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Sanches CA, Silva GA, Librantz AFH, Sampaio LMM, Belan PA. Wearable Devices to Diagnose and Monitor the Progression of COVID-19 Through Heart Rate Variability Measurement: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e47112. [PMID: 37820372 PMCID: PMC10685286 DOI: 10.2196/47112] [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: 03/08/2023] [Revised: 06/28/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Recent studies have linked low heart rate variability (HRV) with COVID-19, indicating that this parameter can be a marker of the onset of the disease and its severity and a predictor of mortality in infected people. Given the large number of wearable devices that capture physiological signals of the human body easily and noninvasively, several studies have used this equipment to measure the HRV of individuals and related these measures to COVID-19. OBJECTIVE The objective of this study was to assess the utility of HRV measurements obtained from wearable devices as predictive indicators of COVID-19, as well as the onset and worsening of symptoms in affected individuals. METHODS A systematic review was conducted searching the following databases up to the end of January 2023: Embase, PubMed, Web of Science, Scopus, and IEEE Xplore. Studies had to include (1) measures of HRV in patients with COVID-19 and (2) measurements involving the use of wearable devices. We also conducted a meta-analysis of these measures to reduce possible biases and increase the statistical power of the primary research. RESULTS The main finding was the association between low HRV and the onset and worsening of COVID-19 symptoms. In some cases, it was possible to predict the onset of COVID-19 before a positive clinical test. The meta-analysis of studies reported that a reduction in HRV parameters is associated with COVID-19. Individuals with COVID-19 presented a reduction in the SD of the normal-to-normal interbeat intervals and root mean square of the successive differences compared with healthy individuals. The decrease in the SD of the normal-to-normal interbeat intervals was 3.25 ms (95% CI -5.34 to -1.16 ms), and the decrease in the root mean square of the successive differences was 1.24 ms (95% CI -3.71 to 1.23 ms). CONCLUSIONS Wearable devices that measure changes in HRV, such as smartwatches, rings, and bracelets, provide information that allows for the identification of COVID-19 during the presymptomatic period as well as its worsening through an indirect and noninvasive self-diagnosis.
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Affiliation(s)
- Carlos Alberto Sanches
- Informatics and Knowledge Management Graduate Program, Universidade Nove de Julho, São Paulo, Brazil
| | - Graziella Alves Silva
- Informatics and Knowledge Management Graduate Program, Universidade Nove de Julho, São Paulo, Brazil
| | | | | | - Peterson Adriano Belan
- Informatics and Knowledge Management Graduate Program, Universidade Nove de Julho, São Paulo, Brazil
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Kwon CY. The Impact of SARS-CoV-2 Infection on Heart Rate Variability: A Systematic Review of Observational Studies with Control Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:909. [PMID: 36673664 PMCID: PMC9859268 DOI: 10.3390/ijerph20020909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 05/13/2023]
Abstract
Autonomic nervous system (ANS) dysfunction can arise after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and heart rate variability (HRV) tests can assess its integrity. This review investigated the relationship between the impact of SARS-CoV-2 infection on HRV parameters. Comprehensive searches were conducted in four electronic databases. Observational studies with a control group reporting the direct impact of SARS-CoV-2 infection on the HRV parameters in July 2022 were included. A total of 17 observational studies were included in this review. The square root of the mean squared differences of successive NN intervals (RMSSD) was the most frequently investigated. Some studies found that decreases in RMSSD and high frequency (HF) power were associated with SARS-CoV-2 infection or the poor prognosis of COVID-19. Also, decreases in RMSSD and increases in the normalized unit of HF power were related to death in critically ill COVID-19 patients. The findings showed that SARS-CoV-2 infection, and the severity and prognosis of COVID-19, are likely to be reflected in some HRV-related parameters. However, the considerable heterogeneity of the included studies was highlighted. The methodological quality of the included observational studies was not optimal. The findings suggest rigorous and accurate measurements of HRV parameters are highly needed on this topic.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dongeui University, 52-57, Yangjeong-ro, Busanjin-gu, Busan 47227, Republic of Korea
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García-Suárez PC, Canton-Martínez E, Rentería I, Moura Antunes B, Machado-Parra JP, Aburto-Corona JA, Gómez-Miranda LM, Jiménez-Maldonado A. Remote, Whole-Body Interval Training Improves Muscular Endurance and Cardiac Autonomic Control in Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13897. [PMID: 36360775 PMCID: PMC9657792 DOI: 10.3390/ijerph192113897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
High-intensity interval training (HIIT) is an exercise modality acknowledged to maintain physical fitness with more engagement in an active lifestyle compared with other traditional exercise models. Nevertheless, its effects on cardiac control and physical performance in an online-guided setting are not yet clarified. The present work assessed physical fitness and heart rate variability (HRV) before and after an online, home-based HIIT program in college-age students while pandemic lockdowns were in effect. Twenty university students (age: 21.9 ± 2.4 years.) that were solely enrolled in online classes were distributed into three groups: control-CON-(n = 6), 14 min of HIIT-HIIT-14-(n = 8), and 21 min of HIIT-HIIT-21-(n = 6). A maximal push-up test was employed to assess muscular endurance and performance, and resting HRV signals were collected with wireless heart rate monitors and were processed in Kubios HRV Std. (Kubios Oy, Finland). There was an increase in total push-up capacity compared to CON (p < 0.05 HIIT-21 vs. CON; p < 0.001 HIIT-14 vs. CON) after 8 weeks. A significant interaction was observed in high-frequency and low-frequency spectra ratios after the HIIT-21 intervention (p < 0.05). The current work demonstrated that either short- or mid-volume online, whole-body HIIT improves muscle strength, whereas mid-volume HIIT (HIIT-21) was the only intervention that developed a sympathovagal adaptation. This study showed promising results on muscular endurance and cardiac autonomic modulation through whole-body HIIT practice at home.
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Affiliation(s)
- Patricia Concepción García-Suárez
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
| | - Ermilo Canton-Martínez
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
| | - Iván Rentería
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
| | - Barbara Moura Antunes
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
| | - Juan Pablo Machado-Parra
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
| | | | - Luis Mario Gómez-Miranda
- Facultad de Deportes Campus Tijuana, Universidad Autónoma de Baja California, Tijuana 22390, Mexico
| | - Alberto Jiménez-Maldonado
- Facultad de Deportes Campus Ensenada, Universidad Autónoma de Baja California, Ensenada 22800, Mexico
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4
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Karthan M, Martin R, Holl F, Swoboda W, Kestler HA, Pryss R, Schobel J. Enhancing mHealth data collection applications with sensing capabilities. Front Public Health 2022; 10:926234. [PMID: 36187627 PMCID: PMC9521646 DOI: 10.3389/fpubh.2022.926234] [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: 04/22/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Smart mobile devices such as smartphones or tablets have become an important factor for collecting data in complex health scenarios (e.g., psychological studies, medical trials), and are more and more replacing traditional pen-and-paper instruments. However, simply digitizing such instruments does not yet realize the full potential of mobile devices: most modern smartphones have a variety of different sensor technologies (e.g., microphone, GPS data, camera, ...) that can also provide valuable data and potentially valuable insights for the medical purpose or the researcher. In this context, a significant development effort is required to integrate sensing capabilities into (existing) data collection applications. Developers may have to deal with platform-specific peculiarities (e.g., Android vs. iOS) or proprietary sensor data formats, resulting in unnecessary development effort to support researchers with such digital solutions. Therefore, a cross-platform mobile data collection framework has been developed to extend existing data collection applications with sensor capabilities and address the aforementioned challenges in the process. This framework will enable researchers to collect additional information from participants and environment, increasing the amount of data collected and drawing new insights from existing data.
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Affiliation(s)
- Maximilian Karthan
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,*Correspondence: Maximilian Karthan
| | - Robin Martin
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Hans A. Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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Scala I, Rizzo PA, Bellavia S, Brunetti V, Colò F, Broccolini A, Della Marca G, Calabresi P, Luigetti M, Frisullo G. Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review. J Clin Med 2022; 11:jcm11133883. [PMID: 35807167 PMCID: PMC9267913 DOI: 10.3390/jcm11133883] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.
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Affiliation(s)
- Irene Scala
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Pier Andrea Rizzo
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Simone Bellavia
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Valerio Brunetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Francesca Colò
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Aldobrando Broccolini
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Giacomo Della Marca
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Paolo Calabresi
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Marco Luigetti
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
- Correspondence: ; Tel.: +39-06-30154435
| | - Giovanni Frisullo
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
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Ecarnot F, Rebora P, Focà E, Zucchelli A, Citerio G, Valsecchi MG, Marengoni A, Bellelli G. Mechanical Ventilation in COVID-19 Patients: Insights into the Role of Age and Frailty from a Multicentre Observational Study. Aging Dis 2022; 13:340-343. [PMID: 35371606 PMCID: PMC8947826 DOI: 10.14336/ad.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
In patients with COVID-19, frailty has been shown to better predict outcomes than age alone. We investigated factors associated with mechanical ventilation (MV) during hospitalization for COVID-19 among older adults in a multicentre study during the first two waves in Italy. Using data from the FRACOVID project, we included consecutive patients admitted to the participating centres during the first and second waves. We recorded sociodemographics, comorbidities, time since symptom onset, ventilatory support at admission, and chest X-ray findings. Frailty was assessed using a frailty index (FI). Results are reported as hazard ratios (HR) with 95%CI. 1,344 patients were included; 487 females (36.2%), median age 68 (56; 79) years; 52.4% had hypertension, 10.6% had chronic obstructive pulmonary disease, 15.2% were obese. Median FI was 0.088 (0.03, 0.20), and 67% had bilateral consolidations at admission. Median time since symptom onset was 7 days (4, 10). During hospitalization, 47 patients (3.6%, 95%CI 0.33-13.6%) received MV. Multivariable Cox regression analysis found that the likelihood of intubation decreased with increasing age (HR 0.945 (95%CI 0.921-0.969), p<0.0001), while heart rate >110bpm (HR 3.429 (95%CI 1.583-7.429), p=0.0018), and need for continuous positive airway pressure (CPAP) at admission (HR 2.626 (95%CI 1.330-5.186), p=0.0054) were significantly associated with a greater likelihood of intubation. Older patients are less likely to receive intubation, while those with heart rate >110 bpm and need for CPAP at admission are more likely to receive MV during hospitalization for COVID-19.
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Affiliation(s)
- Fiona Ecarnot
- EA3920, University of Franche-Comté and Department of Cardiology, University Hospital Besançon, Besançon, France.,Correspondence should be addressed to: Dr. Fiona Ecarnot, Department of Cardiology, University Hospital Besançon, 3 Boulevard Fleming, 25000 Besancon, France.
| | - Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, University of Brescia, and Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Italy.,Neuro Intensive Care, San Gerardo hospital, ASST-Monza, Monza Italy.
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano - Bicocca, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy.
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Vernon SD, Funk S, Bateman L, Stoddard GJ, Hammer S, Sullivan K, Bell J, Abbaszadeh S, Lipkin WI, Komaroff AL. Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Med (Lausanne) 2022; 9:917019. [PMID: 35847821 PMCID: PMC9285104 DOI: 10.3389/fmed.2022.917019] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Some patients with acute COVID-19 are left with persistent, debilitating fatigue, cognitive impairment ("brain fog"), orthostatic intolerance (OI) and other symptoms ("Long COVID"). Many of the symptoms are like those of other post-infectious fatigue syndromes and may meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Common diagnostic laboratory tests are often unrevealing. Methods We evaluated whether a simple, standardized, office-based test of OI, the 10-min NASA Lean Test (NLT), would aggravate symptoms and produce objective hemodynamic and cognitive abnormalities, the latter being evaluated by a simple smart phone-based app. Participants People with Long COVID (N = 42), ME/CFS (N = 26) and healthy control subjects (N = 20) were studied just before, during, immediately after, 2 and 7 days following completion of the NLT. Results The NLT provoked a worsening of symptoms in the two patient groups but not in healthy control subjects, and the severity of all symptoms was similar and significantly worse in the two patient groups than in the control subjects (p < 0.001). In the two patient groups, particularly those with Long COVID, the NLT provoked a marked and progressive narrowing in the pulse pressure. All three cognitive measures of reaction time worsened in the two patient groups immediately following the NLT, compared to the healthy control subjects, particularly in the Procedural Reaction Time (p < 0.01). Conclusions A test of orthostatic stress easily performed in an office setting reveals different symptomatic, hemodynamic and cognitive abnormalities in people with Long COVID and ME/CFS, compared to healthy control subjects. Thus, an orthostatic challenge easily performed in an office setting, and the use of a smart phone app to assess cognition, can provide objective confirmation of the orthostatic intolerance and brain fog reported by patients with Long COVID and ME/CFS.
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Affiliation(s)
- Suzanne D. Vernon
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - Sherlyn Funk
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lucinda Bateman
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - Gregory J. Stoddard
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sarah Hammer
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - Karen Sullivan
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - Jennifer Bell
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - Saeed Abbaszadeh
- The Bateman Horne Center of Excellence, Salt Lake City, UT, United States
| | - W. Ian Lipkin
- Center for Solutions for ME/CFS, Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Anthony L. Komaroff
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Anthony L. Komaroff
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De Donno A, Acella A, Angrisani C, Gubinelli G, Musci G, Gravili G, Ciritella C, Santamato A. Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study. Front Med (Lausanne) 2021; 8:754456. [PMID: 34917632 PMCID: PMC8669589 DOI: 10.3389/fmed.2021.754456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has revolutionized the habits of entire communities, having even more profound negative effects on assistance for the chronically ill. The sudden demand for extraordinary resources caught all worldwide countries unprepared, highlighting shortages in provision of care services. This applies to all patients, affected by COVID-19 or not, as many need continuing access to chronic diseases treatments. Almost all of the energy available has been directed toward care of COVID-19 patients, and almost nothing has been done to continue therapy for patients with spasticity. This study builds on a recent article and discusses its results as a basis for highlighting the ethical dilemmas and unintended consequences of health systems changing their priorities during the pandemic. The above mentioned study has shown increased patient-perceived spasticity during lockdown (72.2%) with reductions in perceived quality of life (70.9%). Telemedicine tools have proved insufficient, with access by only 7.3% of these patients. Despite the health emergency, it cannot be denied that this situation is a violation of these patients' rights and dignity. The healthcare system will also have to bear increased costs in the future to recover the loss of previous therapies benefits, because of their interruption. The real challenge will be to exploit the critical issues emerged during the pandemic, and to resolve the measures needed to take the care to the patient, and not vice versa. This applies particularly to fragile patients, to respect their dignity and right to care.
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Affiliation(s)
- Antonio De Donno
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Adriano Acella
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Carmelinda Angrisani
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Giulia Gubinelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Musci
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Gravili
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Chiara Ciritella
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
| | - Andrea Santamato
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
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