Pulmonary rehabilitation of a critically Ill patient with severe COVID-19: A case report

@#Coronavirus 19 disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is a case of a previously healthy 61-year-old man who presented to the emergency department with progressive dyspnea and a confirmed COVID-19 test, who was critically ill with severe acute respiratory distress syndrome. The principles of pulmonary rehabilitation were implemented starting from the sixth hospital day (time of referral from the intensive care unit) until he was transferred to a non-COVID ward and discharged. The patient participated in six treatment sessions while admitted, with each session lasting nearly 30 minutes. His Barthel index score improved from 0 (total dependence) to 85/100 (modified independence), with improvements in pulmonary secretions, shortness of breath, rate of perceived exertion, muscle strength, and endurance. He was able to return to work after three months. The application of the principles of pulmonary rehabilitation for critically ill patients with severe COVID-19 helped improve the cardiopulmonary, cognitive, and functional aspects of the patient throughout the course of hospital admission and beyond discharge.

Continuing care through telerehabilitation for patients in a COVID-19 referral center in the Philippines: A case series

@#In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.