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Mesina RS, Rustøen T, Hagen M, Laake JH, Hofsø K. Long-term functional disabilities in intensive care unit survivors: A prospective cohort study. Aust Crit Care 2024; 37:843-850. [PMID: 38171986 DOI: 10.1016/j.aucc.2023.11.008] [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] [Received: 02/07/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Functional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups. OBJECTIVES The objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors. METHODS This prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL). RESULTS A total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14-3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03-2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12-0.95). CONCLUSION In a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities. ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status.
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Affiliation(s)
- Renato S Mesina
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass N-0130, Oslo, Norway
| | - Jon Henrik Laake
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4950, Nydalen N-0424, Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456, Oslo, Norway
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Chapple LAS, Kelly P. Special issue: Challenges and Opportunities for ICU Recovery. Aust Crit Care 2024; 37:835-836. [PMID: 39304406 DOI: 10.1016/j.aucc.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Affiliation(s)
- Lee-Anne S Chapple
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, Australia.
| | - Peter Kelly
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
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Gravante F, Trotta F, Latina S, Simeone S, Alvaro R, Vellone E, Pucciarelli G. Quality of life in ICU survivors and their relatives with post-intensive care syndrome: A systematic review. Nurs Crit Care 2024; 29:807-823. [PMID: 38622971 DOI: 10.1111/nicc.13077] [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] [Received: 06/02/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status. AIM This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Post-Traumatic Stress Disorders (PTSD) in studies investigating PICS. STUDY DESIGN A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123). RESULTS We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F. CONCLUSION PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL. RELEVANCE TO CLINICAL PRACTICE PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission.
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Affiliation(s)
- Francesco Gravante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Latina
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Zhao LM, Lancaster AC, Patel R, Zhang H, Duong TQ, Jiao Z, Lin CT, Healey T, Wright T, Wu J, Bai HX. Association of clinical and imaging characteristics with pulmonary function testing in patients with Long-COVID. Heliyon 2024; 10:e31751. [PMID: 38845871 PMCID: PMC11153179 DOI: 10.1016/j.heliyon.2024.e31751] [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: 09/28/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose The purpose of this study is to identify clinical and imaging characteristics associated with post-COVID pulmonary function decline. Methods This study included 22 patients recovering from COVID-19 who underwent serial spirometry pulmonary function testing (PFT) before and after diagnosis. Patients were divided into two cohorts by difference between baseline and post-COVID follow-up PFT: Decline group (>10 % decrease in FEV1), and Stable group (≤10 % decrease or improvement in FEV1). Demographic, clinical, and laboratory data were collected, as well as PFT and chest computed tomography (CT) at the time of COVID diagnosis and follow-up. CTs were semi-quantitatively scored on a five-point severity scale for disease extent in each lobe by two radiologists. Mann-Whitney U-tests, T-tests, and Chi-Squared tests were used for comparison. P-values <0.05 were considered statistically significant. Results The Decline group had a higher proportion of neutrophils (79.47 ± 4.83 % vs. 65.45 ± 10.22 %; p = 0.003), a higher absolute neutrophil count (5.73 ± 2.68 × 109/L vs. 3.43 ± 1.74 × 109/L; p = 0.031), and a lower proportion of lymphocytes (9.90 ± 4.20 % vs. 21.21 ± 10.97 %; p = 0.018) compared to the Stable group. The Decline group also had significantly higher involvement of ground-glass opacities (GGO) on follow-up chest CT [8.50 (4.50, 14.50) vs. 3.0 (1.50, 9.50); p = 0.032] and significantly higher extent of reticulations on chest CT at time of COVID diagnosis [6.50 (4.00, 9.00) vs. 2.00 (0.00, 6.00); p = 0.039] and follow-up [5.00 (3.00, 13.00) vs. 2.00 (0.00, 5.00); p = 0.041]. ICU admission was higher in the Decline group than in the Stable group (71.4 % vs. 13.3 %; p = 0.014). Conclusions This study provides novel insight into factors influencing post-COVID lung function, irrespective of pre-existing pulmonary conditions. Our findings underscore the significance of neutrophil counts, reduced lymphocyte counts, pulmonary reticulation on chest CT at diagnosis, and extent of GGOs on follow-up chest CT as potential indicators of decreased post-COVID lung function. This knowledge may guide prediction and further understanding of long-term sequelae of COVID-19 infection.
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Affiliation(s)
- Lin-Mei Zhao
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andrew C. Lancaster
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ritesh Patel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen Zhang
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Zhicheng Jiao
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Cheng Ting Lin
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terrance Healey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Thaddeus Wright
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harrison X. Bai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wiertz CMH, Hemmen B, Sep SJS, Verbunt JA. Caregiver burden and impact on COVID-19 patient participation and quality of life one year after ICU discharge - A prospective cohort study. PATIENT EDUCATION AND COUNSELING 2024; 123:108221. [PMID: 38460347 DOI: 10.1016/j.pec.2024.108221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES to investigate changes in caregiver strain, mental health complaints and QoL in caregivers of COVID-19 ICU survivors in the first year after discharge, and their associations with patients' participation and quality of life. METHODS Post-ICU COVID-19 survivors, needing inpatient rehabilitation and their informal caregivers were included. Caregiver self-administered questionnaires included quality of life, self-rated health, caregiver strain, anxiety and depression symptoms, post-traumatic stress and coping style. Patients' participation in society was assessed and quality of life. RESULTS 67 patients (78% male) and 57 caregivers (23.6% male) were included. Three months post-ICU, caregivers experienced caregiver strain (32%), anxiety (41%), depressive symptoms (16%) and PTSD (24%). One year post-ICU, rates decreased, still being 11%, 26%, 10% and 5%, respectively. Caregiver anxiety symptoms and self-rated health at three months were associated with worse patient levels of participation and quality of life one year after ICU discharge (p < 0.05). CONCLUSIONS COVID-19 caregivers experience high levels of mental health complaints one year after a patient's ICU discharge. Furthermore, our results indicate that patient participation levels and quality of life one year after ICU discharge may be negatively associated by caregiver complaints. PRACTICAL IMPLICATIONS Counselling and routine assessment of emotional complaints and unmet needs of the informal caregiver should be incorporated and addressed in the rehabilitation treatment of (COVID-19) post-ICU patients.
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Affiliation(s)
- Carolina M H Wiertz
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Bena Hemmen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Rehabilitation Medicine, Zuyderland, Heerlen, the Netherlands
| | - Simone J S Sep
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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Sneed RS, Stubblefield A, Gardner G, Jordan T, Mezuk B. Chronic Disease, Functional Limitations, and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19. J Aging Soc Policy 2024; 36:380-398. [PMID: 37463162 PMCID: PMC10794544 DOI: 10.1080/08959420.2023.2226291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/17/2022] [Indexed: 07/20/2023]
Abstract
From 2018-2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51-64 years (n = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22-14.43) and lung disease (OR: 3.79; 95% CI: 2.10-6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions.
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Affiliation(s)
- Rodlescia S Sneed
- Division of Public Health, Michigan State University, Flint, MI, USA
- Institute of Gerontology, Detroit, MI, USA
| | | | - Graham Gardner
- Department of Economics, Michigan State University, East Lansing, MI, USA
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Paul N, Cittadino J, Krampe H, Denke C, Spies CD, Weiss B. Determinants of Subjective Mental and Functional Health of Critical Illness Survivors: Comparing Pre-ICU and Post-ICU Status. Crit Care Med 2024; 52:704-716. [PMID: 38189649 PMCID: PMC11008443 DOI: 10.1097/ccm.0000000000006158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To compare ICU survivors' subjective mental and functional health before ICU admission and after discharge and to assess determinants of subjective health decline or improvement. DESIGN Secondary analysis of the multicenter cluster-randomized Enhanced Recovery after Intensive Care trial ( ClinicalTrials.gov : NCT03671447). SETTING Ten ICU clusters in Germany. PATIENTS Eight hundred fifty-five patients with 1478 follow-up assessments. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS At two patient follow-ups scheduled 3 and 6 months after ICU discharge, patients rated their subjective mental and functional/physical health on two separate visual analog scales from 0 (worst) to 10 (best) in the previous week and before ICU admission. We compared pre-ICU and post-ICU subjective health and used mixed-effects regression to assess determinants of a health decline or improvement. At the first follow-up, 20% ( n = 165/841) and 30% ( n = 256/849) of patients reported a decline in subjective mental and functional health of at least three points, respectively; 16% ( n = 133/841 and n = 137/849) outlined improvements of mental and functional health. For 65% ( n = 543/841) and 54% ( n = 456/849), mental and functional health did not change three points or more at the first follow-up. Multivariable mixed-effects logistic regressions revealed that the ICU length of stay was a predictor of mental (adjusted odds ratio [OR] per ICU day, 1.04; 95% CI, 1.00-1.09; p = 0.038) and functional health (adjusted OR per ICU day, 1.06; 95% CI, 1.01-1.12; p = 0.026) decline. The odds of a mental health decline decreased with age (adjusted OR per year, 0.98; 95% CI, 0.96-0.99; p = 0.003) and the odds of a functional health decline decreased with time after discharge (adjusted OR per month, 0.86; 95% CI, 0.79-0.94; p = 0.001). CONCLUSIONS The majority of ICU survivors did not experience substantial changes in their subjective health status, but patients with long ICU stays were prone to subjective mental and functional health decline. Hence, post-ICU care in post-ICU clinics could focus on these patients.
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Affiliation(s)
- Nicolas Paul
- All authors: Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Laporte LR, Chavez AVFG, Ranzani OT, Caldas J, Passos RDH, Ramos JGR. Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review. EINSTEIN-SAO PAULO 2024; 22:eRW0352. [PMID: 38477798 DOI: 10.31744/einstein_journal/2024rw0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. METHODS This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. RESULTS The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. CONCLUSION This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.
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Affiliation(s)
- Larrie Rabelo Laporte
- Clínica Florence, Salvador, BA, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | | | - Otavio Tavares Ranzani
- Barcelona Institute for Global Health, Universitat Pompeu Fabra; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain
- Pulmonary Division, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
- Intensive Care Unit, Hospital São Rafael, Salvador, BA, Brazil
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brazil
| | - Rogerio da Hora Passos
- Intensive Care Unit, Hospital São Rafael, Salvador, BA, Brazil
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brazil
| | - João Gabriel Rosa Ramos
- Clínica Florence, Salvador, BA, Brazil
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brazil
- Internal Medicine Department, Universidade Federal da Bahia, Salvador, BA, Brazil
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Taylor LJ, Jolley SE, Ramani C, Mayer KP, Etchill EW, Mart MF, Fakhri S, Peterson S, Colborn K, Sevin CM, Kadl A, Enfield K, Whitman GJR, Zwischenberger JB, Rove JY. Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19. J Thorac Cardiovasc Surg 2023; 166:842-851.e1. [PMID: 35431034 PMCID: PMC8920082 DOI: 10.1016/j.jtcvs.2021.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge. METHODS Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic. Physical, psychological, and cognitive deficits were measured using validated instruments and compared based on ECMO status. RESULTS Two hundred sixty two mechanically ventilated patients were compared with 46 patients cannulated for venovenous ECMO. Patients receiving ECMO were younger and traveled farther but there was no significant difference in gender, race, or body mass index. ECMO patients were mechanically ventilated for longer durations (median, 26 days [interquartile range, 19.5-41 days] vs 13 days [interquartile range, 7-20 days]) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, investigational COVID-19 therapies, blood transfusions, and inotropes. Patients receiving ECMO experienced greater bleeding and clotting events (P < .01). However, survival at discharge was similar (69.6% vs 70.6%). Of the 217 survivors, 65.0% had documented follow-up within 120 days. Overall, 95.5% were residing at home, 25.7% had returned to work or usual activity, and 23.1% were still using supplemental oxygen; these rates did not differ significantly based on ECMO status. Rates of physical, psychological, and cognitive deficits were similar. CONCLUSIONS Our data suggest that COVID-19 survivors experience significant physical, psychological, and cognitive deficits following intensive care unit admission. Despite a more complex critical illness course, longer average duration of mechanical ventilation, and longer average length of stay, patients treated with venovenous ECMO had similar survival at discharge and outcomes within 120 days of discharge.
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Affiliation(s)
- Lauren J Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Chintan Ramani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Ky
| | - Eric W Etchill
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn
| | - Shoaib Fakhri
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Skyler Peterson
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Kathryn Colborn
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn
| | - Alexandra Kadl
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Kyle Enfield
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Glenn J R Whitman
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Joseph B Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Kentucky, Lexington, Ky
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
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Schanke CM, Brekka AK, Rimehaug SA, Klokkerud M, Andersen TM. Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability. J Clin Med 2023; 12:5033. [PMID: 37568435 PMCID: PMC10419396 DOI: 10.3390/jcm12155033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. METHOD CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. RESULTS The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983-0.994) and at "B" 0.994 (0.990-0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996-0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland-Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. CONCLUSION CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.
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Affiliation(s)
- Charlotte Marie Schanke
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
| | - Anne Kristine Brekka
- Department of Physiotherapy, Sorlandet Hospital, 4838 Arendal, Norway;
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Stein Arne Rimehaug
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
| | - Mari Klokkerud
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Tiina Maarit Andersen
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
- Faculty of Health and Social Sciences, Bergen University College, 5063 Bergen, Norway
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Cijs B, Valkenet K, Heijnen G, Visser-Meily JMA, van der Schaaf M. Patients With and Without COVID-19 in the Intensive Care Unit: Physical Status Outcome Comparisons 3 Months After Discharge. Phys Ther 2023; 103:pzad039. [PMID: 37079487 PMCID: PMC10492575 DOI: 10.1093/ptj/pzad039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/16/2022] [Accepted: 02/15/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Many patients with coronavirus disease 2019 (COVID-19) infections were admitted to an intensive care unit (ICU). Physical impairments are common after ICU stays and are associated with clinical and patient characteristics. To date, it is unknown if physical functioning and health status are comparable between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The primary objective of this study was to compare handgrip strength, physical functioning, and health status between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The second objective was to identify factors associated with physical functioning and health status in patients in the ICU with COVID-19. METHODS In this observational, retrospective chart review study, handgrip strength (handheld dynamometer), physical functioning (Patient-Reported Outcomes Measurement Information System Physical Function), and health status (EuroQol 5 Dimension 5 Level) were compared between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 using linear regression. Multilinear regression analyses were used to investigate whether age, sex, body mass index, comorbidities in medical history (Charlson Comorbidity Index), and premorbid function illness (Identification of Seniors At Risk-Hospitalized Patients) were associated with these parameters in patients in the ICU with COVID-19. RESULTS In total, 183 patients (N = 92 with COVID-19) were included. No significant between-group differences were found in handgrip strength, physical functioning, and health status 3 months after ICU discharge. The multilinear regression analyses showed a significant association between sex and physical functioning in the COVID-19 group, with better physical functioning in men compared with women. CONCLUSION Current findings suggest that handgrip strength, physical functioning, and health status are comparable for patients who were in the ICU with COVID-19 and patients who were in the ICU without COVID-19 3 months after ICU discharge. IMPACT Aftercare in primary or secondary care in the physical domain of postintensive care syndrome after ICU discharge in patients with COVID-19 and in patients without COVID-19 who had an ICU length of stay >48 hours is recommended. LAY SUMMARY Patients who were in the ICU with and without COVID-19 had a lower physical status and health status than healthy people, thus requiring personalized physical rehabilitation. Outpatient aftercare is recommended for patients with an ICU length of stay >48 hours, and functional assessment is recommended 3 months after hospital discharge.
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Affiliation(s)
- Bastiaan Cijs
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Germijn Heijnen
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - J M Anne Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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de Facio CA, Guimarães FS, da Cruz AGT, Bomfim RF, Miranda SRAP, Viana DR, Dos Santos Couto Paz CC, Sato TDO, Lorenzo VAPD. Post-COVID-19 functional status scale: Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version. Braz J Phys Ther 2023; 27:100503. [PMID: 37201307 DOI: 10.1016/j.bjpt.2023.100503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/19/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The Post-COVID-19 Functional Status (PCFS) scale was created to assess the functional status of patients after hospital discharge due to COVID-19. OBJECTIVE To perform cross-cultural adaptation of the PCFS Scale and Manual into Brazilian Portuguese and evaluate its measurement properties in patients post-COVID-19. METHODS For the cross-cultural adaptation, independent translations and back-translations were performed. This was followed by a pre-test, with analysis of the Content Validity Index (CVI), and preparation of the final version, after evaluating the measurement properties. Spearman's correlation between the PCFS and the WHO Disability Classification Scheme (WHODAS 2.0) was used for convergent validity. Weighted Kappa (wκ) was used for test-retest and interobserver reliability for PCFS scores and Kappa (κ) for PCFS items. Internal consistency was assessed using Cronbach's alpha. Only patients with post-discharge COVID-19 were evaluated through video-conferencing platforms. RESULTS The CVI was 0.75-0.83 for comprehension and 0.83-0.84 for the language of the self-administered questionnaire and the structured interview version. For measurement properties, 63 patients were evaluated, 68% male, 51.50 (12.60) years, 12.28 (7.62) days of hospitalization. For the convergent validity, a strong correlation was found (r = 0.73; p<0.01). The test-retest (wκ=0.54) and interobserver (wκ=0.43) reliability was moderate and the item-by-item analyzes ranged from fair to substantial (κ=0.25-0.66) and weak to substantial (κ=0.07-0.79). Internal consistency was excellent (0.85). CONCLUSION The final PCFS in Brazilian Portuguese showed adequate content validity, reliability, internal consistency, and convergent validity for the functional assessment of patients after hospital discharge due to COVID-19.
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Affiliation(s)
| | - Fernando Silva Guimarães
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Daiane Roberta Viana
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP Brazil
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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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Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev 2023; 84:101832. [PMID: 36565961 PMCID: PMC9769029 DOI: 10.1016/j.arr.2022.101832] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Caring for the elderly has always been challenging for the intensive care unit (ICU) physician. Concerns like frailty, comorbidities, polypharmacy and advanced directives come up even before admission into the unit. The COVID-19 pandemic has put forward a variety of issues concerning elderly populations, making the topic more relevant than ever. Admittance to the ICU, an unequivocally multifactorial decision, requires special consideration from the side of the physician when caring for an elderly person. Patients' wishes are to be respected and thus given priority. Triage assessment must also account for age-related physiological alterations and functional status. Once in the ICU, special attention should be given to age-related specificities, such as therapeutic interventions' controversial role, infection susceptibility, and post-operative care, that could potentially alter the course of hospitalization and affect outcomes. Following ICU discharge, ensuring proper rehabilitation for both survivors and their caregivers can improve long-term outcomes and subsequent quality of life. The pandemic and its implications may limit the standard of care for the elderly requiring ICU support. Socioeconomic factors that further perplex the situation must be addressed. Elderly patients currently represent a vast expanding population in ICU. Tailoring safe treatment plans to match patients' wishes, and personalized needs will guide critical care for the elderly from this time forward.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece.
| | - Georgios Schinas
- Department of Internal Medicine, Medical School University of Patras, Greece
| | - Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, National and Kapodistrian University of Athens, Medical School, Greece
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Twamley J, Monks R, Beaver K. Using experience-based co-design to prioritise areas for improvement for patients recovering from critical illness. Intensive Crit Care Nurs 2023; 76:103390. [PMID: 36706498 DOI: 10.1016/j.iccn.2023.103390] [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: 04/14/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Critical illness recovery is a journey; from intensive care unit to hospital ward to home. However, evidence is limited on how best to enable recovery from critical illness. This study aimed to prioritise areas for improvement in care and services for patients recovering from critical illness. RESEARCH DESIGN This study used experience-based co-design. Service users and providers worked in partnership to identify and prioritise service improvements for patients who had survived an episode of critical illness. METHOD Qualitative interviews were carried out with patients (n = 10) who had experienced critical illness, and staff (n = 9) who had experienced caring for patients in the intensive care unit. Key patient touchpoints were identified and used to produce a film, reflecting the critical illness journey. A patient feedback event incorporated an emotional mapping exercise, to identify key points during the recovery journey. A joint patient/family (n = 10) and staff (n = 10) event was held to view the film and identify priorities for improvements. FINDINGS Emotional mapping highlighted areas where services were not synchronised with patients' needs. Four patient-focussed priorities for service improvement emerged 1. Improving the critical care experience, 2. Addressing patients' emotional and psychological needs, 3. Positioning patients at the centre of services and 4. Building a supportive framework for recovery. CONCLUSION Evidence-based co-design was used successfully in this study to identify priorities for improvements for patients recovering from critical illness. This approach positions patients at the centre of service improvements and realigns care delivery around what matters most to patients. Person-centred care provision underpins all identified priorities. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care unit staff should get to know patients and their families by talking more to patients and families about their care and engaging in more non-medical conversations. Emotional and psychological support should be provided to aid rehabilitation and recovery from critical illness in the intensive care unit, on general wards, and in the community. Information and services should be available when patients need them, rather than at fixed time points or settings. Recovery services should focus on enabling and building the self-efficacy of patients to empower them to be in control of their recovery journey.
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Affiliation(s)
- Jacqueline Twamley
- Centre for Health Research and Innovation, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, United Kingdom.
| | - Rob Monks
- School of Nursing, Midwifery and Allied Health Professionals, Faculty of Health, Social Care & Medicine - Room H223, St Helens Road, Ormskirk, Lancashire L39 4QP, United Kingdom.
| | - Kinta Beaver
- School of Health & Wellbeing, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
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Coakley K, Friedman L, McLoughlin K, Wozniak A, Hutchison P. Acute Occupational and Physical Therapy for Patients With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2023; 104:27-33. [PMID: 35926570 PMCID: PMC9340124 DOI: 10.1016/j.apmr.2022.07.010] [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: 01/05/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the function of patients with COVID-19 admitted to an acute care hospital early in the pandemic and to characterize change in function among those admitted to intensive care units (ICU) and to non-critical care services. DESIGN This descriptive, retrospective cohort study examined patients infected with SARS-CoV-2 admitted to a tertiary care medical center during the first wave of the pandemic in 2020. Included patients were stratified into 4 cohorts based on whether or not they received therapy during their hospitalization and whether or not their hospitalization included time in the ICU. Data on demographic characteristics, functional impairments, medical interventions, and functional outcomes were collected. SETTING Hospital. PARTICIPANTS 432 adult patients were included in this study (N=432). RESULTS ICU patients receiving therapy were more likely to have impaired cognition, impaired strength, and impaired sensation than non-ICU patients receiving therapy. Patients made improvements from evaluation to discharge on the Functional Status Score for the ICU, Activity Measure for Post-Acute Care Daily Activity, and AM-PAC Basic Mobility Short Forms. CONCLUSION Patients admitted with COVID-19 experienced significant functional impairments but also demonstrated improvement during the course of their hospitalizations. This study can facilitate health care provider awareness of the detrimental functional effects of COVID-19 and the potential role of rehabilitation services for these patients.
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Affiliation(s)
- Katie Coakley
- Corresponding author Katie Coakley, OTR/L, Loyola University Medical Center, Maywood, IL
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Yang PL, Chaytor NS, Burr RL, Kapur VK, McCurry SM, Vitiello MV, Hough CL, Parsons EC. Rest-Activity Rhythm Fragmentation and Weaker Circadian Strength Are Associated With Cognitive Impairment in Survivors of Acute Respiratory Failure. Biol Res Nurs 2023; 25:5-13. [PMID: 35759356 DOI: 10.1177/10998004221109925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Survivors of acute respiratory failure (ARF) experience long-term cognitive impairment and circadian rhythm disturbance after hospital discharge. Although prior studies in aging and neurodegenerative diseases indicate actigraphy-estimated rest-activity circadian rhythm disturbances are risk factors for cognitive impairment, it is unclear if this applies to ARF survivors. This study explored the relationships of actigraphy-estimated rest-activity circadian rhythms with cognitive functioning in ARF survivors at 3 months after discharge. Methods: 13 ARF survivors (mean age 51 years and 69% males) completed actigraphy and sleep diaries for 9 days, followed by at-home neuropsychological assessment. Principal component factor analysis created global cognition and circadian rhythm variables, and these first components were used to examine the global relationships between circadian rhythm and cognitive measure scores. Results: Global circadian function was associated with global cognition function in ARF survivors (r = .70, p = .024) after adjusting for age, education, and premorbid cognition. Also, greater fragmented rest-activity circadian rhythm (estimated by intradaily variability, r = .85, p = .002), and weaker circadian strength (estimated by amplitude, r = .66, p = .039; relative strength, r = .70, p = .024; 24-h lag serial autocorrelation, r = .67, p = .035), were associated with global cognition and individual cognitive tests. Conclusions: These results suggest circadian rhythm disturbance is associated with poorer global cognition in ARF survivors. Future prospective research with larger samples is needed to confirm these results and increase understanding of the relationship between disrupted circadian rhythms and cognitive impairment among ARF survivors.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, 106177National Defense Medical Center, Taipei, Taiwan
| | - Naomi S Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, 6760Washington State University, Spokane, WA, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 16181University of Washington, Seattle, WA, USA.,Office of Nursing Research, School of Nursing, 16181University of Washington, Seattle, WA, USA
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, 205280University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- School of Nursing, 16181University of Washington, Seattle, WA, USA
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, 7284University of Washington, WA, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, 89020Oregon Health and Science University School of Medicine, Portland, USA
| | - Elizabeth C Parsons
- Division of Pulmonary, Critical Care and Sleep Medicine, 205280University of Washington, Seattle, WA, USA.,Pulmonary and Critical Care Section, VA Puget Sound Health Care System, Seattle, WA, USA
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Zulbaran-Rojas A, Mishra R, Rodriguez N, Bara RO, Lee M, Bagheri AB, Herlihy JP, Siddique M, Najafi B. Safety and efficacy of electrical stimulation for lower-extremity muscle weakness in intensive care unit 2019 Novel Coronavirus patients: A phase I double-blinded randomized controlled trial. Front Med (Lausanne) 2022; 9:1017371. [PMID: 36561714 PMCID: PMC9763311 DOI: 10.3389/fmed.2022.1017371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning. Methods Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and non-functional in the CG. Primary outcomes included ankle strength (Ankles) measured by an ankle-dynamometer, and GNM endurance (GNMe) in response to E-Stim assessed with surface electromyography (sEMG). Outcomes were measured at baseline, 3 and 9 days. Results Thirty-two (IG = 16, CG = 16) lower extremities in 16 patients were independently assessed. The mean time between ICU admission and E-Stim therapy delivery was 1.8 ± 1.9 days (p = 0.29). At 3 days, the IG showed an improvement compared to the CG with medium effect sizes for Ankles (p = 0.06, Cohen's d = 0.77) and GNMe (p = 0.06, d = 0.69). At 9 days, the IG GNMe was significantly higher than the CG (p = 0.04, d = 0.97) with a 6.3% improvement from baseline (p = 0.029). E-Stim did not alter vital signs (i.e., heart/respiratory rate, blood saturation of oxygen), showed no adverse events (i.e., pain, skin damage, discomfort), nor interfere with ICU standard of care procedures (i.e., mechanical ventilation, prone rotation). Conclusion This study supports the safety and efficacy of early E-Stim therapy to potentially prevent deterioration of lower-extremity muscle conditions in critically ill COVID-19 patients recently admitted to the ICU. If confirmed in a larger sample, E-Stim may be used as a practical adjunctive therapy. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT04685213].
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Ramkinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Naima Rodriguez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - James P. Herlihy
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Muhammad Siddique
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Bijan Najafi,
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Muacevic A, Adler JR, Mainali K, Bhalala U. Post-intensive Care Syndrome in a Heterogeneous Pediatric Population. Cureus 2022; 14:e32928. [PMID: 36699782 PMCID: PMC9872940 DOI: 10.7759/cureus.32928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
Background In this study, we aimed to measure the incidence of post-intensive care syndrome among children (PICS-p) who received critical care treatment in our hospital and evaluate patient characteristics and critical care interventions associated with the development of PICS-p. Methodology We conducted a retrospective cohort review of all surviving pediatric patients admitted to an urban, academic, tertiary intensive care unit between July 2017 and June 2018. Based on the existing literature on PICS, we excluded children whose length of stay in the pediatric intensive care unit (PICU) was less than four days. We collected demographic data, clinical data, and data related to outcomes in our study cohort. We defined PICS-p a priori as a change in the Functional Status Scale (FSS) score of three or greater between pre-admission and discharge. Using Student's t-tests and Wilcoxon rank-sum tests, we compared outcomes among those with PICS-p versus those without PICS-p. Results Of the 183 patients, 36 (19.6%) were diagnosed with PICS in our study. Aside from pre-admission FSS (7 vs. 8), analysis of the two groups revealed no statistically significant difference before or at the time of admission. Upon admission to the PICU, statistically significant differences between the PICS and no PICS groups were noted in the hospital length of stay (33.5 days vs. 14.7 days), ventilation-free days (8.3 days vs. 5.2 days), and the number of procedural interventions (2.6 vs. 1). Conclusions Utilizing the FSS to determine PICS is a viable method to standardize the measurement of functional outcomes for critically ill children. In our single-center, retrospective review, nearly one out of five pediatric patients developed PICS with associated factors that included a decreased pre-hospital FSS score, increased hospital length of stay, fewer ventilation-free days, and increased number of procedural interventions. Significant opportunities exist regarding the social and psychiatric domains of PICS-p.
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Wiertz CMH, Hemmen B, Sep SJS, van Santen S, van Horn YY, van Kuijk SMJ, Verbunt JA. Life after COVID-19: the road from intensive care back to living - a prospective cohort study. BMJ Open 2022; 12:e062332. [PMID: 36323469 PMCID: PMC9638746 DOI: 10.1136/bmjopen-2022-062332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of the study was to evaluate recovery of participation in post-COVID-19 patients during the first year after intensive care unit (ICU) discharge. The secondary aim was to identify the early determinants associated with recovery of participation. DESIGN Prospective cohort study. SETTING COVID-19 post-ICU inpatient rehabilitation in the Netherlands, during the first epidemic wave between April and July 2020, with 1-year follow-up. PARTICIPANTS COVID-19 ICU survivors ≥18 years of age needing inpatient rehabilitation. MAIN OUTCOME MEASURES Participation in society was assessed by the 'Utrecht Scale for Evaluation of Rehabilitation-Participation' (USER-P) restrictions scale. Secondary measures of body function impairments (muscle force, pulmonary function, fatigue (Multidimensional Fatigue Inventory), breathlessness (Medical Research Council (MRC) breathlessness scale), pain (Numerical Rating Scale)), activity limitations (6-minute walking test, Patient reported outcomes measurement information system (PROMIS) 8b), personal factors (coping (Utrecht Proactive Coping Scale), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Global Psychotrauma Screen-Post Traumatic Stress Disorder), cognitive functioning (Checklist for Cognitive Consequences after an ICU-admission)) and social factors were used. STATISTICAL ANALYSES linear mixed-effects model, with recovery of participation levels as dependent variable. Patient characteristics in domains of body function, activity limitations, personal and social factors were added as independent variables. RESULTS This study included 67 COVID-19 ICU survivors (mean age 62 years, 78% male). Mean USER-P restrictions scores increased over time; mean participation levels increasing from 62.0, 76.5 to 86.1 at 1, 3 and 12 months, respectively. After 1 year, 50% had not fully resumed work and restrictions were reported in physical exercise (51%), household duties (46%) and leisure activities (29%). Self-reported complaints of breathlessness and fatigue, more perceived limitations in daily life, as well as personal factors (less proactive coping style and anxiety/depression complaints) were associated with delayed recovery of participation (all p value <0.05). CONCLUSIONS This study supports the view that an integral vision of health is important when looking at the long-term consequence of post-ICU COVID-19. Personal factors such as having a less proactive coping style or mental impairments early on contribute to delayed recovery.
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Affiliation(s)
- Carolina M H Wiertz
- Rehabilitation Medicine, Adelante, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Bena Hemmen
- Rehabilitation Medicine, Adelante, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Rehabilitation Medicine, Adelante, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Susanne van Santen
- Department of Intensice Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | | | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Jeanine A Verbunt
- Rehabilitation Medicine, Adelante, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
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Llarch-Pinell E, Monsó-Monsó A, Ars J, Udina C, Inzitari M, Grau-Sánchez J. [Occupational therapy intervention to improve autonomy in individuals postinfection by SARS-CoV-2]. Rehabilitacion (Madr) 2022; 56:294-301. [PMID: 34844780 PMCID: PMC8556589 DOI: 10.1016/j.rh.2021.10.002] [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] [Received: 01/28/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In the post-infection stage by SARS-CoV-2, the functional capacity of the person may be reduced, requiring admission to rehabilitation units. OBJECTIVE To describe an occupational therapy program to improve the level of autonomy in the rehabilitation of individuals after the infection by SARS-CoV-2. MATERIAL AND METHODS Longitudinal observational study of 36 patients admitted between April and June 2020 to an intermediate care facility for functional rehabilitation after SARS-CoV-2 infection. Participants received an occupational therapy program and their autonomy in activities of daily living was evaluated at admission and discharge. RESULTS Patients improved their autonomy in basic (P<.001) and instrumental (P<.001) activities of daily living after the treatment. However, patients but did not return to their baseline levels, especially in instrumental activities. CONCLUSIONS Rehabilitation programs that include occupational therapy are effective to improve the level of autonomy in individuals post-infection by SARS-CoV-2.
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Affiliation(s)
- E Llarch-Pinell
- Unidad de media estancia y Rehabilitación Geriátrica, Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Investigación RE-FiT Barcelona, Parc Sanitari Pere Virgili y Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - A Monsó-Monsó
- Unidad de media estancia y Rehabilitación Geriátrica, Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Investigación RE-FiT Barcelona, Parc Sanitari Pere Virgili y Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - J Ars
- Unidad de media estancia y Rehabilitación Geriátrica, Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Investigación RE-FiT Barcelona, Parc Sanitari Pere Virgili y Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - C Udina
- Unidad de media estancia y Rehabilitación Geriátrica, Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Investigación RE-FiT Barcelona, Parc Sanitari Pere Virgili y Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - M Inzitari
- Unidad de media estancia y Rehabilitación Geriátrica, Hospital de Atención Intermedia Parc Sanitari Pere Virgili, Barcelona, España; Grupo de Investigación RE-FiT Barcelona, Parc Sanitari Pere Virgili y Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España; Estudios de Ciencias de la Salud, Universitat Oberta de Catalunya (UOC), España
| | - J Grau-Sánchez
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa; Universidad Autónoma de Barcelona, Terrasa, Barcelona, España; Unidad de Cognición y Plasticidad Cerebral, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Lorca LA, Leão Ribeiro I, Torres-Castro R, Sacomori C, Rivera C. [Psychometric properties of the Post-COVID 19 Functional Status scale for adult COVID 19 survivors]. Rehabilitacion (Madr) 2022; 56:337-343. [PMID: 34426013 PMCID: PMC8324401 DOI: 10.1016/j.rh.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To evaluate functional state, it is fundamental to have simple instruments that allow for monitoring the course of symptoms and the commitment of the functional status that adult COVID-19 survivors may present. This study aims to evaluate the psychometric properties of the Post COVID-19 Functional Status (PCFS) scale. MATERIAL AND METHODS A cross-sectional scale validation study was performed. In the content validation 22-health professionals, whom through expert judgment evaluated the scale in the sufficiency, clarity, coherence and relevance categories. In addition, two professionals performed the retest with 20 people who had been infected with COVID-19. In addition, their observations and comments are revealed. The degree of agreement amongst the experts was determined with the Kendall coefficient. For the retest test, the Spearman coefficient was utilized. In all the analyzes, a P value of <.05 was considered. RESULTS In regards to the content validity, there was agreement between raters only for the relevance category (P=.032). A strong agreement was obtained between two evaluators (Spearman's Rho=.929 for the score). Some of the content terms were adjusted without affecting the general structure of the scale. Of the original 16 items that make up the PCFS scale, none was eliminated. CONCLUSIONS The Spanish version of the PCFS (Chile) was adapted to the cultural context of the country, shows good psychometric characteristics in terms of reliability.
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Affiliation(s)
- L A Lorca
- Servicio de Medicina Física y Rehabilitación, Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago, Chile
| | - I Leão Ribeiro
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - R Torres-Castro
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - C Sacomori
- Escuela de Kinesiología, Universidad Bernardo O'Higgins, Santiago, Chile
| | - C Rivera
- Clínica Alemana, Santiago, Chile; Hospital de Urgencia Asistencia Pública, Santiago, Chile
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Heimburg K, Cronberg T, Tornberg ÅB, Ullén S, Friberg H, Nielsen N, Hassager C, Horn J, Kjærgaard J, Kuiper M, Rylander C, Wise MP, Lilja G. Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Resusc Plus 2022; 11:100275. [PMID: 36164471 PMCID: PMC9508620 DOI: 10.1016/j.resplu.2022.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Limitations in physical function are common in cardiac arrest survivors. Age and gender are associated with limitations in physical function. Cognitive impairment is a predictive variable for physical limitations. Anxiety and depression symptoms are associated with physical limitations. Physical function should be addressed at follow-up after cardiac arrest.
Title Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Background Out-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. Aims To describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. Methods A cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results 287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. Conclusion Self-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registration ClinicalTrials.gov Identifier: NCT01946932.
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Survivorship After Critical Illness and Post-Intensive Care Syndrome. Clin Chest Med 2022; 43:551-561. [PMID: 36116822 DOI: 10.1016/j.ccm.2022.05.009] [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: 11/24/2022]
Abstract
Improvements in critical care medicine have led to a marked increase in survivors of the intensive care unit (ICU). These survivors encounter many difficulties following ICU discharge. The term post -intensive care syndrome (PICS) provides a framework for identifying the most common symptoms which fall into three domains: cognitive, physical, and mental health. There are numerous risk factors for the development of PICS including premorbid conditions and specific elements of ICU hospitalizations. Management is complex and should take an individualized approach with interdisciplinary care. Future research should focus on prevention, identification, and treatment of this unique population.
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Geen O, Perrella A, Rochwerg B, Wang XM. Applying the geriatric 5Ms in critical care: the ICU-5Ms. Can J Anaesth 2022; 69:1080-1085. [PMID: 35689016 DOI: 10.1007/s12630-022-02270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Olivia Geen
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Andrew Perrella
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
| | - Xuyi Mimi Wang
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Platz T, Kohlmann T, Fleßa S, Einhäupl B, Koppelow M, Willacker L, Gdynia HJ, Henning E, Herzog J, Müller F, Nowak DA, Pletz R, Schlachetzki F, Schmidt-Wilcke T, Schüttler M, Straube A, Süss R, Ziegler V, Bender A. Optimizing home-based long-term intensive care for neurological patients with neurorehabilitation outreach teams - protocol of a multicenter, parallel-group randomized controlled trial (OptiNIV-Study). BMC Neurol 2022; 22:290. [PMID: 35927616 PMCID: PMC9351064 DOI: 10.1186/s12883-022-02814-y] [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: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Even with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN. Methods This healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition. Discussion The OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER. Trial registration The trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326.
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Affiliation(s)
- Thomas Platz
- Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Universitätsmedizin Greifswald, Fleischmannstrasse 44, 17475, Greifswald, Germany. .,Institute for Neurorehabilitation and Evidence-Based Practice, "An-Institut", BDH-Klinik Greifswald, University of Greifswald, Greifswald, Germany.
| | - Thomas Kohlmann
- Institut für Community Medicine, Abt. Methoden der Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Steffen Fleßa
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, University Greifswald, Greifswald, Germany
| | - Bernadette Einhäupl
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martha Koppelow
- Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Universitätsmedizin Greifswald, Fleischmannstrasse 44, 17475, Greifswald, Germany
| | - Lina Willacker
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Esther Henning
- Institut für Community Medicine, Abt. Methoden der Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | | | | | | | - Romy Pletz
- Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Universitätsmedizin Greifswald, Fleischmannstrasse 44, 17475, Greifswald, Germany
| | - Felix Schlachetzki
- Klinik für Neurologie der Universität Regensburg am Medbo Bezirksklinikum, Zentrum für Vaskuläre Neurologie und Intensivmedizin, Regensburg, Germany
| | | | | | - Andreas Straube
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rebekka Süss
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, University Greifswald, Greifswald, Germany
| | - Volker Ziegler
- Klinik für Neurologische Frührehabilitation, Rhön-Klinikum, Bad Neustadt a. d. Saale, Germany
| | - Andreas Bender
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Therapiezentrum Burgau, Hospital for Neurorehabilitation, Burgau, Germany
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Impact of Physiotherapy on Patients Suffering from COVID-19: An Observational Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: COVID-19 was the turning point of 2020, endangering the health of the entire population around the world. Among other therapeutic methods and supportive measures, physiotherapy represents a useful intervention applied on COVID-19 patients suffering from respiratory symptoms, this being supported by recent literature data. Materials and Methods: The study was performed on 45 patients diagnosed with COVID-19 (28 men, 17 women, mean age = 65.03, standard deviation = 14.83). They participated for 2 weeks (the required period of hospitalization) to a series of 14 physiotherapy sessions, which included: position changing, respiratory control, passive joint movements, bed workout, and walking exercises. Depending on the status of the patient, two distinct types of physiotherapy were performed (mild and active). The status of the patients was assessed through a basic assessment of the vital signs, range of motion, degree of dyspnea, and also through the UZ Leuven Start To Move protocol (STMP). The statistical analysis of the data was performed using the Statistica 10 program and included the Spearman correlations (for measuring the strength and direction of association between the ranked variables), the Mann-Whitney test (for measuring the significance of the differences between the groups of patients who undergone light vs. active physiotherapy) and factor analysis (for assessing the changes of the clinical parameters investigated in the study, depending on the type of applied therapy). All differences were considered significant at p < 0.05. Results: The majority of patients (n = 38) benefited from physiotherapy, with the complete disappearance of symptoms met only in the group of patients who followed active physiotherapy. These effects depended on the applied type of physiotherapy (mild vs. active, p = 0.47). In contrast, all patients who were unable to perform physiotherapy (n = 7) remained symptomatic at discharge. Conclusion: The results of this study point out the significant additional role of physiotherapy for a better management of COVID-19 patients. More studies are needed to investigate not only the impact that physiotherapy has on the symptoms of this disease, but also its effects on effort capacity, muscle strength and lung capacity.
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Worse pre-admission quality of life is a strong predictor of mortality in critically ill patients. Turk J Phys Med Rehabil 2022; 68:19-29. [PMID: 35949964 PMCID: PMC9305648 DOI: 10.5606/tftrd.2022.5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives
In this study, we aimed to investigate whether quality of life (QoL) before intensive care unit (ICU) admission could predict ICU mortality in critically ill patients.
Patients and methods
Between January 2019 and April 2019, a total of 105 ICU patients (54 males, 51 females; mean age: 58 years; range, 18 to 91 years) from two ICUs of a tertiary care hospital were included in this cross-sectional, prospective study. Pre-admission QoL was measured by the Short Form (SF)-12- Physical Component Scores (PCS) and Mental Component Scores (MCS) and EuroQoL five-dimension, five-level scale (EQ-5D-5L) within 24 h of ICU admission and mortality rates were estimated.
Results
The overall mortality rate was 28.5%. Pre-admission QoL was worse in the non-survivors independent from age, sex, socioeconomic and education status, and comorbidities. During the hospitalization, the rate of sepsis and ventilator/hospital-acquired pneumonia were similar among the two groups (p>0.05). Logistic regression analysis adjusted for sex, age, education status, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores showed that pre-admission functional status as assessed by the SF-12 MCS (odds ratio [OR]: 14,2; 95% confidence interval [CI]: 2.5-79.0), SF-12 PCS (OR: 10.6; 95% CI: 1.8-62.7), and EQ-5D-5L (OR: 8.0; 95% CI: 1.5-44.5) were found to be independently associated with mortality.
Conclusion
Worse pre-admission QoL is a strong predictor of mortality in critically ill patients. The SF-12 and EQ-5D-5L scores are both valuable tools for this assessment. Not only the physical status, but also the mental status before ICU admission should be evaluated in terms of QoL to better utilize ICU resources.
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van Haastregt JCM, Everink IHJ, Schols JMGA, Grund S, Gordon AL, Poot EP, Martin FC, O'Neill D, Petrovic M, Bachmann S, van Balen R, van Dam van Isselt L, Dockery F, Holstege MS, Landi F, Pérez LM, Roquer E, Smalbrugge M, Achterberg WP. Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance. Eur Geriatr Med 2022; 13:291-304. [PMID: 34800286 PMCID: PMC8605452 DOI: 10.1007/s41999-021-00575-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. METHODS The guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined with experiences from experts in countries participating in the Geriatric Rehabilitation Special Interest Group of the European Geriatric Medicine Society. RESULTS This guidance for post-acute COVID-19 rehabilitation is divided into a section addressing general recommendations for geriatric rehabilitation and a section addressing specific processes and procedures. The Sect. "General recommendations for geriatric rehabilitation" addresses: (1) general requirements for post-acute COVID-19 rehabilitation and (2) critical aspects for quality assurance during COVID-19 pandemic. The Sect. "Specific processes and procedures", addresses the following topics: (1) patient selection; (2) admission; (3) treatment; (4) discharge; and (5) follow-up and monitoring. CONCLUSION Providing tailored geriatric rehabilitation treatment to post-acute COVID-19 patients is a challenge for which the guidance is designed to provide support. There is a strong need for additional evidence on COVID-19 geriatric rehabilitation including developing an understanding of risk profiles of older patients living with frailty to develop individualised treatment regimes. The present guidance will be regularly updated based on additional evidence from practice and research.
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Affiliation(s)
- Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Derby, UK
| | - Else P Poot
- Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Desmond O'Neill
- Trinity College Dublin Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Stefan Bachmann
- Department of Rheumatology and Internal Medicine, Kliniken Valens, Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Frances Dockery
- Department of Geriatrics and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marije S Holstege
- Department of Research GRZPLUS, Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Laura M Pérez
- Clinical Head of Outpatient Clinic and Geriatric Home Care, Intermediate Care Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Research Group on Aging, Frailty and Transitions in Barcelona (RE-FiT BCN), Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Esther Roquer
- Geriatric Service, University Hospital Sant Joan de Reus, Reus, Spain
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chair of the Guidance Committee Post COVID-19 Geriatric Rehabilitation, Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
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Morelli N, Parry SM, Steele A, Lusby M, Montgomery-Yates AA, Morris PE, Mayer KP. Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome. J Intensive Care Med 2022; 37:890-898. [PMID: 35072548 PMCID: PMC9160440 DOI: 10.1177/08850666221075568] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The purpose was to examine Dual Task (DT) performance in patients surviving
severe and critical COVID-19 compared to patients with chronic lung disease
(CLD). Secondarily, we aimed to determine the psychometric properties of the
Timed Up and Go (TUG) test in patients surviving COVID-19. Design Prospective, cross-sectional, observational study. Setting Academic medical center within United States. Patients Ninety-two patients including 36 survivors of critical COVID-19 that required
mechanical ventilation (critical-COVID), 20 patients recovering from
COVID-19 that required supplemental oxygen with hospitalization
(severe-COVID), and 36 patients with CLD serving as a control group. Measurements and Main Results Patients completed the TUG, DT-TUG, Short Physical Performance Battery
(SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A
subset of patients returned at 3-months and repeated testing to determine
the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3)
performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s;
P = .024) and Severe-COVID group (13.1 ± 5.1 s;
P = .025). Within-subject difference between TUG and
DT-TUG was also significantly worse in critical-COVID group (−21%) compared
to CLD (−10%; P = .012), even despite CLD patients having a
higher comorbid burden (P < .003) and older age
(P < .001). TUG and DT-TUG demonstrated strong to
excellent construct validity to the chair rise test, gait speed, and 6MWT
for both COVID-19 groups (r = −0.84to 0.73, P < .05).
One- and 3-months after hospital discharge there was a floor effect of 14%
(n = 5/36) and 5.2% (n = 1/19), respectively for patients in the
critical-COVID group. Ceiling effects were noted in four (11%)
critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at
1-month. Conclusion The ability to maintain mobility performance in the presence of a cognitive
DT is grossly impaired in patients surviving critical COVID-19. DT
performance may subserve the understanding of impairments related to
Post-intensive care syndrome (PICS) for survivors of critical illness.
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Affiliation(s)
- Nathan Morelli
- Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Selina M. Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Angela Steele
- Pulmonary Rehabilitation Center, Therapeutic Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Megan Lusby
- Pulmonary Rehabilitation Center, Therapeutic Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Ashley A. Montgomery-Yates
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
| | - Peter E. Morris
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
| | - Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, University of Kentucky, Lexington, Kentucky, USA
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, USA
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Kourek C, Nanas S, Kotanidou A, Raidou V, Dimopoulou M, Adamopoulos S, Karabinis A, Dimopoulos S. Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support. J Cardiovasc Dev Dis 2022; 9:34. [PMID: 35200688 PMCID: PMC8875180 DOI: 10.3390/jcdd9020034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with severe cardiac, respiratory or combined cardiorespiratory failure. Critically ill patients on ECMO very often present intensive care unit-acquired weakness (ICU-AW); thus, leading to decreased exercise capacity and increased mortality rates. Early mobilization and physical therapy have been proven to be safe and feasible in critically ill patients on ECMO, either as a bridge to lung/heart transplantation or as a bridge to recovery. Rehabilitation has beneficial effects from the early stages in the ICU, resulting in the prevention of ICU-AW, and a decrease in episodes of delirium, the duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates. It also improves functional ability, exercise capacity, and quality of life. Rehabilitation requires a very careful, multi-disciplinary approach from a highly specialized team from different specialties. Initial risk assessment and screening, with appropriate physical therapy planning and exercise monitoring in patients receiving ECMO therapy are crucial factors for achieving treatment goals. However, more randomized controlled trials are required in order to establish more appropriate individualized exercise training protocols.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Anastasia Kotanidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Maria Dimopoulou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
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Longobardi I, do Prado DML, Goessler KF, de Oliveira Júnior GN, de Andrade DCO, Gualano B, Roschel H. Benefits of Home-Based Exercise Training Following Critical SARS-CoV-2 Infection: A Case Report. Front Sports Act Living 2022; 3:791703. [PMID: 35088048 PMCID: PMC8787158 DOI: 10.3389/fspor.2021.791703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
In the current scenario, in which an elevated number of COVID-19 survivors present with severe physical deconditioning, exercise intolerance, persistent symptoms, and other post-acute consequences, effective rehabilitation strategies are of utmost relevance. In this study, we report for the first time the effect of home-based exercise training (HBET) in a survivor patient from critical COVID-19 illness. A 67-year-old woman who had critical COVID-19 disease [71 days of hospitalization, of which 49 days were in the intensive care unit (ICU) with invasive mechanical ventilation due to respiratory failure] underwent a 10-week HBET aiming to recovering overall physical condition. Before and after the intervention, we assessed cardiopulmonary parameters, skeletal muscle strength and functionality, fatigue severity, and self-reported persistent symptoms. At baseline (3 months after discharge), she presented with severe impairment in cardiorespiratory functional capacity (<50% age predicted VO2peak). After the intervention, remarkable improvements in VO2peak (from 10.61 to 15.48 mL·kg-1·min-1, Δ: 45.9%), oxygen uptake efficiency slope (OUES; from 1.0 to 1.3 L·min-1, Δ: 30.1%), HR/VO2 slope (from 92 to 52 bpm·L-1, Δ: -43.5%), the lowest VE/VCO2 ratio (from 35.4 to 32.9 L·min-1, Δ: -7.1%), and exertional dyspnea were observed. In addition, handgrip strength (from 22 to 27 kg, Δ: 22.7%), 30-s Sit-to-Stand (30-STS; from 14 to 16 repetitions, Δ:14.3%), Timed-Up-and-Go (TUG; from 8.25 to 7.01 s, Δ: -15%) performance and post-COVID functional status (PCFS) score (from 4 to 2) were also improved from baseline to post-intervention. Self-reported persistent symptoms were also improved, and Fatigue Severity Scale (FSS) score decreased (from 4 to 2.7) from baseline to post-intervention. This is the first evidence that a semi-supervised, HBET program may be safe and potentially effective in improving cardiorespiratory and physical functionality in COVID-19 survivors. Controlled studies are warranted to confirm these findings.
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Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Ding M, Yang C, Li Y. Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review. Front Pediatr 2022; 10:905167. [PMID: 35783316 PMCID: PMC9249083 DOI: 10.3389/fped.2022.905167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Survivors of critical illness may experience short- and long-term physical function impairments. This review aimed to identify the risk factors for physical function impairments from the current literature. DATA SOURCES A systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guideline was performed. STUDY SELECTION The risk factors reported in all human studies reporting physical function impairments in children admitted to the pediatric intensive care unit (PICU) were reviewed and categorized. Two investigators independently screened, evaluated, and selected studies for inclusion. Data from eligible studies were extracted by one investigator, and another investigator reviewed and verified the data. A systematic narrative approach was employed to review and summarize the data. RESULTS A total of 264 studies were found to be eligible, with 19 studies meeting the inclusion criteria. Children admitted to the PICU experienced physical function impairments during their stay, which can last for years. The studies varied primarily in the measurement timing and tools used. The most frequently reported risk factors for physical function impairments were age, race or ethnicity, a pre-admission chronic condition, sex, disease severity, duration or the presence of mechanical ventilation, and admission diagnosis. CONCLUSIONS Physical function impairments may be persistent in PICU survivors. To prevent these impairments in critically ill patients, pediatricians should pay attention to modifiable risk factors, such as the duration of mechanical ventilation. Future studies need to promote a combination of standardized measures for the detection and prevention of physical function impairments.
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Affiliation(s)
- Min Ding
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Chunfeng Yang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Yumei Li
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
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35
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Toobe M. [Post-intensive care syndrome in pediatrics]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021; 78:408-414. [PMID: 34962736 PMCID: PMC8765375 DOI: 10.31053/1853.0605.v78.n4.32809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The term “Post-intensive care syndrome” describe new impairments after critical illness, that worsen physical, cognitive, or mental health, and persist after acute care hospitalization. Methods a bibliographic search was carried out using the Medline database. The search period was from 2012 to 2020 using keywords. Results Emerging evidence suggests that there are significant and persistent physical, cognitive, and psychiatric morbidities among adult and pediatric survivors of critical illness. In this population it can also affect the “social health” sphere. The families of hospitalized patients often manifest psychological symptoms. For prevention and management there are various tools, the package of measures "ABCDEFGH", the conformation and organization of the health team, early mobilization and physical rehabilitation, nutritional contribution, environmental management, intensive care unit diaries and support between pairs. Conclusion Each patient´s situation is unique and the challenges they face may require different interventions. These should be studied to increase the available evidence in the pediatric population. We still do not have a specific instrument to monitor the syndrome in pediatrics or information on long-term sequelae in children.
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Affiliation(s)
- Marina Toobe
- Hospital de Pediatria S.A.M.I.C Prof. Dr. Juan P. Garrahan.
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36
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. SPLIT ENZ: Survivorship of Patients post Long Intensive care stay, Exploration/Experience in a New Zealand cohort (A mixed methods study protocol) (Preprint). JMIR Res Protoc 2021; 11:e35936. [PMID: 35297773 PMCID: PMC8972103 DOI: 10.2196/35936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/35936
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Affiliation(s)
- Lynsey Sutton
- Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Geen O, Rochwerg B, Wang XM. Optimisation des soins chez les personnes âgées gravement malades. CMAJ 2021; 193:E1850-1859. [PMID: 34872961 PMCID: PMC8648358 DOI: 10.1503/cmaj.210652-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Olivia Geen
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont.
| | - Bram Rochwerg
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
| | - Xuyi Mimi Wang
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
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38
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Larsson AC, Palstam A, Persson HC. Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19: A Descriptive Cross-Sectional Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111600. [PMID: 34770113 PMCID: PMC8582899 DOI: 10.3390/ijerph182111600] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022]
Abstract
An estimated 14–20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.
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Affiliation(s)
- Alexandra C. Larsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
- Correspondence:
| | - Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Neuro Science, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Hanna C. Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
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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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Daste C, Ficarra S, Dumitrache A, Cariou A, Lefèbvre A, Pène F, Roche N, Roren A, Thery C, Vidal J, Nguyen C, Rannou F, Lefèvre-Colau MM. Post-intensive care syndrome in patients surviving COVID-19. Ann Phys Rehabil Med 2021; 64:101549. [PMID: 34182168 PMCID: PMC8233854 DOI: 10.1016/j.rehab.2021.101549] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 05/31/2021] [Indexed: 10/29/2022]
Affiliation(s)
- Camille Daste
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France; AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France.
| | - Simona Ficarra
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Alina Dumitrache
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Alain Cariou
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Médecine intensive et Réanimation, 75014 Paris, France
| | - Aurélie Lefèbvre
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Pneumologie, 75014 Paris, France
| | - Frédéric Pène
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Nicolas Roche
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Pneumologie, 75014 Paris, France
| | - Alexandra Roren
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Camille Thery
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Jean Vidal
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Christelle Nguyen
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - François Rannou
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Centre Universitaire des Saints-Pères, 75006 Paris, France,Institut Fédératif de Recherche sur le Handicap, 75013 Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
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41
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Affiliation(s)
- Olivia Geen
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont.
| | - Bram Rochwerg
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
| | - Xuyi Mimi Wang
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
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Predisease Physical Activity Level and Current Functional Capacity in Patients With COVID-19: Relationship With Pneumonia and Oxygen Requirement. J Phys Act Health 2021; 18:1358-1363. [PMID: 34548418 DOI: 10.1123/jpah.2021-0008] [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] [Received: 01/14/2021] [Revised: 06/12/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, restrictive measures can reduce physical activity. The purpose of this study was to evaluate predisease physical activity and current functional capacity in patients with and without the presence of pneumonia and oxygen requirement in Turkish survivors of COVID-19. METHODS Among the COVID-19 patients admitted to the hospital, 100 patients were selected. Data about predisease physical activity (by short-form International Physical Activity Questionnaire), oxygen requirement and presence of pneumonia, and current functional capacity (by the 6-min walking test) were collected. Continuous and categorical variables were compared with the Mann-Whitney U and χ2 test, respectively (P < .05). RESULTS The predisease physical activity levels and current functional capacity of patients with pneumonia and oxygen requirement were significantly lower than patients without pneumonia and oxygen requirement (P < .05). However, there was no significant difference between males and females (P > 0.05). Pneumonia and oxygen requirement was more common in the older adults (P < .05). Also, a significant correlation was found between age with predisease physical activity (r = .530, P = .000) and current functional capacity (r = -.346, P = .000) and predisease physical activity level with current functional capacity (r = .523, P = .001). CONCLUSION The physical activity level may be related to the severity of COVID-19 disease.
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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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Morelli N, Johnson NF, Cassity EP, Kalema AG, Morris PE, Montgomery-Yates AA, Mayer KP. Feasibility of Contrasting Brain Connectivity Patterns in Cognitive and Motor Cerebral Networks to Clinical Outcomes in Patients Surviving Acute Respiratory Failure: A Pilot Study. Cureus 2021; 13:e17785. [PMID: 34659996 PMCID: PMC8495532 DOI: 10.7759/cureus.17785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is a paucity of research regarding the feasibility and association of cerebral cortex function to patient outcomes after acute respiratory failure (ARF). PURPOSE To determine the feasibility of functional connectivity measures and examine the association of functional connectivity to a multifaceted battery of outcomes in survivors of ARF. METHODS Eight ARF patients (age:58±3.7, ICU days:10.4±8.6) completed functional magnetic resonance imaging (fMRI), cognitive, physical-function, anxiety, depression, and driving simulator tests at one month post-hospital discharge. Pearson's correlations assessed the relationship between functional connectivity within the default mode network (FPN), sensorimotor network (SMN), and frontoparietal network (FPN) to outcomes. RESULTS Low physical-function (r=0.75, p=0.03) and divided-attention (r=-0.86, p=0.03) during the driving simulator task correlated with low FPN connectivity. Low SMN connectivity demonstrated relationships to slower gait speed (r=0.82, p=0.01) and low short physical performance battery (SPPB) scores (r=0.81, p=0.01). CONCLUSIONS fMRI is feasible to assess ARF patients' post-ICU limitations, as low post-ARF brain connectivity may be linked to low physical function, providing potential development of therapeutic interventions.
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Affiliation(s)
- Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, USA
| | - Nathan F Johnson
- Department of Physical Therapy, University of Kentucky, Lexington, USA
| | - Evan P Cassity
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Peter E Morris
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Kirby P Mayer
- Department of Physical Therapy, University of Kentucky, Lexington, USA
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45
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The Efficacy and Safety of In-Intensive Care Unit Leg-Cycle Ergometry in Critically Ill Adults. A Systematic Review and Meta-analysis. Ann Am Thorac Soc 2021; 17:1289-1307. [PMID: 32628501 DOI: 10.1513/annalsats.202001-059oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Survivors of critical illness may experience physical-function deficits after intensive care unit (ICU) discharge. In-ICU cycle ergometry may facilitate early mobilization and decrease functional impairment.Objective: We conducted a systematic review and meta-analysis to understand the effect of in-ICU leg-cycle ergometry on patient-important and clinically relevant outcomes.Data Sources: We searched eight electronic databases from inception until July 2019.Data Extraction: We included randomized controlled trials (RCTs) and nonrandomized studies of critically ill adults admitted to the ICU for ≥24 hours, comparing cycling interventions to control arms that did not receive cycling. Main outcomes included physical function, mechanical ventilation (MV) duration, length of stay (LOS), quality of life (QoL), mortality, and safety. We conducted independent duplicate-citation screening, data abstraction, and risk-of-bias assessments. We pooled RCTs using a random-effects model and calculated the risk ratio (RR), mean difference (MD), or standardized MD with 95% confidence intervals (CIs). We assessed certainty of outcomes using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: Of 6,531 citations, we included 12 RCTs and 2 nonrandomized studies (n = 926). Between the cycling and control groups, there were no differences in physical function at hospital discharge (3 RCTs; n = 225; standardized MD, 0.07 [95% CI, -0.38 to 0.53]; very low certainty), MV duration (9 RCTs; n = 676; MD, 0.01 [-1.04 to 1.07] days; moderate certainty), ICU LOS (10 RCTs; n = 511; MD, 0.23 [-1.44 to 1.89] days; moderate certainty), hospital LOS (7 RCTs; n = 393, MD -0.07 [-3.87 to 3.73] days; moderate certainty), QoL at 6 months after hospital discharge (2 RCTs; n = 103; MD, 9.13 [13.80 to 32.05] points higher; very low certainty), or hospital mortality (7 RCTs; n = 710; RR 1.09 [0.82 to 1.46]; moderate-certainty). The adverse event rate in cycling sessions was 0.16% across studies (10 studies; 5 of 3,117 sessions; very low certainty).Conclusions: Cycling initiated in the ICU is probably safe; however, we did not find any differences in physical function, MV duration, LOS, QoL, or mortality compared with those not receiving cycling. Rigorously designed RCTs are needed to improve precision and further investigate the effect of cycling on patient-important outcomes.
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46
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Bench S, Czuber-Dochan W, Shah A, Stayt L. Exploring adult critical illness survivors' experiences of fatigue: A qualitative study. J Adv Nurs 2021; 77:4836-4846. [PMID: 34363641 DOI: 10.1111/jan.14995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS To explore adult experiences of fatigue after discharge from an intensive care unit and identify potential management strategies. DESIGN An exploratory qualitative study. METHODS One to one audio-recorded semi-structured interviews with 17 adult survivors of critical illness in the United Kingdom, lasting up to 1 h, between September 2019 and January 2020. Anonymised and verbatim-transcribed interview data underwent a standard process of inductive thematic analysis as described by Braun and Clarke. FINDINGS Three themes were identified: fatigue is different for everyone; complex interrelating interactions; and personalised fatigue strategies. Fatigue was described as a distressing symptom, unique to the individual that causes an array of complex, often long-term interrelating impacts on the survivor and their wider family, made worse by a lack of understanding, empathy and support resources. Support from others, alongside interventions such as exercise, good nutrition, information and alternative therapies are used by survivors with variable degrees of success. CONCLUSIONS This qualitative study reports peoples' experiences of fatigue after critical illness. Findings highlight the significant impact it has on people's lives and those of their family and friends.
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Affiliation(s)
- Suzanne Bench
- Institute of Health and Social Care, London South Bank University, London, UK.,Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Schmidt K, Gensichen J, Gehrke-Beck S, Kosilek RP, Kühne F, Heintze C, Baldwin LM, Needham DM. Management of COVID-19 ICU-survivors in primary care: - a narrative review. BMC FAMILY PRACTICE 2021; 22:160. [PMID: 34303344 PMCID: PMC8308076 DOI: 10.1186/s12875-021-01464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022]
Abstract
Many survivors of critical illness suffer from long-lasting physical, cognitive, and mental health sequelae. The number of affected patients is expected to markedly increase due to the COVID-19 pandemic. Many ICU survivors receive long-term care from a primary care physician. Hence, awareness and appropriate management of these sequelae is crucial. An interdisciplinary authorship team participated in a narrative literature review to identify key issues in managing COVID-19 ICU-survivors in primary care. The aim of this perspective paper is to synthesize important literature to understand and manage sequelae of critical illness due to COVID-19 in the primary care setting.
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Affiliation(s)
- Kfr Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany. .,Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
| | - J Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - S Gehrke-Beck
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - R P Kosilek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - F Kühne
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - C Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - L M Baldwin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - D M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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48
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Collaboration of Clinical Psychology in the Critical Care Unit: Prevention and treatment of post-ICU syndrome. INTERACCIONES: REVISTA DE AVANCES EN PSICOLOGÍA 2021. [DOI: 10.24016/2021.v7.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Letter to the Editor.
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49
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Collaboration of Clinical Psychology in the Critical Care Unit: Prevention and treatment of post-ICU syndrome. INTERACCIONES: REVISTA DE AVANCES EN PSICOLOGÍA 2021. [DOI: 10.24016/2020.v7.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Letter to the Editor.
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50
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Trevissón-Redondo B, López-López D, Pérez-Boal E, Marqués-Sánchez P, Liébana-Presa C, Navarro-Flores E, Jiménez-Fernández R, Corral-Liria I, Losa-Iglesias M, Becerro-de-Bengoa-Vallejo R. Use of the Barthel Index to Assess Activities of Daily Living before and after SARS-COVID 19 Infection of Institutionalized Nursing Home Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7258. [PMID: 34299709 PMCID: PMC8304574 DOI: 10.3390/ijerph18147258] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
The objective of the present study was to evaluate the activities of daily living (ADLs) using the Barthel Index before and after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and also to determine whether or not the results varied according to gender. The ADLs of 68 cohabiting geriatric patients, 34 men and 34 women, in two nursing homes were measured before and after SARS-CoV-2 (Coronavirus 2019 (COVID-19)) infection. COVID-19 infection was found to affect the performance of ADLs in institutionalized elderly in nursing homes, especially in the more elderly subjects, regardless of sex. The COVID-19 pandemic, in addition to having claimed many victims, especially in the elderly population, has led to a reduction in the abilities of these people to perform their ADLs and caused considerable worsening of their quality of life even after recovering from the disease.
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Affiliation(s)
- Bibiana Trevissón-Redondo
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | | | - Pilar Marqués-Sánchez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Emmanuel Navarro-Flores
- Frailty Research Organizaded Group (FROG), Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain;
| | - Raquel Jiménez-Fernández
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Inmaculada Corral-Liria
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Marta Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
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