Effectiveness of Liu-zi-jue exercise on coronavirus disease 2019 in the patients: a randomized controlled trial.

OBJECTIVE: The aim of this study was to examine the effect of Liu-zi-jue exercise on the respiratory symptoms, quality of life, and mental health of patients with mild coronavirus disease 2019 (COVID-19). METHODS: A single-center randomized controlled trial was conducted with 104 patients with mild COVID-19. The patients were randomly assigned to the Liu-zi-jue plus conventional therapy group and conventional therapy group. The outcome measures included Modified Borg Dyspnea Scale (MBDS) score, Patient Health Questionnaire-9 (PHQ-9) score, Fatigue Scale-14 (FS-14), respiratory symptoms, and vital signs. Data were collected on the first and sixth days of hospitalization and on the discharge day. RESULTS: Repeated-measures ANOVA revealed that the whole scales all showed a downward trend in the two groups (all 0.05). The results of single-group effect suggested that the whole scale score in the intervention group was significantly lower than that in the control group at the sixth day of hospitalization. Compared with the control group, only the MBDS, expectoration, and FS-14 scores showed significantly lower scores at the discharge day ( 0.001, 0.011, 0.002). Comparison within the group showed that all the variables were significantly different at the three time points with a decreasing trend ( 0.05), except for the PHQ-9 and expectoration scores ( 0.331, 0.052). All patients' vital signs remained within a stable normal range throughout the hospital stay. CONCLUSION: The results suggested that Liu-zi-jue exercise as a complementary and alternative therapy showed beneficial effects on improving the symptoms (shortness of breath, fatigue, and cough), quality of life, and mental health of patients with mild COVID-19.

Effectiveness of a telerehabilitation program for COVID-19 survivors (TERECO) on exercise capacity, pulmonary function, lower limb muscle strength, and quality of life: a randomized controlled trial (preprint)

Objectives To investigate superiority of a telerehabilitation program for Covid-19 (TERECO) over no rehabilitation with regard to functional exercise capacity, lower-limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL), and perceived dyspnoea. Design Parallel-group randomised controlled-trial with 1:1 block-randomisation. Setting Three major hospitals from Jiangsu and Hubei provinces, China. Participants 120 Covid-19 survivors with modified Medical Research Council (mMRC) dyspnoea score of 2-3 who had been discharged from hospital were randomised. 61 were allocated to the control group and 59 to the TERECO group. Intervention The control group received educational instructions. The TERECO group participated in a 6-week home-based, pulmonary rehabilitation program delivered via smartphone and monitored with chest-worn heart rate telemetry. Exercise types comprised breathing control and thoracic expansion, aerobic exercise, and LMS exercise. Outcomes Primary outcome was 6-minute walking distance (6MWD) in metres. Secondary outcomes were LMS measured as squat time in seconds; pulmonary function assessed by spirometry with parameters being forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, maximum voluntary ventilation (MVV), and peak expiratory flow; HRQOL measured with SF-12 physical component score (PCS) and mental component score (MCS); and mMRC dyspnoea, favourable outcome (no dyspnoea). Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up). Results 120 patients were randomised, 15 (12.5%) were lost to follow-up at study endpoint. No serious adverse events occurred. 38 participants in the TERECO group complied with the exercise protocol (64.41% of randomized). The adjusted between-group difference in change in 6MWD from baseline was 65.45 metres (95% CI 43.8-87.1, p<0.001) at post-treatment and 68.62 metres (95% CI 46.39-90.85, p<0.001) at follow-up. Treatment effects for LMS were 20.12 seconds (95% CI 12.34-27.9, p<0.001) post-treatment and 22.23 seconds (95% CI 14.24-30.21, p<0.001) at follow-up. No group differences were found for lung function apart from post-treatment MVV (10.57 litres/minute, 95% CI 0.26-17.88, p=0.005). Increase in SF-12 PCS was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24-6.35, p=0.004) at post-treatment and 2.69 (95% CI 0.06-5.32, p=0.045) at follow-up. No significant between-group differences were found for improvements in SF-12 MCS. At post-treatment 90.4% endorsed a favourable outcome for mMRC dyspnoea in the TERECO group vs. 61.7% in control (adjusted RR 1.46, 1.17-1.82, p=0.001). Conclusions This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and SF-12 PCS. We found no persistent effects on pulmonary function, SF-12 MCS, and perceived dyspnoea. Trial registration Chinese Clinical Trial Registry: ChiCTR2000031834, 11 Apr 2020, URL: http://www.chictr.org.cn/showproj.aspx?proj=52216 KEY POINTS What is already known Many Covid-19 survivors discharged from hospital have reduced exercise capacity, impaired pulmonary function, muscle weakness, and reduced quality of life, all of which might be addressed with pulmonary rehabilitation. However, evidence on effective pulmonary rehabilitation measures for this population is currently lacking. As delivery of conventional rehabilitation services is furthermore limited due to pandemic control measures, telerehabilitation programs represent a possible alternative. What the study adds We developed a telerehabilitation program for Covid-19 survivors (TERECO program) that is delivered via smartphone and can be carried out at home. Our study suggests that TERECO was safe and participants of the TERECO program had improved exercise capacity, lower-limb muscle strength, and physical quality of life. No relevant group differences were found for lung function, self-reported breathlessness, and mental quality of life. The TERECO program is inexpensive and could be implemented on a large scale to improve physical health of Covid-19 survivors after discharge from hospital.

Acupressure Therapy and Liu-Zi-Jue Qigong for Pulmonary Function and Quality of Life in Patients with Severe Novel Coronavirus Pneumonia (COVID-19): Study Protocol for a Randomized Controlled Trial (preprint)

Background: In December, 2019, a pneumonia associated with the 2019 novel coronavirus (COVID-19) emerged in Wuhan, China. The number of cases has increased rapidly, severe patients have a poor prognosis and there are no effective therapies or vaccines for it. Only one rapid advice guideline for symptomatic supportive care has been used for it. A Traditional Chinese medicine Rehabilitation（TCMR） program consisting of acupressure therapy and Liuzijue Qigong can be used as a complementary therapy for COVID-19.Hence, we designed a randomized trial to evaluate the efficacy and advantages of TCMR for treating severe patients with COVID-19. Methods: /design This is a parallel-design, two-arm, analyst-assessor blinded, randomized controlled trial. A total of 120 patients with COVID-19 aged from 20 to 80 will be recruited and assigned randomly into a guideline therapy group and a guideline therapy plus TCMR group at a 1:1 ratio. Patients in both groups will receive guideline therapy. The patients in intervention group will perform acupressure therapy and Liuzijue Qigong exercise on the basis of conventional treatments, twice a day, and have been persistent from admission to discharge. The primary outcomes are measured with Modified Dyspnea Scale (MDS) and Activities of Daily Living (ADL). The secondary outcomes include Patient Health Questionnaire-9 (PHQ-9), Length of Hospital Stay (LHS), Respiratory Symptoms (RS), Liver function test, Renal function test and lung CT. Clinical assessments will at three points (before treatment, 7th day during hospitalization and the discharge day). Adverse events will be noted and recorded for the safety evaluation. Discussion: This trail will provide a high-quality evidence of the value of TCMR, which is consist of acupressure therapy and Liuzijue Qigong exercise for treating severe patients with COVID-19.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000029994 Registered 18 February 2020, http://www.chictr.org.cn/showproj.aspx?proj=49309

Patient with COVID-19 who has no specific onset symptoms and progresses rapidly to death: a case report (preprint)

BackgroundSince its outbreak, COVID-19 has continued to spread rapidly more than 3 months, which constituted a public health emergence worldwide.The onset symptoms of patients with COVID-19 are not specific, especially in non-respiratory symptoms, it is easy to be ignored, which can cause widespread infection. For critically ill patients, glucocorticoids are used for anti-inflammatory treatment. However, after the application cycle recommended by the guidelines, the deterioration of the patient's condition and treatment to suppress cytokine storms is more critical.Case presentationA previous patient was admitted to the hospital due to abdominal pain and diarrhea, and accidentally was confirmed with positive SARS-CoV-2. The patient progressed rapidly from mild to severe within 2 days of admission. With timely anti-viral and anti-inflammatory drugs and early ventilator respiratory support, the patient's condition improved temporarily, and subsequently accompanied by a decrease in glucocorticoids, the patient's condition worsened and eventually died. Her family members were also hospitalized due to close contact.ConclusionThis case highlights that even if glucocorticoids are discontinued in accordance with the guidelines, deterioration of the patient's condition is inevitable attribute to the cytokine storms. And related Chinese and western medicines that suppress cytokine storms should be applied in time. In addition, more systematic epidemiological surveillance and stool tests are necessary due to potential lethal risk and route of transmission.