1
|
Yang J, Li H, Zhao H, Xie Y, Li J, Wang M. Effectiveness of telerehabilitation in patients with post-COVID-19: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e074325. [PMID: 38964791 DOI: 10.1136/bmjopen-2023-074325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE To assess the effects of telerehabilitation on clinical symptoms, physical function, psychological function and quality of life (QoL) in patients with post-COVID-19. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES PubMed, Web of Science, Embase and Cochrane Library were searched for publications from 1 January 2020 to 17 April 2024. ELIGIBILITY CRITERIA RCTs investigating the effects of telerehabilitation in patients with post-COVID-19 were included. The outcomes of interest encompassed clinical symptoms, physical function, psychological function and QoL. Only studies reported in English were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and evaluated the risk of bias. Statistical analysis was conducted using Review Manager V.5.3, employing mean difference (MD) with a 95% CI, and the corresponding P value was used to ascertain the treatment effect between groups. Heterogeneity was quantified using the I2 statistic. The quality of evidence was assessed by GRADE. RESULTS 16 RCTs (n=1129) were included in this systematic review, 15 of which (n=1095, 16 comparisons) were included in the meta-analysis. The primary pooled analysis demonstrated that, compared with no rehabilitation or usual care, telerehabilitation can improve physical function (measured by 30 s sit-to-stand test [6 RCTs, n=310, MD=1.58 stands, 95% CI 0.50 to 2.66; p=0.004]; 6 min walking distance [6 RCTs, n=324, MD=76.90 m, 95% CI 49.47 to 104.33; p<0.00001]; and physical function from the 36-item short-form health survey [5 RCTs, n=380, MD=6.12 units, 95% CI 2.85 to 9.38; p=0.0002]). However, the pooled results did not indicate significant improvements in clinical symptoms, pulmonary function, psychological function or QoL. The quality of the evidence was graded as low for physical function and Hospital Anxiety and Depression Scale-anxiety and very low for other assessed outcomes. The overall treatment completion rate was 78.26%, with no reports of severe adverse events in any included trials. CONCLUSIONS Despite the lack of significant improvements in certain variables, telerehabilitation could be an effective and safe option for enhancing physical function in patients with post-COVID-19. It is advisable to conduct further well-designed trials to continue in-depth exploration of this topic. STUDY REGISTRATION PROSPERO, CRD42023404647.
Collapse
Affiliation(s)
- Jiang Yang
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
| | - Huiru Li
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
| | - Hulei Zhao
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
- Department of Respiratory Critical Care, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yang Xie
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
- Department of Respiratory Critical Care, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jiansheng Li
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
| | - Minghang Wang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou, Henan, China
- Department of Respiratory Critical Care, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| |
Collapse
|
2
|
Huang J, Qiao X, Song K, Liu R, Huang S, He J, Zhu S, Reinhardt JD, He C. Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis. Clin Rehabil 2024; 38:857-883. [PMID: 38629433 DOI: 10.1177/02692155241239881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVE Assessing rehabilitation effectiveness for persistent symptoms post-infection with emerging viral respiratory diseases. DATA SOURCES Systematic review of seven databases (MEDLINE, EMBASE, Cochrane Library, PEDro, MedRxiv, CNKI, Wanfang) until 30 December 2023. REVIEW METHODS Evaluated 101 studies (9593 participants) on respiratory function, exercise capacity, and quality of life. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for observational studies and non-RCTs, and the NIH Quality Assessment Tools for before-after studies. RESULTS The most common rehabilitation program combined breathing exercises with aerobic exercise or strength training. Rehabilitation interventions significantly enhanced respiratory function, as evidenced by improvements on the Borg Scale (MD, -1.85; 95% CI, -3.00 to -0.70, low certainty), the mMRC Dyspnea Scale (MD, -0.45; 95% CI, -0.72 to -0.18, low certainty), and the Multidimensional Dyspnoea-12 Scale (MD, -4.64; 95% CI, -6.54 to -2.74, moderate certainty). Exercise capacity also improved, demonstrated by results from the Six-Minute Walk Test (MD, 38.18; 95% CI, 25.33-51.03, moderate certainty) and the Sit-to-Stand Test (MD, 3.04; 95% CI, 1.07-5.01, low certainty). CONCLUSION Rehabilitation interventions are promising for survivors of viral respiratory diseases, yet gaps in research remain. Future investigations should focus on personalizing rehabilitation efforts, utilizing remote technology-assisted programs, improving research quality, and identifying specific subgroups for customized rehabilitation strategies to achieve the best outcomes for survivors.
Collapse
Affiliation(s)
- Jinming Huang
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xu Qiao
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kangping Song
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rong Liu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shuangshuang Huang
- Rehabilitation Medicine Department, The Fifth People's Hospital of Sichuan Province, Chengdu, China
| | - Jing He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Siyi Zhu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jan D Reinhardt
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Center for Rehabilitation Research, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chengqi He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Kerling A, Beyer S, Dirks M, Scharbau M, Hennemann AK, Dopfer-Jablonka A, Lampe V, Salzmann JHW, Tegtbur U, Drick N, Pink I, Haufe S. Effects of a randomized-controlled and online-supported physical activity intervention on exercise capacity, fatigue and health related quality of life in patients with post-COVID-19 syndrome. BMC Sports Sci Med Rehabil 2024; 16:33. [PMID: 38308307 PMCID: PMC10835885 DOI: 10.1186/s13102-024-00817-5] [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: 10/04/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The Post-COVID-19 syndrome (PCS), which can occur after acute respiratory syndrome coronavirus 2 infection, leads to restrictions in everyday activity. Our study assessed the impact of an online-guided intervention which intended to facilitate physical activity on the mental and physical capability of PCS patients. METHODS We randomized 62 patients with PCS (20 male/ 42 female; age: 46 ± 12 years; body mass index: 28.7 ± 6.7 kg/m2) with a score ≥ 22 in the fatigue assessment scale (FAS) to a 3-month exercise-focused intervention (IG n = 30) or control period (CG n = 32). We assessed changes in exercise capacity (bicycle exercise test with measurements of gas exchange), fatigue, markers of health-related quality of life (HrQoL) and mental health. RESULTS The FAS score decreased significantly in both study groups (IG: 35.1 ± 7.4 to 31.8 ± 8.5 points; CG: 35.6 ± 7.4 to 32.6 ± 7.5 points, both p < 0.01). Exercise capacity did not increase in the CG or IG (within-group changes for IG: peak oxygen uptake: 0.9 ± 2.6 ml/min/kg, p = 0.098; peak power output: 6.1 ± 17.8 W, p = 0.076) with no significant changes in HrQoL and work ability. Patients with a FAS score at baseline ≥ 35 (severe fatigue) showed no change in exercise capacity with the 3-month intervention whereas the sub-group of patients with FAS < 35 points (moderate fatigue) showed improvements, independent of the study group. CONCLUSIONS Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance. TRIAL REGISTRATION German Clinical Trials Register (registration trial number: DRKS00026245) on September 2 2021.
Collapse
Affiliation(s)
- Arno Kerling
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sebastian Beyer
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Meike Dirks
- Clinic for Neurology, Hannover Medical School, Hannover, Germany
| | - Michèle Scharbau
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | | | - Viktoria Lampe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Uwe Tegtbur
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Isabell Pink
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Sven Haufe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| |
Collapse
|