Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study.

After the resolution of the acute SARS-COV-2 infection, an important percentage of patients do not fully recover and continue to present several symptoms. Nevertheless, there is a lack of data in the literature on the effects of rehabilitation programs on medium- and long-term long COVID symptoms. Therefore, the aim of this study was to evaluate the long-term outcomes after rehabilitation programs in long COVID syndrome patients. A prospective cohort study was conducted from August 2021 to March 2022, involving 113 patients with long COVID syndrome. The patients in the experimental group (EG, n=25) received a tailored and multidisciplinary rehabilitative program, involving aquatic exercises, respiratory and motor exercises, social integration training and neuropsychologic sessions, LASER therapy and magnetotherapy. Patients in the other three comparison groups received eastern medicine techniques (CG1), balneotherapy and physiotherapy (group CG2), self-training and home-based physical exercise (CG3). Once the several rehabilitation protocols had been performed, a structured telephone contact was made with the patients after 6 months ± 7 days from the end of the rehabilitation treatment, in order to record the frequency of hospital ad-missions due to exacerbation of post-exacerbation syndrome, death or disability, and the need for other types of care or drugs. The patients in the comparison groups were more likely to request therapeutic care for emerging long COVID symptoms (χ2=6.635, p=0.001; χ2=13.463, p=0.001; χ2=10.949, p=0.001, respectively), as well as more likely to be hospitalized (χ2=5.357, p=0.021; χ2=0.125, p=0.724; χ2=0.856, p=0.355, respectively) when compared to the patients of the EG. The relative risk (RR) of hospital admissions in the observed cohort was 0.143 ±1,031 (СI: 0.019; 1.078); 0.580±1,194 (CI: 0.056; 6.022); 0,340±1,087 (CI: 0.040; 2.860). The RR of hospital admissions for patients with long COVID syndrome was reduced by 85.7%; 42.0% and 66.0%, respectively, when the experimental rehabilitation technique was employed. In conclusion, a tailored and multidisciplinary rehabilitative program seems to have a better preventive effect not only in the short term, but also over the next 6 months, avoiding the new onset of disabilities and the use of medicines and specialist advice, than other rehabilitative programs. Future studies will need to further investigate these aspects to identify the best rehabilitation therapy, also in terms of cost-effectiveness, for these patients.

Impact of COVID-19 Pandemic on Reorganization of a Rehabilitation Unit in Italy...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate and describe the changes that the COVID-19 pandemic has determined in the organization of the Rehabilitation, particularly in the rehabilitative management of patients with acute infection and Long Covid syndrome. A survey was performed from May to August 2020, during the first pandemic surge. The study was conducted at padua General Hospital - University, namely in the Rehabilitation Unit, Department of Neuroscience. Patients referred to the Rehabilitation Unit completed the survey. A questionnaire was provided to each patient who accessed our outpatient clinics or who was contacted via digital devices. Patients completed the survey before the visit. Not applicable. Overall, 121 questionnaires completed by patients were analysed. The study participants were 91 female and 30 male patients. The reorganization of the activities by establishing treatment priorities and continuing to ensure early rehabilitative interventions in acute conditions has been essential to rationalize the deployment of staff and personal protective equipment in the emergency. Patients with acute infections were generally rehabilitated in hospital settings, but patients with Long Covid syndrome were largely rehabilitated in out-of-hospital settings. During the pandemic surge, the volume of ambulatory visits had decreased by 70%. Of the remaining visits, approximately 50% were performed via e-mail, 30% telephonically and 20% (nonpostponable evaluations) in person. Data have shown that 81% of patients preferred face-to-face visits rather than alternative communication methods and only 9% preferred to avoid the ambulatory visit because of the fear of contagion. As in-person evaluations and treatments have proven to be preferred by patients and hospitals cannot deal with the patient load during the pandemic, out-of-hospital alternatives, may be necessary, for example, to take care of patients with persistent outcomes after recovery from acute COVID-19 infection, such as fatigue or neurocognitive deficits. No conflict of interests to declare.

Impact of COVID-19 Pandemic on Reorganization of a Rehabilitation Unit in Italy

Research Objectives To investigate and describe the changes that the COVID-19 pandemic has determined in the organization of the Rehabilitation, particularly in the rehabilitative management of patients with acute infection and Long Covid syndrome. Design A survey was performed from May to August 2020, during the first pandemic surge. Setting The study was conducted at padua General Hospital - University, namely in the Rehabilitation Unit, Department of Neuroscience. Participants Patients referred to the Rehabilitation Unit completed the survey. Interventions A questionnaire was provided to each patient who accessed our outpatient clinics or who was contacted via digital devices. Patients completed the survey before the visit. Main Outcome Measures Not applicable. Results Overall, 121 questionnaires completed by patients were analysed. The study participants were 91 female and 30 male patients. The reorganization of the activities by establishing treatment priorities and continuing to ensure early rehabilitative interventions in acute conditions has been essential to rationalize the deployment of staff and personal protective equipment in the emergency. Patients with acute infections were generally rehabilitated in hospital settings, but patients with Long Covid syndrome were largely rehabilitated in out-of-hospital settings. During the pandemic surge, the volume of ambulatory visits had decreased by 70%. Of the remaining visits, approximately 50% were performed via e-mail, 30% telephonically and 20% (nonpostponable evaluations) in person. Data have shown that 81% of patients preferred face-to-face visits rather than alternative communication methods and only 9% preferred to avoid the ambulatory visit because of the fear of contagion. Conclusions As in-person evaluations and treatments have proven to be preferred by patients and hospitals cannot deal with the patient load during the pandemic, out-of-hospital alternatives, may be necessary, for example, to take care of patients with persistent outcomes after recovery from acute COVID-19 infection, such as fatigue or neurocognitive deficits. Author(s) Disclosures No conflict of interests to declare.

Short-Time Effects Of Spa-Rehabilitative Interventions On Pain, Mood And Quality Of Life In Musculoskeletal Disorders...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate the short-term effects of a spa rehabilitative protocol on pain perception, mood, and Quality of Life among patients affected by degenerative musculoskeletal disorders or post orthopaedic surgery outcomes. A multicenter observational study was conducted through pre- and post-treatment evaluations, planned follow-ups at three and six months were not conducted because of the COVID-19 pandemic. The study was carried out in six spa facilities (Sirmione, Lombardy region, Italy;Abano Terme, Veneto region, Italy;Battaglia Terme, Veneto region, Italy;Levico Terme, Trentino Alto Adige region, Italy;Bibione, Veneto region, Italy;Casciana Terme, Tuscany region, Italy). From March 2019 up to October 2019, data from the 160 users of the spa facilities with a medical prescription were collected. Twelve sessions of water-based exercise (thermal or warm water), six sessions per week, for a period of two weeks. A group of 44 patients also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for two weeks. Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12), and the EuroQol-5D (EQ-5D). Data analysis has highlighted significant improvements in NRSp (p< 0.001), NRSa (p< 0.001), SF-12 PCS (p< 0.001), SF-12 MCS (p< 0.001), EQ-5D (p< 0.001), and NRSm (p=0.005) after the treatments. Different water types seemed to influence results, showing significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D scores (p-value respectively, 0.003, < 0.001, < 0.001, < 0.001, < 0.001). he spa environment in real-life demonstrated it could provide an out-of-hospital alternative for post-surgical patients. The addition of traditional thermal treatments should be a viable strategy for rehabilitation in degenerative conditions. No conflict of interests to declare.

Short-Time Effects Of Spa-Rehabilitative Interventions On Pain, Mood And Quality Of Life In Musculoskeletal Disorders

Research Objectives To investigate the short-term effects of a spa rehabilitative protocol on pain perception, mood, and Quality of Life among patients affected by degenerative musculoskeletal disorders or post orthopaedic surgery outcomes. Design A multicenter observational study was conducted through pre- and post-treatment evaluations, planned follow-ups at three and six months were not conducted because of the COVID-19 pandemic. Setting The study was carried out in six spa facilities (Sirmione, Lombardy region, Italy;Abano Terme, Veneto region, Italy;Battaglia Terme, Veneto region, Italy;Levico Terme, Trentino Alto Adige region, Italy;Bibione, Veneto region, Italy;Casciana Terme, Tuscany region, Italy). Participants From March 2019 up to October 2019, data from the 160 users of the spa facilities with a medical prescription were collected. Interventions Twelve sessions of water-based exercise (thermal or warm water), six sessions per week, for a period of two weeks. A group of 44 patients also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for two weeks. Main Outcome Measures Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12), and the EuroQol-5D (EQ-5D). Results Data analysis has highlighted significant improvements in NRSp (p< 0.001), NRSa (p< 0.001), SF-12 PCS (p< 0.001), SF-12 MCS (p< 0.001), EQ-5D (p< 0.001), and NRSm (p=0.005) after the treatments. Different water types seemed to influence results, showing significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D scores (p-value respectively, 0.003, < 0.001, < 0.001, < 0.001, < 0.001). Conclusions he spa environment in real-life demonstrated it could provide an out-of-hospital alternative for post-surgical patients. The addition of traditional thermal treatments should be a viable strategy for rehabilitation in degenerative conditions. Author(s) Disclosures No conflict of interests to declare.

Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes?

A variety of rehabilitation programmes can be offered to Long COVID patients, specifically physical training. Indeed 90% of these patients reports impairments of verticalization, stability and spatial orientation, making difficult exercise in the gym. The aim of our study was to assess the effectiveness and safety of aquatic exercise techniques as part of a comprehensive rehabilitation program for patients with Long COVID. The first of a two-stage program involved development of aquatic exercises technique, which was evaluated in 12 patients with impaired upright posture control before and after exercising by "Habilect" video gait analysis system. During the second phase, effectiveness and safety of aqua exercises were tested in water pool as part of a comprehensive rehabilitation programme conducted in 23 patients with Long COVID outcomes. Physical examination, 6-minute step test, Euro-QL-5D questionnaire, Borg scale, laser Doppler flowmetry, cardiointervalography, and spirometry were performed before and after the aquatic exercises program. After the training with aquatic exercises, indices of deviations of the main body axes of the head and the body mass centre ameliorated, as well as direction of body movement vector decreased (p<0.05). This study demonstrated a statistically significant improvement in exercise tolerance in both groups, as measured by the 6-minute step test after rehabilitation. The comparison group averaged 236.7 metres [126; 380] (T=8, p=0.047) after the rehabilitation course and the intervention group averaged 233.71 metres [150; 320] (T=8.0, p=0.047). When tested with the Euro-QL-5D questionnaire, a post-treatment improvement was noted in the comparison group on the anxiety/depression subscale (3 [3;3] (T=0, p=0.043)). In the intervention group, laser Doppler flowmetry revealed a statistically significant increase in microcirculation (6.36 standard units after rehabilitation) [5.54; 8.17] (T=7.0, p=0.004), and a decrease of oxidative metabolism index of 6.89 standard units. [4.76; 6.96] (T=4.0, p=0.03). No serious adverse events were reported. In conclusion, the developed aquatic exercises technique seems to contribute to recovery of impaired upright posture and motor function, normalizing the walking pattern.

Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role?

Pulmonary rehabilitation is essential in post-COVID subjects, reporting respiratory impairment after the discharge from the hospital. Because the number of patients with respiratory outcomes is high and there are few facilities available, we wonder if a spa setting could represent a valid out-of-hospital alternative. We aim to explore recent evidence related to respiratory rehabilitation in the spa environment to understand if it can represent an appropriate setting for respiratory rehabilitation interventions in post-COVID subjects. Studies were found by screening PubMed, MEDLINE, and Google Scholar databases from 2011 up to February 2021. Studies were eligible if they were reviews, randomized controlled trials (RCTs), or clinical trials, investigating respiratory interventions in the spa environment. Recent evidence has shown that inhalations and mineral-rich water immersions are effective in fighting and preventing multiple chronic respiratory tract diseases. Therefore, these treatments could also be applied to post-COVID patients with medium long-term respiratory outcomes.

Italian and Japanese public attention toward balneotherapy in the COVID-19 era.

Italian and Japanese public widely use balneotherapy. The population interest in balneotherapy in coronavirus disease-2019 (COVID-19) era should be investigated. Therefore, we aimed to exploit Google Trends analysis, as a measure of peoples' interest in balneotherapy, in two countries, Italy and Japan. In this infodemiology study, Google Trends was queried for the lay terms widely used by the Italian population to refer to the balneotherapy setting (terme + termale) and by the Japanese to refer to the bathing place and balneotherapy facilities ( + スパ). The internet searches in 2020 were compared to overlapping time spans in 2016-2019 and were correlated with new confirmed cases/deaths. This study demonstrated that from February 23 to June 20, 2020, and from October 4 to December 26, 2020, the internet searches of the Italian words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were not significantly different in June 21 to October 3, 2020, compared to overlapping time spans in 2016-2019 in Italy. The study also showed that from March 15 to September 5, 2020, and from November 29 to December 26, 2020, the internet searches of the Japanese words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were significantly increased in September 13 to November 7, 2020, and were not significantly different in November 8 to 28, 2020, compared to overlapping time spans in 2016-2019 in Japan. There were significant negative correlations between the relative search volume and number of new cases (rho=-0.634; p<0.001)/deaths (rho=-0.856; p<0.001) in Italy and the number of new deaths (rho=-0.348; p=0.012) in Japan. Population interest in balneotherapy has changed in the COVID-19 era both in Italy and Japan. During the early stage of pandemic (March to June), the interest was lower. After this early stage, the interest showed a recovery in both countries. In Italy, the population interest reached to its prior levels in late June through early October, with a peak in August. In Japan, the recovery exceeded the prior 4-year levels in mid-September through early November. Then, both countries demonstrated a decline in interest: began in early October in Italy and late November in Japan. This information would allow us to understand/address the population response in the pandemic in respect of the balneotherapy and would guide the preparedness of healthcare providers and planners both in this pandemic and future similar situations.

Post COVID-19 persistent fatigue: a proposal for rehabilitative interventions in the spa setting.

With this letter to Editor, we aim at offering our viewpoint on the potential use of the spa resources to contribute to the treatment of persistent COVID-19 sequelae. In particular, our argumentations focus on the comprehensive management of fatigue persisting after the resolution of the acute infection. This sequela seems to be the most frequent disabling outcome, leading to a delay in social reintegration and return to working life.We suggest that spa facilities including multidisciplinary interventions and trained staffs could be an appropriate setting for providing rehabilitative protocols to treat chronic fatigue in post COVID-19 subjects. Spa treatments may improve the physical symptoms of chronic fatigue and modulate the immune imbalance, reducing persisting inflammation. Moreover, in the spa setting, specific respiratory rehabilitation and neuropsychological interventions could be provided. The rehabilitative protocol could also properly address comorbidities.In conclusion, respecting the hygiene and preventive measures, the spa setting could represent the appropriate environment to take care of post-COVID chronic fatigue, offering adequate and multidisciplinary rehabilitation protocols. Further, prospective trials on this topic are needed to fully evaluate the positive impact of a comprehensive rehabilitative treatment in the spa environment for subjects with post-COVID-19 fatigue.

Skeletal muscle weakness in older adults home-restricted due to COVID-19 pandemic: a role for full-body in-bed gym and functional electrical stimulation.

Persons suffering with systemic neuromuscular disorders or chronic organ failures, spend less time for daily physical activity, aggravating their mobility impairments. From 2020, patients at risk are also older adults, who, though negative for the SARS-Cov-2 infection, suffer with a fatigue syndrome due to home restriction/quarantine. Besides eventual psycological managements, it could be useful to offer to these patients a rehabilitation workouts easy to learn and to independently repeat at home (Full-Body In-Bed Gym). Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation (FES), we suggest for this fatigue syndrome a 10-20 min long daily routine of easy and safe physical exercises that may recover from muscle weakness the main 400 skeletal muscles used for every-day activities. Leg muscles could be trained also by an adjunctive neuro-muscular electrical stimulation (NMES) in frail old persons. Many of the exercises could be performed in bed (Full-Body in-Bed Gym), thus hospitalized patients can learn this light training before leaving the hospital. Full-Body in-Bed Gym is, indeed, an extension of well-established cardiovascular-ventilation rehabilitation training performed by patients after heavy surgery. Blood pressure readings, monitored before and after daily routine of Full-Body in-Bed Gym, demonstrate a transient decrease in peripheral resistance due to increased blood flow to major body muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the fatigue syndrome related to the restrictions/quarantine imposed to the general population during the COVID-19 pandemic.

The Important Impact of COVID-19 Pandemic on the Reorganization of a Rehabilitation Unit in a National Healthcare System Hospital in Italy: Lessons From Our Experience.

ABSTRACT: Since March 2020, when COVID-19 pandemic broke out, the world's healthcare systems' main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.