Effects of cardiorespiratory rehabilitation program on submaximal exercise in patients with long-COVID-19 conditions: a systematic review of randomized controlled trials and recommendations for future studies

INTRODUCTION

Long-COVID-19 patients (LC19Ps) often experience cardiovascular and respiratory complications. Cardiorespiratory rehabilitation programs (CRRPs) have emerged as promising interventions to enhance exercise capacity in this population. This systematic review aimed to assess the impact of CRRPs on submaximal exercise performance, specifically the 6-minute walk test (6MWT) outcomes, in LC19Ps through an analysis of available randomized controlled trials (RCTs).

METHODS

A systematic search was conducted in PubMed/Medline and Scopus to identify relevant RCTs. Six RCTs meeting inclusion criteria were included in this review, investigating the effects of CRRPs on 6MWT outcomes in LC19Ps.

RESULTS

The findings from the included RCTs provide compelling evidence supporting the effectiveness of CRRPs in improving submaximal exercise performance in LC19Ps. These results underscore the potential of CRRPs to enhance submaximal exercise capacity and overall functional well-being in this population. However, future research is imperative to determine optimal CRRPs, including duration, intensity, and specific intervention components. Additionally, the long-term sustainability and durability of CRRP-induced improvements warrant further exploration. Future studies should prioritize patient-centric outcomes and address potential implementation barriers.

CONCLUSION

CRRPs show promise in ameliorating submaximal exercise performance among LC19Ps. Further research is needed to refine these programs and ensure their lasting impact on this patient group.

SYSTEMATIC REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/HMN38. [Figure: see text].

Effect of Individualized Coaching at Home on Quality of Life in Subacute Stroke Patients

Background: Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods: This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results: The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively (p = 0.02). Discussion: Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.

Quality of life and its predicting factors for Tunisian children with cerebral palsy

Background

Cerebral palsy (CP) can cause motor, sensory, perceptual, cognitive, communication and behavioural disorders. The complexity of this condition justifies measuring the quality of life (QOL) of children with CP. This measurement depends on personal and socio-economic factors, hence the relevance of performing it in our cultural context of Tunisia.

Objectives

The objectives of this study were to assess the QOL of Tunisian children with CP and to identify predictive factors for QOL.

Method

A cross-sectional study using a self-administered questionnaire (the CP QOL-Child) was employed. It included 68 children with CP and their parents who consulted the outpatient clinics of Physical Medicine and Rehabilitation of the University Hospital of Sahloul Sousse.

Results

The QOL of children with CP was altered, and the mean total score for the CP QOL-Child was 59.3 (± 14). All domains were affected by this alteration. Six predictive factors for lowered QOL in children with CP were identified, namely age older than 6 years, swallowing disorders, more intense chronic pain, greater level of motor impairment, the use of botulinum toxin injection and the absence of verbal communication.

Conclusion

Intervention with children with CP must be mindful of their altered QOL. Five out of the six predictive factors of QOL are modifiable through a multidisciplinary approach within the framework of the International Classification of Functioning, Disability and Health (ICF).

Contribution

The multiplicity of the factors associated with QOL revealed by this study incites clinicians to adopt the ICF approach by displaying its practical implications on the efficiency of the medical intervention.

Compassion fatigue among frontline healthcare workers during the covid-19 pandemic in Tunisia

BACKGROUND

Healthcare workers (HCWs) are highly vulnerable to compassion fatigue (CF), which not only leads to decreased mental and physical health, but also to deterioration in the safety of care delivered. Our study aims to measure compassion satisfaction (CS), CF levels and their predictors among Tunisian HCWs.

METHODS

We conducted a cross-sectional study among HCWs caring for confirmed and suspected Covid-19 patients, staff at two university hospitals in Sousse, Tunisia during the 4thwave of coronavirus through a self-administrated Questionnaire, using the French version of the Professional Quality of Life scale ProQol, version 5.

RESULTS

A total of 274 professionals were recruited with a mean age of 32.87±8.35 years. HCWs tend to have an overall moderate levels of compassion satisfaction, secondary traumatic stress and burnout with mean scores 35.09±7.08, 29.72±7.62, 28.54±5.44 respectively. Self-reported resilience (β = 0.14, p = 10-3), work engagement (β = 0.39, p = 10-3) and burnout (β = -0.32, p = 10-3) were the predictors of compassion satisfaction in the linear regression analysis (adjusted r2 = 0.45). Similarly, limited work experience, compassion satisfaction and secondary traumatic sub-scores were the determinants of burnout (β = -0.1, p = 0.04; β = -0.54, p = 10-3; β = 0.35, p = 10-3 respectively); (adjusted r2 = 0.48). Regarding STS, female professionals (β = 0.20, p = 10-3), being married (β = 0.19, p = 10-3), the fear of transmitting the infection (β = 0.11, p = 0.03) and burnout (β = 0.39, p = 10-3) were the predictors for the occurrence of secondary traumatic stress (adjusted r2 = 0.48).

CONCLUSION

More resilience promoting interventions and more coping skills programs must be implemented to fulfill HCWs' psychological well-being needs.

Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients’ hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points (p < 0.001), forced expiratory volume in one second by 110 ± 180 ml (p = 0.04), 6-min walk distance by 35 ± 42 m (p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg (p = 0.048), resting heart-rate by 7 ± 9 bpm (p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg (p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work.

Comments about the “Systematic Review: Physical Rehabilitation Therapy for Long COVID-19 Patient with Respiratory Sequelae”

I read with great interest the systematic review of Prabawa et al. “Physical Rehabilitation Therapy for Long COVID-19 Patient with Respiratory Sequelae: A Systematic Review”. The rational of this systematic review is very interesting, since it discusses the rehabilitation therapy for long coronavirus disease 2019 (COVID-19) syndrome with respiratory sequelae. In COVID-19, physical rehabilitation is a new management axis, and studies related to its impacts on COVID-19 patients’ data are scarce. In their paper, Prabawa et al. have included one Tunisian study (Benzarti W, et al. General practitioners should provide the cardiorespiratory rehabilitation’ ‘minimum advice’ for long COVID-19 patients. Lib J Med. 2022;17(1):2009101) published by the authors of this correspondence. However, three remarks related to the following points were noted: i) Citation of a wrong country of Benzarti et al., ii) Publishing a figure belonging to Benzarti et al. without obtaining the authors’ permission, and iii) Omission to develop a chapter for nutrition rehabilitation. The present Letter to Editor is an appeal for a more rigor when reporting data from previous publications (eg; avoid mistakes related to the country of the first author), and is a remain that permission is needed if some authors want to use a figure created by somebody else.

Long COVID-19 chez des patients Nord-Africains : l’incapacité évaluée par les données du test de marche de six minutes

Introduction

Le long COVID-19 est défini par la persistance des symptômes au-delà de 12 semaines sans diagnostic alternatif après l’acquisition de l’infection, quel que soit le statut viral. Dans le long COVID-19, les séquelles cardiorespiratoires, notamment l’incapacité ne sont pas encore bien élucidées. Le but de ce travail était d’évaluer l’aptitude aérobie sous-maximale (via les données du test de marche de six minutes (TM6)) des patients ayant présenté une pneumopathie hypoxémiante à COVID-19.

Méthodes

Cinquante-cinq patients atteints d’une pneumopathie hypoxémiante à COVID-19 étaient inclus. Les données anthropométriques (âge, indice de masse corporelle (IMC)) étaient collectées. Une spirométrie simple et unTM6 étaient pratiqués. Les données suivantes étaient notées: volume expiratoire maximal en une seconde sur la capacité vitale forcée (VEMS/CVF), distance de marche (Dm6, m, %), fréquence cardiaque (FC, bpm, %), saturation pulsée en oxygène (SpO₂, %), dyspnée (échelle visuelle analogique (EVAd)). Les définitions suivantes étaient appliquées: Dm6 anormale (Dm6 < à la limite inférieure de la normale), désaturation (chute de la SpO₂ > 5 points), dyspnée anormale (dyspnée à la fin du TM6 > 5), insuffisance chronotrope (FC à la fin du TM6 < 60 %), réponse cardiaque excessive (FC à la fin du TM6 > 80 %).

Résultats

Les moyennes d’âge, d’IMC, et du rapport VEMS/CVF étaient, respectivement, de 59 ± 8 ans, de 30 ± 5 kg/m², et de 0,79 ± 0,08. La moyenne de la Dm6 (m, %) était de 574 ± 73 m (97 ± 14 %). Les moyennes de la FC (bpm, %) et de la dyspnée de repos étaient, respectivement, de 78 ± 11 bpm (55 ± 7 %), et 1 ± 1. À la fin du TM6, elles avaient augmenté d’une manière statistiquement significative avec des moyennes de 115 ± 23 bpm (67 ± 13 %) et 3 ± 2. La moyenne de la SpO₂ de repos était de 96 ± 2 % et a diminué d’une manière statistiquement significative à la fin du TM6 avec une moyenne de 94 ± 4 %. À la fin du TM6, 16 (29 %), 12 (22 %), 7 (13 %), 4 (7 %), et 4 (7 %) patients avaient, respectivement, une insuffisance chronotrope, une Dm6 anormale, une réponse cardiaque excessive, une désaturation, et une dyspnée anormale.

Conclusion

Les patients atteints du long COVID-19 semblent avoir une altération de l’aptitude aérobie sous-maximale. Un programme de réhabilitation respiratoire pourrait restituer cette altération.

POS1285 FOOT DISORDERS AND FALLS RISK IN OLDER PERSONS

Background:

Falls are major problems in older people, leading to serious morbidity and mortality. Many studies have identified intrinsic and extrinsic fall risk factors in order to develop preventive strategies and guidelines. There are few reports which studied the impacts of aging feet on falls [1].

Objectives:

The present study aimed to explore foot musculoskeletal disorders and their relationship to falls in a healthy aging population.

Methods:

This was a cross-sectional descriptive study involving the patients aged 65 years and over who were independent in self-care and walking followed at the physical medicine and rehabilitation department of the university hospital of sousse over 3 months. The analysed data focused on the epidemiological and clinical characteristics.Trained physicians evaluated health status, foot problems, and fall(s) history of all subjects. Walking performance was assessed using the ‘Timed Get Up & Go’ test and the unipedal stance test was used for the assessment of balance. Footprints were taken from the standing position. Associated factors of foot disorders and falls were analyzed.

Results:

There were 45 subjects: 18 men, 27 women with a mean age of 69.6 [65-86] years. Foot deformities presented in 87% and were a significantly associated with walking performance or falls (p=0.01, p=0.02). The most common foot musculoskeletal disorder were Halux valgus 31%, followed by Mallet toe 15%. Arch of foot classified by physical examination revealed that pes planus was presented in 35% of cases. There was a significant correlation between BMI and an arch index (p=0.04). Foot problems remained significantly associated with impaired timed up and go test and the unipedal stance test. The causes of pain were plantar fasciitis, hallux valgus, callus, metatarsalgia, and inappropriate footwear. Falls were reported in 33.3 of patients. Falls were significantly associated with Hallux valgus, mallet toe and pain (p<0.05).

Conclusion:

Independent of the influence of age, gender, common conditions; foot problems have a significant impact on the ability to perform functional tasks integral to independent living.

References:

[1]Menz HB, Lord SR: Foot problems, functional impairment, and falls in older people. J Am Podiatr Med Assoc 1999;89:458– 467. 3 Americ

Disclosure of Interests:

None declared

POS1286 SHORT-TERM AND MID-TERM EFFICACY OF CAUDAL EPIDURAL STEROID INJECTIONS IN THE MANAGEMENT OF DEGENERATIVE SCIATICA

Background:

Epidural steroid injections are largely used in the management of osteoarthritis-related sciatica. Three possible sites of injection are possible: the caudal through the sacral hiatus, the interlaminar and the transforaminal site. The caudal technique is known to be the most simple one. However, doubts still persist about this infiltration’s efficacy.

Objectives:

The aim of this work was to study the short-term and mid-term efficacy of caudal epidural steroid injections in patients suffering from sciatica related to a degenerative etiology and to study the determining factors of its efficacy.

Methods:

A retroscpective, descriptive and monocentric study was conducted in Sahloul university hospital of Tunisia. Medical records of patients who suffered from sciatica due to disc herniation or spinal stenosis were analysed. Only patients who benefited from at least one caudal epidural steroid injection were included. Other etiologies were ruled out by CT-scan or MRI and laboratory tests. Efficacy of the injection was evaluated by the visual analog scale of pain (VAS) at the first week post infiltration, 3 months and 6 months later. The infiltration was considered effective if the difference of pain scoe by VAS was ≥50% compared to baseline‘s score. The presence of anxiety and depression was also tracked down with the hospital anxiety and depression scale. Data was collected and analysed using the statistical tool SPSS.20.

Results:

Twenty-five patients were included. They were 7 males and 18 females. The mean age at diagnosis was 51.88± 15.28 years. Eleven patients had another osteoarthritis site. Five patients had previous back surgery: 2 dissectomies, 1 arthrodesis, and 2 laminectomies. Median duration of sciatica was 30 months. Sciatica was bilateral in 41.7% of the cases, impulsive during efforts in 52% of the cases and with claudication in 92% of the cases. The median VAS score at baseline was 7 out of 10 (min=4; max=9). All patients had tried medical treatment using NSAIDS and painkillers, and physical therapy before prescribing the infiltration. The technique was similar in all patients: Lidocaine 1% was first injected at a median volume of 5ml, followed by corticosteroids and finally a saline solution (median volume of 20ml). The median number of epidural caudal injections was 3 injections (min=1; max=3). The caudal epidural steroid injections were effective in 60% of the patients at the first week, 56% in the cases at 3 months and 56% of the cases at 6 months. Factors associated with efficacy of the injection at the first week were greater total volume injected (p=0.001), and greater saline solution volumes (p=0.016). At 3 months, factors significantly associated with efficacy of the infiltration were having unilateral pain (p=0.05), a positive straight leg raise test sign (p=0.028), a lower anxiety score (0.014) and a lower depression (0.000) score. At 6 months, factors associated with efficacy were not having cervical osteoarthritis (p=0.03), unilateral pain (p=0.05), low anxiety (p=0.014) and low depression (p=0.001) scores and a higher number of steroid injections (p=0.05).

Conclusion:

Caudal epidural steroid injections seem effective on the short-term and this efficacy is maintained till the mid-term. Greater volumes may help with pain by possible adhesiolyse-like mechanisms and having unilateral pain, positive straight leg raise sign, a higher number of injections, no anxiety or depression and no other osteoarthritis sites makes the infiltration more effective.

References:

[1]Dincer U, Kiralp MZ, Cakar E, Yasar E, Dursan H. Caudal epidural injection versus non-steroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine. 2007;5.

Disclosure of Interests:

None declared

POS1154 CHARACTERISTICS OF SURGICALLY TREATED TUBERCULOUS AND BRUCELLAR SPONDYLODISCITIS

Background:

Although rare in most developed countries, tuberculous and brucellar spondylodiscitis are still frequent in the mediterranean countries. Management of spondylodiscitis may require a surgical intervention in cases of spinal cord or root compression, bone destructions and deformities, unsuccessfull medical treatment or large abcesses.

Objectives:

To study characteristics and outcome of surgically treated tuberculous and brucellar spondylodiscitis.

Methods:

Medical records of patients who were admitted into the physical therapy and rehabilitation ward immediately post surgery of the spine were retrospectively studied. The study included records from January 2010 to December 2020.

Results:

Twenty patients were diagnosed with tuberculous or brucellar spondylodiscitis for which they underwent surgery. The mean age of diagnosis was 49.7± 11.9 years. The sex ratio was 1:1. The diagnosis was delayed in 60% of the cases due to atypical presentations. Fatigue was reported in 45% of the patients, back pain in 60% of the cases, radicular pain in 15% of the cases, fever in 20% of the patients and abnormal gait in 60% of the cases. Tuberculosis was identified in 75% of cases and brucellar infection in 25% of the cases. On biology, elevated inflammatory markers were noted in 60% of the cases. Intradermal reaction for tuberculosis was positive in 9 patients while cultures allowed the diagnosis of tuberculosis in 1 patient. Wright serology test confirmed the diagnosis of brucellar infection in all 5 cases. In the remaing ones, vertebral biopsy or intraoperative samples allowed the diagnosis of the tuberculous spondylodiscitis. Cervical spine involvement was noted in 5% of cases, lumbar spine in 25% and dorsal spine in 30% of the cases. All patients recieved antibiotics and spinal immobilization. Surgery was indicated in 78.6% of cases for spinal cord decompression and in 21.4% of the cases for voluminous abcesses. Anterior approach was used in 7.1% of the cases and posterior approach in 92.9% of cases. 23.1% of the patients benifited concomitantly with spinal fusion surgery. Post operative success was immediately confirmed by recovery of normal gait in 15.4% of the patients. Complications after surgery were reported in 35.7% of the cases. They consisted in spinal instability in 60% of the cases, abcesses in 20% of the cases and the emergence of secondary articular localizations in 20% of the cases. 28.6% of the patients underwent a second surgery mainly to stabalize the spine. Before surgery, walking was impossible for 65% of the patients and 12 months after surgery only 30% of the patients couldn’t walk (p=0.001). 15.8% of the patients developed later on pressure ulcers and 45% of the patients were prescribed appropriate wheelchairs.

Conclusion:

Spinal surgery in tuberculous or brucellar spondylitis may be indicated if medical treatment is insufficient and especially if neurological complications occur. Surgery may be invasive with various complications but sometimes it could be the only option to treat a neurological deficit.

References:

[1]Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012; 36: 413–420.

Disclosure of Interests:

None declared.

The management of Joubert Syndrome in Physical Medicine and Rehabilitation department

Since Joubert et al. first described a familial syndrome comprised of agenesis of the cerebellar vermis, episodic hyperpnea and apnea, abnormal eye movements, ataxia, and retardation associated with genesis of the cerebellar vermis, several additional cases have been reported from various parts of the world. Other abnormalities have been associated with Joubert syndrome, such as an occipital meningocele, polydactyly, facial asymmetry, and chorioretinal coloboma. We report the case of a 4-year-old male, referred to our rehabilitation department with a history of hypotonia and delayed psychomotor development. Cerebral magnetic resonance imaging (MRI) led to the clinical diagnosis of Joubert Syndrome.