 34086516 DOI: 10.1080/09638288.2021.1933619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. MATERIALS AND METHODS This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990-2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. RESULTS All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990-2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. CONCLUSIONS An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions.IMPLICATIONS FOR REHABILITATIONAsia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa.The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data.The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level.
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Affiliation(s)
- Tiago S Jesus
- Global Healthand Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Suresh Kumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health - Hyderabad (IIPH-H), Hyderabad, India
| | - Michel D Landry
- School of Medicine, Duke University, Durham, NC, USA.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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28
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LaMarca AL, MacDonald KC. On "Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome." Smith J, Lee AC, Zeleznik H, et al. Phys Ther. 2020;100:1062-1073. Phys Ther 2021; 101:6158916. [PMID: 33751127 DOI: 10.1093/ptj/pzab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Amber L LaMarca
- Outpatient Physical Therapy, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Kathryn C MacDonald
- Outpatient Physical Therapy, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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29
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Postigo-Martin P, Cantarero-Villanueva I, Lista-Paz A, Castro-Martín E, Arroyo-Morales M, Seco-Calvo J. A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists. J Clin Med 2021; 10:1691. [PMID: 33920035 PMCID: PMC8071011 DOI: 10.3390/jcm10081691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Ana Lista-Paz
- Faculty of Physiotherapy, University of La Coruña, 15006 La Coruña, Spain;
| | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Jesús Seco-Calvo
- Physiotherapy Department, Institute of Biomedicine (IBIOMED), University of Leon, Campus de Vegazana s/n, 24071 Leon, Spain;
- Department of Physiology, Visiting Professor and Researcher of University of the Basque Country, 48940 Leioa, Spain
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30
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Musheyev B, Borg L, Janowicz R, Matarlo M, Boyle H, Singh G, Ende V, Babatsikos I, Hou W, Duong TQ. Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge. J Intensive Care 2021; 9:31. [PMID: 33789772 PMCID: PMC8011060 DOI: 10.1186/s40560-021-00542-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A significant number of COVID-19 patients have been treated using invasive mechanical ventilation (IMV). The ability to evaluate functional status of COVID-19 survivors early on at ICU and hospital discharge may enable identification of patients who may need medical and rehabilitation interventions. METHODS The modified "Mental Status", ICU Mobility, and Barthel Index scores at ICU and hospital discharge were tabulated for 118 COVID-19 survivors treated with invasive mechanical ventilation (IMV). These functional scores were compared with pre-admission functional status, discharge durable medical equipment, discharge medical follow-up recommendation, duration on IMV, duration post-IMV, demographics, comorbidities, laboratory tests, and vital signs at ICU and hospital discharge. RESULTS The majority of COVID-19 IMV patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), although 94% of these patients were functionally independent prior to COVID-19 illness. Half of the patients were discharged with supplemental oxygen equipment. The most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations. Functional status improved from ICU discharge to hospital discharge (p < 0.001). Worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p < 0.05, ANOVA). CONCLUSIONS The majority of IMV COVID-19 survivors were not functionally independent at discharge and required significant follow-up medical care. The COVID-19 circumstance has placed constraints on access to in-hospital rehabilitation. These findings underscore the need for prospective studies to ascertain the short- and long-term sequela in COVID-19 survivors.
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Affiliation(s)
- Benjamin Musheyev
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lara Borg
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Rebeca Janowicz
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Michael Matarlo
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Hayle Boyle
- Department of Physical and Occupational Therapy, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Gurinder Singh
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Victoria Ende
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ioannis Babatsikos
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Wei Hou
- Department of Family, Population and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
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31
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Carraro U, Albertin G, Martini A, Giuriati W, Guidolin D, Masiero S, Kern H, Hofer C, Marcante A, Ravara B. To contrast and reverse skeletal muscle weakness by Full-Body In-Bed Gym in chronic COVID-19 pandemic syndrome. Eur J Transl Myol 2021; 31. [PMID: 33709653 PMCID: PMC8056156 DOI: 10.4081/ejtm.2021.9641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 01/30/2023] Open
Abstract
Mobility-impaired persons, either very old or younger but suffering with systemic neuromuscular disorders or chronic organ failures, spend small amounts of time for daily physical activity, contributing to aggravate their poor mobility by resting muscle atrophy. Sooner or later the limitations to their mobility enforce them to bed and to more frequent hospitalizations. We include among these patients at risk those who are negative for the SARS-COV-2 infection, but suffering with COVID-19 pandemic syndrome. Beside managements of psychological symptoms, it is mandatory to offer to the last group physical rehabilitation approaches easy to learn and self-managed at home. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation, we suggest also for chronic COVID-19 pandemic syndrome a 10-20 min long daily routine of easy and safe physical exercises that can activate, and recover from weakness, the main 400 skeletal muscles used for every-day mobility activities. Persons can do many of them in bed (Full-Body in-Bed Gym), and hospitalized patients can learn this light training before leaving the hospital. It is, indeed, an extension of well-established cardiovascular-respiratory rehabilitation training performed after heavy surgical interventions. Blood pressure readings, monitored before and after daily routine, demonstrate a transient decrease in peripheral resistance due to increased blood flow of many muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the COVID-19 pandemic syndrome.
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Affiliation(s)
- Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Italy; CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; A-C M-C Foundation for Translational Myology, Padova.
| | - Giovanna Albertin
- CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; A-C M-C Foundation for Translational Myology, Padova.
| | - Alessandro Martini
- Department of Neuroscience, University of Padova, Italy; Padova University Research Center "I Approve", University of Padov.
| | | | - Diego Guidolin
- Department of Neuroscience, Section of Human Anatomy, University of Padova.
| | - Stefano Masiero
- CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova.
| | - Helmut Kern
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten, Austria; Physiko- und Rheumatherapie, St. Pölten.
| | | | - Andrea Marcante
- UOC Recovery and Functional Rehabilitation, Lonigo Hospital, Azienda ULSS 8 Berica, Lonigo.
| | - Barbara Ravara
- Department of Biomedical Sciences, University of Padova, Italy; CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; AC M-C Foundation for Translational Myology, Padova, Italy; Department of Neuroscience, Section of Human Anatomy, University of Padova.
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32
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Sebelski CA, Tschoepe BA, Green-Wilson J, Zeigler S, Clark D. Needed 100 Years Ago and Still Needed Now: Leadership Through Crisis and Recovery. Phys Ther 2021; 101:6064340. [PMID: 33411892 DOI: 10.1093/ptj/pzaa234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/17/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Chris A Sebelski
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall Ste 1026, St. Louis, MO 63104, USA
| | - Barbara A Tschoepe
- Physical Therapy Learning Institute, Whitworth University, Boulder, Colorado, USA
| | | | | | - Diane Clark
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
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33
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Carraro U, Albertin G, Martini A, Giuriati W, Guidolin D, Masiero S, Kern H, Hofer C, Marcante A, Ravara B. To contrast and reverse skeletal muscle weakness by Full-Body In-Bed Gym in chronic COVID-19 pandemic syndrome. Eur J Transl Myol 2021. [DOI: 10.4081/ejtm.2020.9641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mobility-impaired persons, either very old or younger but suffering with systemic neuromuscular disorders or chronic organ failures, spend small amounts of time for daily physical activity, contributing to aggravate their poor mobility by resting muscle atrophy. Sooner or later the limitations to their mobility enforce them to bed and to more frequent hospitalizations. We include among these patients at risk those who are negative for the SARS-COV-2 infection, but suffering with COVID-19 pandemic syndrome. Beside managements of psychological symptoms, it is mandatory to offer to the last group physical rehabilitation approaches easy to learn and self-managed at home. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation, we suggest also for chronic COVID-19 pandemic syndrome a 10–20 min long daily routine of easy and safe physical exercises that can activate, and recover from weakness, the main 400 skeletal muscles used for every-day mobility activities. Persons can do many of them in bed (Full-Body in-Bed Gym), and hospitalized patients can learn this light training before leaving the hospital. It is, indeed, an extension of well-established cardiovascular-respiratory rehabilitation training performed after heavy surgical interventions. Blood pressure readings, monitored before and after daily routine, demonstrate a transient decrease in peripheral resistance due to increased blood flow of many muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the COVID-19 pandemic syndrome.
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34
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Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome. J Clin Med 2021; 10:jcm10040614. [PMID: 33561946 PMCID: PMC7915692 DOI: 10.3390/jcm10040614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies have reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients' condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.
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35
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Hoel V, Zweck CV, Ledgerd R. The impact of Covid-19 for occupational therapy: Findings and recommendations of a global survey. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2021. [DOI: 10.1080/14473828.2020.1855044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Viktoria Hoel
- Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
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36
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West TE, Schultz MJ, Ahmed HY, Shrestha GS, Papali A. Pragmatic Recommendations for Tracheostomy, Discharge, and Rehabilitation Measures in Hospitalized Patients Recovering From Severe COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:110-119. [PMID: 33534772 PMCID: PMC7957235 DOI: 10.4269/ajtmh.20-1173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
New studies of COVID-19 are constantly updating best practices in clinical care. However, research mainly originates in resource-rich settings in high-income countries. Often, it is impractical to apply recommendations based on these investigations to resource-constrained settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for tracheostomy, discharge, and rehabilitation measures in hospitalized patients recovering from severe COVID-19 in LMICs. We recommend that tracheostomy be performed in a negative pressure room or negative pressure operating room, if possible, and otherwise in a single room with a closed door. We recommend using the technique that is most familiar to the institution and that can be conducted most safely. We recommend using fit-tested enhanced personal protection equipment, with the fewest people required, and incorporating strategies to minimize aerosolization of the virus. For recovering patients, we suggest following local, regional, or national hospital discharge guidelines. If these are lacking, we suggest deisolation and hospital discharge using symptom-based criteria, rather than with testing. We likewise suggest taking into consideration the capability of primary caregivers to provide the necessary care to meet the psychological, physical, and neurocognitive needs of the patient.
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Affiliation(s)
- T. Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Hanan Y. Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S. Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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Physiotherapeutic management for patients with Covid-19. BIOMEDICAL ENGINEERING TOOLS FOR MANAGEMENT FOR PATIENTS WITH COVID-19 2021. [PMCID: PMC8192306 DOI: 10.1016/b978-0-12-824473-9.00008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physiotherapeutic management for patients with COVID-19 emphasizes the importance of improving respiratory function by reducing respiratory effort and optimizing oxygenation. The need for an approach specific to patients who exhibit symptoms associated with infection with COVID-19 is shown in the main fact that patients who develop medium and severe forms of this disease have oftentimes one or more diagnosis in the cardiorespiratory, oncology, renal, metabolic, etc. fields. Such treatment must be individualized, taking into account the conditions associated with the health state of the patient. The treatment is drafted by overlapping the efforts of a multidisciplinary team: physician, assistants, and physiotherapist, all of them having the same achieved goal: ensuring, at discharge from the hospital, a patient with improved signs and symptoms, able to continue their daily activities on their own. Early rehabilitation therapy for patients with COVID-19 with critical stages and average stages aims to decrease breathing difficulties, provide relief of symptoms, relieve anxiety and depression, and decrease the incidence of complications. The intervention process of early rehabilitation is applied after a general clinical assessment. The functional respiratory assessment (the evaluation of the activity of the thoracic cage, the amplitude of diaphragm activity, the pattern and breathing frequency), the heart status, the capacity to mobilize, and the ability to realize ADL must be highlighted. The rehabilitation therapy of the patients with COVID-19 includes mainly the posture management and respiratory physiotherapy. Change of posture can change the ratio of ventilation/perfusion and may lead to an improvement in the exchange of gases, but may lead to an unexpected worsening. It is recommended to use the pillows and auxiliary devices which permit a comfortable, stable position, without the need of any effort of the patient. The postural drainage can reduce the influence of sputum on the respiratory tract, which is particularly important to improve the ratio V/Q (ventilation/perfusion). The patients need to be educated to get themselves in a position that will allow gravity to assist in draining the excretions of the pulmonary lobes or the lung segments. Standing is the best position of the body for breathing in the state of rest. Physical exercises can completely expand the lungs and help in removing secretions in the lung alveoli and respiratory ways. Also the vital capacity increases and improves the respiratory function. The breathing exercises are based on deep and slow breathing (in inspiration the patient must move the diaphragm actively) and on thoracic expansion combined with the mobilization of the scapular girdle (the inspiration must be deep and slow, during the inspiration the thoracic cage is moving forward and with the raising of the upper limbs; in the expiration the thoracic cage is moving rear, and the upper limbs return to the initial position). The active cycle of the respiratory techniques is composed of three phases (control of breathing, the thoracic expansion, and the expiration). The modality of a breathing cycle must be developed regarding the patient’s health status. Even if it is estimated that at the current time approximately 80% of patients who contact the virus do not develop symptoms and will recover without having any special treatment, the given repercussions due to prolonged hospitalization or quarantine at home will represent the beginning regarding the establishment of a respiratory recovery program, which will have as objectives the improvement of the quality of life, combating a sedentary lifestyle, and bringing some benefits in the psychosocial sphere of the individual, etc. The early mobilizations and the return to an active life must be encouraged for patients with COVID-19. The prevention of the complications due to prolonged immobilization, the transfers (changing position from sitting in standing and vice versa), obtaining the static and dynamic balance, and the realization of ADL are very important.
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Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil 2020. [PMID: 33364571 DOI: 10.5606/tfrd.2020.6889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
The novel coronavirus-2019 (COVID-19) pandemic primarily affects the respiratory system. Elderly individuals with comorbidity are severely affected. Survivors weaned from mechanical ventilation are at a higher risk of developing post-intensive care syndrome (PICS). This scoping review, based on 40 recent publications, highlights pulmonary rehabilitation (PR) in COVID-19. There is a paucity of high-quality research on this topic. However, rehabilitation societies including the Turkish Society of Physical Medicine and Rehabilitation have issued PR recommendations in COVID-19 pneumonia with productive cough can benefit from diaphragmatic breathing, pursed-lip breathing, and resistance-breathing training. Besides, those in mechanical ventilation and post-PICS COVID-19 cases, oxygen therapy, early mobilization, airway clearance, aerobic exercise, gradual-graded limb muscle resistance exercise, nutritional and psychological interventions should be consideration. During PR, careful evaluation of vital signs and exercise-induced symptoms is also required. When in-person PR is not possible, telerehabilitation should be explored. However, the long-term effects of PR in COVID-19 need further evaluation.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Department of Physical Medicine and Rehabilitation, Brahmanbaria Medical College, Brahmanbaria, Bangladesh
- School of Health Sports and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Johannes J Rasker
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands
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Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehabil 2020; 66:480-494. [PMID: 33364571 PMCID: PMC7756838 DOI: 10.5606/tftrd.2020.6889] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus-2019 (COVID-19) pandemic primarily affects the respiratory system. Elderly individuals with comorbidity are severely affected. Survivors weaned from mechanical ventilation are at a higher risk of developing post-intensive care syndrome (PICS). This scoping review, based on 40 recent publications, highlights pulmonary rehabilitation (PR) in COVID-19. There is a paucity of high-quality research on this topic. However, rehabilitation societies including the Turkish Society of Physical Medicine and Rehabilitation have issued PR recommendations in COVID-19 pneumonia with productive cough can benefit from diaphragmatic breathing, pursed-lip breathing, and resistance-breathing training. Besides, those in mechanical ventilation and post-PICS COVID-19 cases, oxygen therapy, early mobilization, airway clearance, aerobic exercise, gradual-graded limb muscle resistance exercise, nutritional and psychological interventions should be consideration. During PR, careful evaluation of vital signs and exercise-induced symptoms is also required. When in-person PR is not possible, telerehabilitation should be explored. However, the long-term effects of PR in COVID-19 need further evaluation.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Department of Physical Medicine and Rehabilitation, Brahmanbaria Medical College, Brahmanbaria, Bangladesh
- School of Health Sports and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Johannes J. Rasker
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands
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Smith EM, Lee ACW, Smith JM, Thiele A, Zeleznik H, Ohtake PJ. COVID-19 and Post-intensive Care Syndrome: Community-Based Care for ICU Survivors. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2020. [DOI: 10.1177/1084822320974956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.
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Affiliation(s)
| | | | | | | | - Hallie Zeleznik
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patricia J. Ohtake
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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Pattison M. Message from the President: It is occupational therapy's time to shine. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2020. [DOI: 10.1080/14473828.2020.1825312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Edwards D, Chiaia T, Hettler J, Wilson K, Tuohy S, de Mille P. HSS Beyond: Moving Forward After COVID-19. HSS J 2020; 16:183-188. [PMID: 32837413 PMCID: PMC7424244 DOI: 10.1007/s11420-020-09776-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Danielle Edwards
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Theresa Chiaia
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jessica Hettler
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Katherine Wilson
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Sharlynn Tuohy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Polly de Mille
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Johnson JK, Lapin B, Green K, Stilphen M. Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19. Phys Ther 2020; 101:5912500. [PMID: 32986836 PMCID: PMC7543647 DOI: 10.1093/ptj/pzaa181] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients' mobility status at discharge and probability of discharging home. METHODS This retrospective study included patients with COVID-19 admitted to any of 11 hospitals in 1 health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility scales. Discharge to home versus to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models. RESULTS For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI, 1.54-5.71) and Johns Hopkins Highest Level of Mobility scores (b = 1.15; 95% CI, 0.37-1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI, 1.25-2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed. CONCLUSION Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. IMPACT Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread. LAY SUMMARY Patients with COVID-19 can benefit from more frequent and longer physical therapy visits in the hospital.
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Affiliation(s)
- Joshua K Johnson
- Address all correspondence to Dr Johnson at: Rehabilitation and Sports Therapy. Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio 44195-5243 (USA); ; @joshkj_dpt
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Karen Green
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
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Ar Mohamed Hussein A, Galal I, Saad MM, Zayan HEE, Abdelsayed MZ, Moustafa MM, Ezzat AR, Helmy RE, Abd Elaal HK, Aly K, Abdelrheem SS. Post-COVID-19 Functional Status: Relation to age, smoking, hospitalization and comorbidities.. [DOI: 10.1101/2020.08.26.20182618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractRationalRecently, a new “Post-COVID-19 Functional Status (PCFS) scale” is recommended in the current COVID-19 pandemic. It is proposed that it could be used to display direct retrieval and the functional sequelae of COVID-19.Aim of the studyTo assess the Post COVID-19 functional status in Egypt and to evaluate if age, gender, comorbidities have any effect on functional limitations in recovered COVID-19 patients.Patients and methodsA total of 444 registered confirmed COVID-19 patients were included. They were interviewed in our follow-up clinics or by calls and filled an Arabic translated PCFS scale in paper or online forms as well as their demographic and clinical data.Results80% of COVID-19 recovered cases have diverse degrees of functional restrictions ranging from negligible (63.1%), slight (14.4%), moderate (2%) to severe (0.5%) based on PCFS. Furthermore, there was a substantial variance between the score of PCFS with age (P= 0.003), gender (P= 0.014), the duration since the onset of the symptoms of COVID-19 (P <0.001), need for oxygen supplementation (P<0.001), need for ICU admittance (P= 0.003), previous periodic influenza vaccination (P<0.001), smoking status (P < 0.001) and lastly the presence of any comorbid disorder (P <0.001).ConclusionsMost of the COVID-19 recovered cases have diverse degrees of functional restrictions ranging from negligible to severe based on PCFS. These restrictions were affected by age, gender, periodic influenza vaccination, smoking, duration since symptoms onset, need for oxygen or ICU admittance, and lastly the presence of coexisting comorbidity.
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Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petraroli A, Moggio L, Ammendolia A. Rehabilitation of patients post-COVID-19 infection: a literature review. J Int Med Res 2020; 48:300060520948382. [PMID: 32840156 PMCID: PMC7450453 DOI: 10.1177/0300060520948382] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
Rehabilitation is important for patients with coronavirus disease 2019 (COVID-19) infection. Given the lack of guidelines in English on the rehabilitation of these patients, we conducted a review of the most recent reports. We performed this literature review using the principal research databases and included randomized trials, recommendations, quasi-randomized or prospective controlled clinical trials, reports, guidelines, field updates, and letters to the editor. We identified 107 studies in the database search, among which 85 were excluded after screening the full text or abstract. In total, 22 studies were finally included. The complexity of the clinical setting and the speed of spread of the severe acute respiratory syndrome coronavirus 2, which leads to rapid occupation of beds in the intensive care unit, make it necessary to discharge patients with COVID-19 who have mild symptoms as soon as possible. For these reasons, it is necessary to formulate rehabilitation programs for these patients, to help them restore physical and respiratory function and to reduce anxiety and depression, particularly patients with comorbidities and those who live alone or in rural settings, to restore a good quality of life.
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Affiliation(s)
- A. Demeco
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - N. Marotta
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - M. Barletta
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - I. Pino
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - C. Marinaro
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - A. Petraroli
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - L. Moggio
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Surgical and Medical Sciences,
University of Catanzaro “Magna Graecia”, Catanzaro, Italy
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de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo MG. Systematic rapid living review on rehabilitation needs due to COVID-19: update as of April 30th, 2020. Eur J Phys Rehabil Med 2020; 56:354-360. [DOI: 10.23736/s1973-9087.20.06378-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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48
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Dean E, Jones A, Yu HPM, Gosselink R, Skinner M. Translating COVID-19 Evidence to Maximize Physical Therapists' Impact and Public Health Response. Phys Ther 2020; 100:1458-1464. [PMID: 32589718 PMCID: PMC7337734 DOI: 10.1093/ptj/pzaa115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs). The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage. Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the contiuum of COVID-19 care. Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada,Address all correspondence to Dr. Dean at:
| | - Alice Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Sichuan, China; and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Jesus TS, Landry MD, Hoenig H, Zeng Y, Kamalakannan S, Britto RR, Pogosova N, Sokolova O, Grimmer K, Louw QA. Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4139. [PMID: 32531949 PMCID: PMC7312462 DOI: 10.3390/ijerph17114139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Michel D. Landry
- School of Medicine, Duke University, Durham, NC 27710, USA;
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA;
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Yi Zeng
- Center for Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University, Durham, NC 27710, USA;
- National School of Development and Raissun Institute for Advanced Studies, Peking University, Beijing 100871, China
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health, Hyderabad 500 033, (IIPH-H), India;
| | - Raquel R. Britto
- Rehabilitation Science Post Graduation Programs of Universidade Federal de Minas Gerais and Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Olga Sokolova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Karen Grimmer
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
| | - Quinette A. Louw
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
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Sonel Tur B, Evcik D. Is Physical Medicine and Rehabilitation needed much more for COVID-19 pandemic? Turk J Phys Med Rehabil 2020; 66:101-103. [PMID: 32760886 PMCID: PMC7401683 DOI: 10.5606/tftrd.2020.60012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Evcik
- Department of Physical Medicine and Rehabilitation, Güven Hospital, Ankara, Turkey
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