ABSTRACT
Background and/or Objectives: Current guidelines recommend all children, including those with disabilities, obtain 60 minutes of daily physical activity. The COVID-19 pandemic has affected children with disabilities' (CWD) access to physical activity, with studies reporting 50-70% of CWD exercising less during the pandemic than before. The aims of this study were to assess whether a cohort of CWD were getting less physical activity than recommended national guidelines, examine specific barriers, and gauge parental interest in physical activity programs for their children. Design(s): Cross-sectional survey study Setting: Multi-center outpatient study within academic freestanding hospitals Participants: 59 parents of children with chronic disabilities Interventions: N/A Main Outcome Measure(s): Likert scale for how much child is leaving home compared to pre-pandemic, how much physical activity child is getting daily, main barriers to physical activity, interest for physical activity programs. Result(s): There were n=59 parents of children with disabilities who participated in the study. Child's age had a mean of 10.1 +/- 5.6 years. Twenty of the children were female and 39 were male. Forty-six parents (78%) either agreed or strongly agreed that their child left the house less during the pandemic than before. Forty parents (68%) reported their child was getting less than 60 mins of daily physical activity. The main barrier to physical activity was "concern for COVID transmission," with 38 parents (64%) citing that as a concern. If there were structured physical activity programs available, 41 parents (70%) said they were interested in enrolling their child. Conclusion(s): The physical activity levels of children with disabilities have been impacted by the COVID-19 pandemic, which can have deleterious effects on overall mental and physical health. The main barrier to physical activity for CWD is parental concern for COVID transmission. Virtual physical activity programs tailored towards children with disabilities could be a methodology for improving physical activity engagement in these children during the pandemic.
ABSTRACT
Objective: To describe the inpatient rehabilitation (IPR) course of patients who underwent bilateral lung transplant due to severe COVID-19 pulmonary disease. Design(s): Retrospective chart review Setting: Free-standing, academic, urban inpatient rehabilitation hospital Participants: Seventeen patients aged 28-67 years old (mean 53.9 +/- 10.7) who developed COVID-19 respiratory failure and underwent bilateral lung transplant. Intervention(s): Patients participated in a comprehensive IPR program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual. Main Outcome Measure(s): Primary outcome measures of functional improvements, include mobility and self-care GG scores, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, and Mann Assessment of Swallowing Ability (MASA). Wilcoxon Signed Rank Sum Test was used to evaluate statistical significance between admission and discharge scores. Result(s): Fourteen patients completed inpatient rehabilitation. Self-care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6-minute walk distance improved from 174.1 to 455.1 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All scores changes were statistically significant with p value < 0.01. 76% of patients discharged home. Conclusion(s): This retrospective review demonstrates that this new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications. Advances in medical technology have increased the number of people with severe respiratory failure who are eligible for lung transplant and inpatient rehabilitation facilities have adapted to the changing COVID-19 medical landscape. It is important for rehabilitation providers to recognize opportunities to treat new patient populations and to be able to adjust treatment protocols accordingly.
ABSTRACT
Background and/or Objectives: Elevated levels of inflammatory laboratory markers have been shown to be associated with increased severity of acute COVID- 19 infection, and may have prognostic value in predicting mortality. However, the relationship between inflammatory markers and functional outcomes in inpatient rehabilitation has not yet been studied. Our study examines this relationship, with the goal of investigating if there is prognostic value of these labs for rehabilitation potential. Design(s): Retrospective cohort study Setting: Acute inpatient rehabilitation at Shirley Ryan AbilityLab, Chicago IL Participants: N=182 patients admitted to an inpatient rehabilitation facility (IRF) for functional impairment secondary to acute COVID-19 infection. Intervention(s): Not applicable Main Outcome Measure(s): The relationship between change in mobility, self-care, and cognition functional independence measures from admission to discharge, and selected laboratory values on admission: leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Statistical analysis was performed using Spearman's rank correlation for lab values as continuous variables and two-sample t-tests for labs as categorical values (normal vs abnormal). Result(s): There were no statistically significant associations between change in functional outcomes and selected inflammatory laboratory values. However, the baseline laboratory values of ESR and CRP trended towards an association with change in self-care (p=0.09 and p=0.08, respectively), and baseline CRP trended towards an association with change in mobility (p=0.07). An abnormal platelet count trended towards less improvement in self-care scores in IRF from admission to discharge (p=0.08). Conclusion(s): Inflammatory laboratory markers do not show a clear association with functional improvement through inpatient rehabilitation for COVID-19-related debility. However, given the near significance of several lab values, a larger sample size may elucidate prognostic value of several of these markers, which would provide utility for expected rehabilitation needs after infection with acute COVID-19.
ABSTRACT
Chronic low back pain constitutes the major form of chronic pain, with a prevalence as high as 70-85 percent in adults at some time in their lives. This 26-week, double blind, randomized, placebo controlled two-arm parallel-group study will evaluate 244 participants to determine if treatment with d-cycloserine in individuals with chronic, refractory low back pain will demonstrate greater reduction in pain compared to individuals treated with placebo. After a two-week screening period, individuals are randomized to receive either 12 weeks of d-cycloserine or placebo and then followed for an additional 12 weeks to evaluate persistence of benefit at study endpoint, 24 weeks after randomization. Follow-up visits and data collection will occur at baseline and 2, 6, 12, and 24 weeks after randomization to assess general health, pain, proper treatment use, and side effects. Pain and safety will also be assessed at 16 and 20 weeks after randomization by phone calls.