Supplemental Oxygen Utilization During Physical Therapy Interventions:

Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study

INTRODUCTION

The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges.

OBJECTIVES

We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored.

MATERIAL AND METHODS

Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team.

RESULTS

Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64).

CONCLUSIONS

The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.

Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial

Many clinical practice recommendations indicate rehabilitation as essential for patients with sequelae of severe or critical COVID-19 and suggest the prompt initiation of a multicomponent rehabilitation program focused on aerobic and endurance training. However, randomized controlled trials (RCTs) regarding aerobic exercise are lacking. Therefore, we aimed to assess the feasibility and effectiveness of the addition of aerobic training to standard rehabilitation in subjects with subacute COVID-19. Participants were 32/214 patients with the sequelae of severe or critical COVID-19 in the acute phase who were eligible and agreed to participate in the study (eligibility = 15%, recruitment = 100%). After randomization and assessment with functional and strength tests, all the participants underwent an inpatient-tailored rehabilitation program (50 min/day, 5 days/week, 10 sessions); in addition, the experimental group performed a low- to moderate-intensity aerobic exercise (30 min/day, 10 sessions). No dropouts or severe adverse events were reported, with an attendance rate of 95.6%. Most of the secondary outcomes significantly improved in both groups, but the improvement in the Functional Independence Measure and Cumulated Ambulation Score-Italian version was significantly greater in the experimental group (at least, p < 0.05). This RCT showed that aerobic exercise is feasible and safe in subacute COVID-19. Moreover, it appears to be beneficial and useful in improving patients' independence and mobility.

Feasibility of the Six-Minute Walk Test for Patients Who Have Cystic Fibrosis, Are Ambulatory, and Require Mechanical Ventilation Before Lung Transplantation

BACKGROUND AND PURPOSE

The Six-Minute Walk Test (6MWT) is a requirement for lung transplantation evaluation by the United Network for Organ Sharing. A subset of patients being evaluated for a lung transplantation require mechanical ventilation (MV) because of respiratory failure. The 6MWT has not been validated as an outcome measure for patients dependent on MV. Literature supports alternative forms of the 6MWT, including those with an oval track or treadmill, as valid for accommodating other populations. This case report describes the use of the 6MWT for 2 patients who had cystic fibrosis and required MV before a lung transplant.

CASE DESCRIPTION

A 34-year-old woman and a 37-year-old woman were admitted to a medical intensive care unit for exacerbation of cystic fibrosis requiring prolonged intubation and a subsequent tracheostomy. Their hospital courses were characterized by participation in early rehabilitation and variable dependence on MV. Both patients performed the 6MWT for a lung transplantation workup while dependent on MV.

OUTCOMES

Both patients performed the 6MWT while using portable MV and achieved a distance greater than that required for transplantation consideration and approximately 50% of the reference-based expected distance for adults who are healthy. Confounding factors included external pacing and the use of an oval track.

DISCUSSION

The use of the 6MWT for 2 patients receiving MV appeared to be feasible. Research regarding the validity of this outcome is warranted.