ABSTRACT
INTRODUCTION Telehealth for COVID-19 patients is still limited. We aimed to assess the clinical effects of a home-based tele-rehabilitation exercise program following hospital discharge during the first lockdown in Greece, April to July 2020. METHODS A pre-and post-intervention design was applied in two stages. Firstly, patients were instructed to use a specially designed for COVID-19, e-book during four tele-health sessions. Afterwards, a 2-month home-based program consisted of self-practice exercise and one-hour supervised tele-rehabilitation exercise sessions every 10 days, was delivered. At baseline and at the end of the program, participants were interviewed about their physical, psychological status and quality of life (QoL) during the post-hospitalization period. The IPAQ-Gr, the HADS and the SF-36 questionnaires were used, respectively, and the participants were functionally assessed via teleconferences, using the 60 sec Sit to Stand Test (60secSTS), the Short Physical Performance Battery (SPPB) and the 3 min Step Test (3MST). RESULTS Seventy-four patients, median age 52.5 (IQR: 43–61) years were included at the first stage. From those, only 22 patients, mean ± SD age 50.1 ± 13.2 years completed the 2-month exercise program. The training program was well tolerated by all 22 patients. The mean number of unsupervised exercise sessions was 18.4 ± 3.5. No adverse effects were observed either during initial and follow-up assessment via tele-communication or during home-exercise sessions. Training improved significantly (p<0.001) lower limb muscle performance [median (IQR) 60secSTS: 22 (20–26) to 31 (25–36)], anxiety [median (IQR) HADS: 9 (6–13) to 4.3 (3.2–9.6)], depression [median (IQR) HADS: 5 (3–8) to 1.8 (0.9–3.7)], QoL [mean ± SD SF-36pcs: 37.5 ± 10.3 to 52.1 ± 6, and mean ± SD SF-36mcs: 42.9 ± 11.6 to 45.5 ± 12.3]. CONCLUSIONS Tele-rehabilitation may be feasible and may improve physical and psychological status of COVID-19 patients after hospital discharge. © 2022 Kortianou E. et al.
ABSTRACT
Background: Experience from previous coronavirus outbreaks had shown that infected patients are at risk for developing psychiatric disorders, such as mood and sleep disturbances. Similarly, accumulating evidence suggests that patients with COVID-19 infection experience an excess of adverse psychological outcomes and neuropsychiatric complications [1,2]. The aim of this study was to investigate the impact of COVID-19 infection and hospitalization on the mental health, quality of life, and sleep of patients following hospital discharge. Methods: Patients were assessed during follow up visits in the outpatient clinic 1-2 months after hospital discharge from a large Covid-19 reference hospital in Athens, Greece (from May 8th 2020 till February 4th 2021) using validated screening tools for Depression and Anxiety (HADS), post-traumatic stress disorder (IES-R), sleeping difficulties (Athens Insomnia Scale, AIS), and Quality of Life (EQ-5D-5L). Sociodemographic information, smoking history, co-morbidities and severity of disease (hospitalization, ICU) were also collected. Results: A total of 131 eligible patients who provided informed consent were included. Overall, Covid-19 patients experienced considerable levels of mental health symptoms following hospital discharge. Moreover, rates were significantly higher for female compared to male patients despite having shorter duration of hospitalizations (14.89 vs 18.82 bed days) and/or ICU admissions (13.51 vs 14.92). This finding was consistent across all recorded psychological outcomes i.e. depression (p=0.004), anxiety (p=0.017), traumatic stress (p<0.001), fear (p<0.001) and insomnia (p=0.002). In addition, differences in prevalence rates between genders were particularly marked for moderate levels of depression and traumatic stress and for severe levels of anxiety. Smoking and comorbidities were not found to significantly correlate with the presence of affective symptoms or sleep dysfunction. However, an association was observed between severity and the existence of comorbidity with the proportion of patients with comorbidities increasing from 67.5% of the patients with minimal depression to 91.43% to those with mild and 80% with moderate depression (p-value=0.018). Finally, quality of life was worse for patients that have had an admission in the ICU (EQ-5D-5L: 15.82 ± 5.27) compared to those who were hospitalized but did not require ICU treatment (EQ-5D-5L: 8.39 ± 2.81) (p-value<0.001). Conclusion: COVID-19 disease can have a significant psychological impact on hospitalized patients and particularly women despite the relative less severe course of their illness. This finding is in line with a previous study, showing that, despite significantly lower levels of baseline inflammatory markers, female patients suffered more for both anxiety and depression at one-month follow-up following hospital admission (3). Regardless of potential sex differences, the prevalence of moderate and severe mental illness symptoms in COVID‐19 patients may be higher compared with the general population or other high risk groups such as different patient groups or healthcare workers [2-4]. Our results highlight the need for appropriate interventions to promote physical and mental wellbeing of COVID-19 survivors and cater for long-term needs. No conflict of interest