ABSTRACT
The COVID-19 pandemic has potentially altered the system of population movement around the world. As COVID-19 hit cities the hardest in the wake of the pandemic, apocalyptic headlines anticipated the ‘death of cities'. Yet, little was known about the impact of the COVID-19 pandemic on cities and the ways it has shaped the patterns of internal population movement in and out of cities. This virtual special issue aims to consolidate our knowledge of the impacts of the COVID-19 pandemic on internal migration, discuss key lessons we have learnt so far, and identify areas for future enquiry. It brings together evidence from six different countries: Australia, Germany, Japan, Spain, Sweden and the United Kingdom, covering the pandemic in varying temporal lengths. Systematic patterns emerge. A first commonality is an overall reduction of internal migration rates during the early days of the pandemic but to a lesser degree than expected. Second, the impacts of COVID-19 leading to out-migration from cities seem to have been temporary, though evidence from Spain and Britain points to scarring effects with persistent losses in highly dense areas. Third, changes in internal migration generated small impacts on the population structure of cities but large-scale changes in small, rural and low-density areas. © 2023 John Wiley & Sons Ltd.
ABSTRACT
PURPOSE/HYPOTHESIS: The purpose of this quality improvement study is to determine if a structured outpatient rehabilitation program can improve physical function, aerobic capacity, and pulmonary function in individuals recovering from COVID-19 infection. These individuals are presenting with impairments similar to those of acute respiratory distress syndrome (ARDS) and other critical illnesses.1,2 Previous research on ARDS and critical illness attests to the benefits of early, targeted outpatient rehabilitation. 1-5 Our hypothesis is that a structured exercise and functional training program based on cardiopulmonary rehabilitation principles will help these individuals regain their functional capacity and independence. NUMBER OF SUBJECTS: 12 patients were scheduled for PT evaluation between 5/15/2020 and 7/24/2020, 9 attended the evaluation and 7 participated in therapy. MATERIALS AND METHODS: Individuals referred to outpatient cardiopulmonary rehabilitation following a diagnosis of COVID-19 infection were included in the study. Outcome measures utilized included the 6 Minute Walk Test (6MWT), 2-minute stepping test (2MST), Short Physical Performance Battery (SPPB), chest wall mobility and excursion, Duke Activity Status Index (DASI), Ferrans and Powers Quality of Life -Pulmonary Version III (F&PQOL), University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ), Patient Health Questionnaire-9 (PHQ-9), and Handheld Dynamometry. RESULTS: Three out of the 9 were intubated with an average length of intubation of 14 days, median hospital length of stay for the 9 individuals was 14 days. Median age for those participating in therapy was 59 years. 57% were female and 43% were male. Five out of 7 completed therapy as of July 24, 2020. A minimally important difference (MID) was found for the 6MWT with an average increase of 325 ft (99 m), well above the 30 m MID for ARDS patients.6 There was also a clinically significant improvement for SPPB with an average improvement of 1.8 points.7 There was also a statistically significant change post-rehabilitation on the 2MST for METs (P = 0.0009), self-selected gait speed (P = 0.03), SPPB (P = 0.05), 6MWT distance (P = 0.03), and 6MWT METs (P = 0.04). Improvements were also found post-rehabilitation on the PHQ-9, UCSD-SOBQ, F&PQOL, chest wall mobility and excursion, and speed performing chair stands, although they were not statistically significant. CONCLUSIONS: The results of these data show that a structured cardiopulmonary rehabilitation program lead by skilled physical therapists will result in enhanced recovery after COVID-19 infection including improvements in physical function, aerobic capacity, and muscular strength. Despite the extremely small sample size, due to the novelty of this virus and the rehabilitation program, there was a statistically significant change in some of the outcome measures. CLINICAL RELEVANCE: Due to the novelty of this virus and limited data on effective intervention during rehabilitation, dissemination of these results will be extremely helpful for other physical therapists to justify treatment for these individuals and guide appropriate methods of skilled intervention and outcomes assessment.