1
|
Martins RDL, Monteiro EDSS, de Lima AMJ, Santos ADC, Brasileiro-Santos MDS. Effect of Telerehabilitation on Pulmonary Function, Functional Capacity, Physical Fitness, Dyspnea, Fatigue, and Quality of Life in COVID-19 Patients: A Systematic Review and Metanalysis. Telemed J E Health 2024. [PMID: 38920003 DOI: 10.1089/tmj.2023.0653] [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: 06/27/2024] Open
Abstract
Background: This study aimed to demonstrate the technological means used to offer telerehabilitation and to evaluate the effect of physical exercise on the population affected by COVID-19. Methods: Clinical trials were searched in the electronic databases Cochrane Library, PubMed/MEDLINE, EBSCO (CINAHL), PEDro, and Web of Science from January 16 to 19, 2023. The effect measure was estimated as mean difference (MD) or standard MD (SMD) with 95% confidence intervals (CI). Subgroup analysis was used to study potential moderating factors. Results: Twenty-four articles, describing trials with a total of 1,344 individuals affected by COVID-19, were included in the qualitative synthesis and 14 articles in the meta-analysis. The pooled results revealed that telerehabilitation improves the functional capacity (MD 79.65 [63.57, 95.73]m, p < 0.00001), agility (MD -0.69 [-1.33, -0.04] s, p = 0.04), lower limb strength and endurance (SMD 0.74 [0.52, 0.96], p < 0.00001), forced expiratory volume in 1 s (MD 0.22 [-0.04, 0.49] L, p = 0.10), and dyspnea (SMD -0.94 [-1.64, -0.24], p = 0.009). The dynamic muscular resistance training associated or not with other exercise modalities led to improvements in muscular strength (MD 4.69 [0.44, 8.94] kg, p = 0.03) and fatigue (SMD -0.97 [-1.74, -0.20], p = 0.01). In addition, telerehabilitation showed improvements in the quality of life in the contagious-phase COVID-19 patients. Although this intervention improved inspiratory muscle strength (MD 13.71 [5.41, 22.0] cmH2O, p = 0.001), it did not favor forced vital capacity. Conclusions: Telerehabilitation contributed to improving functional capacity, inspiratory muscle strength, physical fitness, and quality of life, and reducing dyspnea and fatigue in COVID-19 adult survivors.
Collapse
Affiliation(s)
- Renata de Lima Martins
- Laboratory of Physical Training Studies Applied to Health, Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
- Graduate Program in Physiotherapy, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Eduardo Dos Santos Soares Monteiro
- Laboratory of Physical Training Studies Applied to Health, Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | | | - Amilton da Cruz Santos
- Laboratory of Physical Training Studies Applied to Health, Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
- Graduate Program in Physiotherapy, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Maria do Socorro Brasileiro-Santos
- Laboratory of Physical Training Studies Applied to Health, Department of Physical Education, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
- Graduate Program in Physiotherapy, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| |
Collapse
|
2
|
Lai CY, Lin CH, Chao TC, Lin CH, Chang CC, Huang CY, Chiang SL. Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101853. [PMID: 38824899 DOI: 10.1016/j.rehab.2024.101853] [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: 10/06/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Telerehabilitation has been developed and applied for years for cardiac and pulmonary diseases with good clinical outcomes. However, its application to participants with long COVID remains limited. OBJECTIVES To investigate the effectiveness of a 12-week telerehabilitation training program in participants with long COVID. The primary outcome was cardiorespiratory fitness (CRF), and secondary outcomes were physical activity (PA) amounts, exercise self-efficacy, sleep quality, and health-related quality of life (HRQOL). METHODS A parallel-group, randomized controlled trial was conducted. Eligible participants with long COVID (n = 182) were randomly assigned in a 1:1 ratio to either the experimental group (EG) or the control group (CG). The EG received 12 weeks of telerehabilitation training with weekly remote monitoring for exercise maintenance and support. The CG received PA counseling only. CRF, PA amounts, exercise self-efficacy, sleep quality, and HRQOL were assessed at baseline and 12 weeks. Generalized estimating equations were used to analyze the intervention effects by examining the interaction between time and group. RESULTS One hundred twenty-two participants (67 %) completed the study, and 182 were included in the intention-to-treat analysis. The EG had greater walking behavior (β = -763.3, p < 0.001), total amount of PA (β= -711, p = 0.003), exercise self-efficacy (β = -1.19, p < 0.001), and better sleep quality (β = 1.69, p = 0.012) after the 12-weeks of telerehabilitation training than the CG. However, there were no significant differences in any CRF parameters or HRQOL at 12 weeks between the EG and CG. CONCLUSION Telerehabilitation training offers a personalized and convenient approach that can increase exercise willingness and PA amounts and improve sleep quality. These findings underscore the potential benefits of telerehabilitation training for promoting healthier lifestyles and improving overall health outcomes. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT05205460) on January 25, 2022.
Collapse
Affiliation(s)
- Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
3
|
Carpallo-Porcar B, Calvo S, Alamillo-Salas J, Herrero P, Gómez-Barrera M, Jiménez-Sánchez C. An Opportunity for Management of Fatigue, Physical Condition, and Quality of Life Through Asynchronous Telerehabilitation in Patients After Acute Coronavirus Disease 2019: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2024:S0003-9993(24)00986-9. [PMID: 38710426 DOI: 10.1016/j.apmr.2024.04.014] [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: 09/02/2023] [Revised: 03/05/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To compare the preliminary efficacy of asynchronous telerehabilitation in patients after acute coronavirus disease 2019 (COVID-19) on fatigue, physical condition, quality of life, and feasibility of this pilot study with that of a booklet format. DESIGN Randomized pilot study with 2 intervention arms: asynchronous telerehabilitation group and booklet-based rehabilitation group, with 2 follow-ups at 3 and 6 months. SETTING Hospital. PARTICIPANTS Patients discharged after COVID-19 were recruited and evaluated (N=35). INTERVENTIONS The intervention consisted of a 12-week multimodal rehabilitation program via telerehabilitation or by a booklet. MAIN OUTCOME MEASURES Fatigue as the main outcome and functional status, quality of life, and feasibility as secondary outcomes were evaluated. RESULTS After the intervention, there was no significant difference between groups in fatigue, but there were significant differences in favor of the asynchronous telerehabilitation group for the 6-Minute Walk Test (p=.008), the 30-Second Sit-to-Stand Test (p=.019), and physical quality of life (p=.035). These improvements were maintained throughout the 6-month follow-up. Telerehabilitation was shown to be a viable option, without incidents and with a higher adhesion (p=.028) than the booklet format. CONCLUSIONS A multimodal rehabilitation program by means of asynchronous telerehabilitation appears as a more effective option than traditional formats in improving post-acute COVID-19 sequelae.
Collapse
Affiliation(s)
- Beatriz Carpallo-Porcar
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain; IIS Aragon, Zaragoza, Spain
| | - Sandra Calvo
- IIS Aragon, Zaragoza, Spain; Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | | | - Pablo Herrero
- IIS Aragon, Zaragoza, Spain; Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Manuel Gómez-Barrera
- Departament of Pharmacy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain; Pharmacoeconomics & Outcomes Iberia, Madrid, Spain
| | - Carolina Jiménez-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain; IIS Aragon, Zaragoza, Spain
| |
Collapse
|
4
|
Zampolini M, Oral A, Barotsis N, Aguiar Branco C, Burger H, Capodaglio P, Dincer F, Giustini A, Hu X, Irgens I, Negrini S, Tederko P, Treger I, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2024; 60:165-181. [PMID: 38477069 PMCID: PMC11135123 DOI: 10.23736/s1973-9087.24.08396-5] [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: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.
Collapse
Affiliation(s)
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | | | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Hospital of Entre o Douro e Vouga E.P.E., Porto, Portugal
- Faculty of Dentistry, University of Porto, Porto, Portugal
| | - Helena Burger
- University Rehabilitation Institute of the Republic of Slovenia, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paolo Capodaglio
- Orthopedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ingebjorg Irgens
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Piotr Tederko
- Department of Rehabilitation, Center of Postgraduate Medical Education, Otwock, Poland
| | - Iuly Treger
- Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | |
Collapse
|
5
|
Calvache-Mateo A, Reychler G, Heredia-Ciuró A, Martín-Núñez J, Ortiz-Rubio A, Navas-Otero A, Valenza MC. Respiratory training effects in Long COVID-19 patients: a systematic review and meta-analysis. Expert Rev Respir Med 2024; 18:207-217. [PMID: 38800959 DOI: 10.1080/17476348.2024.2358933] [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: 12/01/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION To date, it is unknown whether respiratory training interventions can benefit Long COVID-19 patients. The main objective was to analyze the effects of respiratory training on patients with Long COVID-19, concretely on respiratory muscle strength, lung function, dyspnea, and functional capacity. METHODS We performed a systematic review following PRISMA statement using PubMed, Scopus, and PEDro (last search November 2023). The risk of bias was assessed using the Cochrane tool. We included randomized controlled trials testing the effect of respiratory training interventions in Long COVID-19 patients versus no intervention, control, or placebo intervention. The data was pooled, and a meta-analysis was complete. RESULTS We selected 7 studies, which included 572 patients. Meta-analysis results show significant differences in favor of respiratory training in respiratory muscle strength (MD = 13.71; 95% CI = 5.41; 22; p = 0.001), dyspnea (SDM = 1.39; 95% CI = 0.33; 2.46; p = 0.01) and functional capacity (SDM = 0.90; 95% CI = 0.37; 1.43; p = 0.0009), but not in lung function (MD = 0.28; 95%CI = -0.27; 0.83; p = 0.32). CONCLUSION The results of this systematic review with meta-analysis suggest that respiratory training improves respiratory muscle strength and functional capacity in Long COVID-19 patients, as well as dyspnea if combined with therapeutic exercise. However, respiratory training does not improve lung function in these patients. REVIEW REGISTRATION PROSPERO IDENTIFIER CRD42022371820.
Collapse
Affiliation(s)
- Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alba Navas-Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| |
Collapse
|
6
|
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
|
7
|
Kintrilis N, Kontaxakis A, Philippou A. EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2024; 7:18647. [PMID: 38328738 PMCID: PMC10847974 DOI: 10.2340/jrmcc.v7.18647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
Objective To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention. Design Patients and Methods Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke. Results The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index. Discussion and Conclusion Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.
Collapse
Affiliation(s)
- Nikolaos Kintrilis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kontaxakis
- Physical and Rehabilitation Medicine Department, 414 Military Hospital of Special Diseases, Penteli, Greece
| | - Anastasios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
León-Herrera S, Magallón-Botaya R, Oliván-Blázquez B, Sagarra-Romero L, Jaurrieta CM, Méndez-López F. Online multimodal rehabilitation programme to improve symptoms and quality of life for adults diagnosed with long COVID-19: a Randomised Clinical Trial protocol. Front Public Health 2023; 11:1222888. [PMID: 37744502 PMCID: PMC10513419 DOI: 10.3389/fpubh.2023.1222888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Long COVID is a multisystemic condition which affects quality of life and implies a multidisciplinary treatment approach. There is still limited evidence on management techniques for this syndrome. "Telerehabilitation" could be an important tool when addressing the symptoms of this patients with the aim of increasing their quality of life. The purpose of this trial is to analyse the effectiveness of an online multimodal rehabilitation programme to improve the symptomatology of people with long COVID and their quality of life. Methods A pragmatic randomised controlled trial will be performed with two parallel groups: (1) usual treatment by the primary care practitioner (Treatment as usual, TAU; control group) and (2) TAU plus the use of an online multimodal rehabilitation programme, including videoconferences and content published on a Moodle platform (intervention group). The data will be collected before and after the intervention. A follow-up will take place 3 months later. Discussion There is still a lack of knowledge regarding the management of the symptoms of long COVID. This creates the need to add scientific evidence about the care of this disease, considering that multidisciplinary social and health teams can offer the necessary care so that these patients can recover their previous quality of life.Clinical trial registration: The protocol for this study was registered with the ISRCTN Registry [registration number: ISRCTN15414370] on 28 December 2022.
Collapse
Affiliation(s)
- Sandra León-Herrera
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Lucía Sagarra-Romero
- GAIAS Research Group, Department of Health Sciences, Faculty of Health Sciences, Zaragoza, Spain
| | | | | |
Collapse
|
9
|
Pouliopoulou DV, Macdermid JC, Saunders E, Peters S, Brunton L, Miller E, Quinn KL, Pereira TV, Bobos P. Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2333838. [PMID: 37725376 PMCID: PMC10509723 DOI: 10.1001/jamanetworkopen.2023.33838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
Importance Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. Objective To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. Data Sources A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. Study Selection This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. Main Outcomes and Measures The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Results Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.
Collapse
Affiliation(s)
- Dimitra V. Pouliopoulou
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Joy C. Macdermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| | - Emily Saunders
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Laura Brunton
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Erin Miller
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Kieran L. Quinn
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V. Pereira
- Health Technology Assessment Unit, Department of Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Pavlos Bobos
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Hospital, London, Ontario, Canada
| |
Collapse
|
10
|
da Silva MMC, Viana DR, Colucci MG, Gonzaga LA, Arcuri JF, Frade MCM, de Facio CA, Zopelari LMP, de Figueiredo TEN, Franco FJBZ, Catai AM, Di Lorenzo VAP. Effects of a cardiopulmonary telerehabilitation using functional exercises in individuals after COVID-19 hospital discharge: A randomized controlled trial. J Telemed Telecare 2023:1357633X231188394. [PMID: 37559399 DOI: 10.1177/1357633x231188394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Individuals with severe coronavirus disease 2019 (COVID-19) may present respiratory and motor complications, requiring rehabilitation programs (RP) for long periods. However, access to cardiopulmonary rehabilitation is poor. Cardiopulmonary telerehabilitation is an alternative for cardiopulmonary dysfunction, improving functional capacity, dyspnea, and quality of life. Moreover, few clinical trials verified the effectiveness of telerehabilitation using functional exercise for post-COVID symptoms. Thus, the present study aimed to verify the effects of cardiopulmonary telerehabilitation using functional and accessible exercises in individuals after COVID-19 hospital discharge. METHODS This blinded, randomized, and controlled clinical trial and included 67 adult individuals after COVID-19 hospital discharge. Participants were randomized into the groups of telerehabilitation (TG; n = 33) and control (CG; n = 34). TG underwent an individualized exercise program (functional and accessible exercises) supervised by a physical therapist (videoconference), and CG received guidance on general care and self-monitoring of vital signs (videoconference). The primary outcome was performance and physiological responses on the 6-minute step test (6MST). Secondary outcomes were performance on the 2-minute stationary walk test (2MSWT), 30-second chair stand test (30CST), and quality of life using the 36-Item Short Form Health Survey (SF-36) questionnaire physical functioning concept (PF). RESULTS Functional capacity (6MST) improved by 28 ± 17 steps in TG and 15 ± 26 in CG (p = 0.04). For secondary outcomes, performance on 2MSWT increased by 39 ± 6 steps in TG and 10 ± 6 in CG (p = 0.00); 30CST by 3 ± 1 repetitions in TG and 1.5 ± 0.5 in CG (p = 0.05); and PF (SF-36) by 17 ± 4 points in TG and 12 ± 4 in CG (p = 0.00). Also, peak oxygen uptake VO2peak (6MST) improved by 3.8 ± 1 mL min-1 kg-1 in TG and 4.1 ± 1 in CG (p = 0.6), and heart rate demand (6MST) by 11 ± 37% in TG and -4 ± 19% in CG (p = 0.04). CONCLUSIONS Cardiopulmonary telerehabilitation using functional exercises improved the exercise and functional capacity assessed using 6MST, 30CST, and 2MSWT and the quality of life of individuals after COVID-19 hospital discharge.
Collapse
Affiliation(s)
- Marcela M C da Silva
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
- Physical Therapy Department, Santo Amaro University - Santo Amaro, São Paulo, Brazil
| | - Daiane R Viana
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Maria G Colucci
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Luana A Gonzaga
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Juliano F Arcuri
- University Center Nossa Senhora do Patrocínio (CEUNSP) - Itu, São Paulo, Brazil
| | - Maria C M Frade
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Carina A de Facio
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | | | | | | | - Aparecida M Catai
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | | |
Collapse
|
11
|
Estebanez-Pérez MJ, Martín-Valero R, Vinolo-Gil MJ, Pastora-Bernal JM. Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review. Healthcare (Basel) 2023; 11:1970. [PMID: 37444803 DOI: 10.3390/healthcare11131970] [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: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Long COVID syndrome has been recognized as a public health problem. Digital physiotherapy practice is an alternative that can better meet the needs of patients. The aim of this review was to synthesize the evidence of digital physiotherapy practice in Long COVID patients. A systematic review was carried out until December 2022. The review was complemented by an assessment of the risk of bias and methodological quality. A narrative synthesis of results was conducted, including subgroup analyses by intervention and clinical outcomes. Six articles, including 540 participants, were selected. Five articles were considered of high enough methodological quality. Parallel-group, single-blind, randomized controlled trials were the most commonly used research design. Tele-supervised home-based exercise training was the most commonly used intervention. Great heterogeneity in clinical outcomes and measurement tools was found. A subgroup analysis showed that digital physiotherapy is effective in improving clinical outcomes. Significant differences in favor of digital interventions over usual care were reported. Nevertheless, discrepancies regarding effectiveness were found. Improvements in clinical outcomes with digital physiotherapy were found to be at least non-inferior to usual care. This review provides new evidence that digital physiotherapy practice is an appropriate intervention for Long COVID patients, despite the inherent limitations of the review. Registration: CRD42022379004.
Collapse
Affiliation(s)
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, 29071 Málaga, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | | |
Collapse
|
12
|
Mazzaglia G. Long COVID Syndrome: Lesson Learned and Future Implications. J Clin Med 2023; 12:jcm12103450. [PMID: 37240555 DOI: 10.3390/jcm12103450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has caused severe illness and mortality on a global scale, with an impact not witnessed since the 1918-19 Spanish influenza pandemic [...].
Collapse
Affiliation(s)
- Giampiero Mazzaglia
- Center for Public Health Research (CESP), Department of Medicine and Surgery, University of Milan-Bicocca, I-20900 Monza, Italy
| |
Collapse
|