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.

Sleep spindles changes in people with previous COVID-19 infection.

Stage 2 sleep spindles are considered useful biomarkers for the integrity of the central nervous system and for cognitive and memory skills. We investigated sleep spindles patterns in subjects after 12 months of their hospitalization in the intensive care unit (ICU) of the Padova Teaching Hospital due to COVID-19 between March and November 2020. Before the nap, participants (13 hospitalized in ICU - ICU; 9 hospitalized who received noninvasive ventilation - nonlCU; 9 age and sex-matched healthy controls - CTRL, i.e., not infected by COVID-19) underwent a cognitive and psychological as-sessment. During the nap, high-density electroencephalography (EEG) recordings were acquired. Slow (i.e., [9]-[12] Hz) and fast (i.e.,]12-16] Hz) spindles were automatically detected. Spindle density and spindle source reconstruction in brain grey matter were extracted. The psychological assessment revealed a statistical difference comparing CTRL and nonlCU in Beck Depression Inventory score and in the Physical Quality of Life index (pvalue = 0.03). The cognitive assessment revealed a trend of worsening results in executive functions in COVID-19 survivors. Slow spindle density significantly decreased comparing CTRL to COVID-19 survivors (pvalue= 0.001). There were statistically significant differences in EEG source-waveforms fast spindle amplitude onset among the three groups, mainly between CTRL and nonlCU. Clinical Relevance- Our results suggest that nonlCU were more susceptible to the hospitalization experience than ICU participants with a slight effect on cognitive tests. This impacted the spindle generation revealing a decreased density of slow spindles and affecting the generators of fast spindles in COVID-19 survivors especially in nonlCU.

High-density EEG sleep correlates of cognitive and affective impairment at 12-month follow-up after COVID-19.

OBJECTIVE: To disentangle the pathophysiology of cognitive/affective impairment in Coronavirus Disease-2019 (COVID-19), we studied long-term cognitive and affective sequelae and sleep high-density electroencephalography (EEG) at 12-month follow-up in people with a previous hospital admission for acute COVID-19. METHODS: People discharged from an intensive care unit (ICU) and a sub-intensive ward (nonICU) between March and May 2020 were contacted between March and June 2021. Participants underwent cognitive, psychological, and sleep assessment. High-density EEG recording was acquired during a nap. Slow and fast spindles density/amplitude/frequency and source reconstruction in brain gray matter were extracted. The relationship between psychological and cognitive findings was explored with Pearson correlation. RESULTS: We enrolled 33 participants ( 17 nonICU) and 12 controls. We observed a lower Physical Quality of Life index, higher post-traumatic stress disorder (PTSD) score, and a worse executive function performance in nonICU participants. Higher PTSD and Beck Depression Inventory scores correlated with lower executive performance. The same group showed a reorganization of spindle cortical generators. CONCLUSIONS: Our results show executive and psycho-affective deficits and spindle alterations in COVID-19 survivors - especially in nonICU participants - after 12 months from discharge. SIGNIFICANCE: These findings may be suggestive of a crucial contribution of stress experienced during hospital admission on long-term cognitive functioning.

Cognitive impairment in people with previous COVID-19 infection: A scoping review.

Severe acute respiratory syndrome coronavirus 2 is a worldwide public health issue. Almost 2 years into the pandemic, the persistence of symptoms after the acute phase is a well-recognized phenomenon. We conducted a scoping review to map cognitive domain impairments, their frequency, and associated psycho-affective disorders in people with a previous COVID-19 infection. We searched PubMed/MEDLINE, Scopus, and PsycInfo to identify relevant reports published between December 1, 2019 and February 21, 2022. We followed the PRISMA (Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses) extension for scoping review guidelines. Three independent reviewers selected and charted 25 records out of 922. Memory, attention, and executive functions appeared to be the most affected domains. Delayed recall and learning were the most impaired domains of memory. Among the executive functions, abstraction, inhibition, set shifting, and sustained and selective attention were most commonly impaired. Language and visuo-spatial abilities were rarely affected, although this finding might be biased by the scarcity of reports. Neurological and respiratory conditions were often reported in association with cognitive deficits. Results on psycho-affective conditions were inconclusive due to the low frequency of reported data. Admission to an intensive care unit is not related to cognitive deficits. This review highlighted a potential effect of a previous post-COVID-19 infection on a pattern of memory, attention, and executive functions impairments. These findings need to be confirmed on larger cohorts with comprehensive neuropsychological batteries and correlated to neurophysiological and neurobiological substrates.

The 2022 On-site Padua Days on Muscle and Mobility Medicine hosts the University of Florida Institute of Myology and the Wellstone Center, March 30 - April 3, 2022 at the University of Padua and Thermae of Euganean Hills, Padua, Italy: The collection of abstracts.

In the autumn of 2021, the 2022 Padua Days of Muscle and Mobility Medicine (PDM3) was planned to be held from March 30 to April 2, 2022. Despite the fact that Coronavirus COVID-19 outbreak continued to impose restrictions all over the world, the program was planned with Scientific Sessions to occur over three full days at either the University of Padua Aula Magna or the Hotel Petrarca on the Thermae of Euganean Hills (Padua), Italy. During the winter the epidemic worsened, but waned by early February 2022, allowing confirmation of the planned On-site Meeting. The success of submission of abstracts (over 100 abstracts, i. e., three times the previous years) is attributable to the fact that the 2022 On-site PDM3 is a combined meeting, hosting the spring Meeting of the Myology Institute and Wellstone Center of the University of Florida, USA. The first three days will include a large series of presentations of the University of Florida scientists and clinicians and of their Invited Speakers from Canada, France, Switzerland Italy and the U.K. European researchers and clinicians from France, Germany, Iceland, Ireland, Italy, Slovenia, Russia and UK fill the program of last two days. To provide slot times to young Speakers, the 2022 On-site PDM3 was extended to April 3, 2022. The Collection of Abstracts is e-published in the 32 (1) 2022 Issue of the European Journal of Translational Myology (EJTM), together with the detailed Program organized in the Aula Magna of the University of Padua (March 30) and for March 31 - April 3, 2022 at the Conference Halls of Hotel Petrarca of the Thermae of Euganean Hills (Padua), Italy. The Program ends late on Sunday April 3, 2022 with an invitation to join the 2023 PDM3, March 27 - 31 at the Thermae of Euganean Hills (Padua), Italy. You are invited to join and to submit your Communications to the European Journal of Translational Myology and to a Special Issue of the Journal diagnostics, MDPI, Basel. Both journals will provide 50% discount to the first 15 accepted typescripts.

The outbreak of the SARS-CoV-2 Omicron variant make imperative the adoption of telerehabilitation in the Bulgarian health care system.

The rapid spread of the highly contagious Omicron variant of SARS-CoV-2 globally will challenge the accessibility and the delivery of physical and rehabilitation medicine (PRM) services. Many health care systems throughout the world performed effective reforms such as the transition to telerehabilitation (TR). In Bulgaria, TR is still not regulated by law, and terms such as teleconsultation and tele-education have not yet been introduced. The adoption of TR in the Bulgarian health care system will undoubtedly increase the accessibility to rehabilitation treatment for a larger group of Bulgarian patients with various neurological, cardiorespiratory, musculoskeletal, and oncological conditions and will significantly contribute to the PRM services modernization in Bulgaria.

Impact of social and mobility restrictions in Parkinson's disease during COVID-19 lockdown.

BACKGROUND: The consequences of strict COVID-19 mobility restrictions on motor/non-motor features in Parkinson's disease (PD) have not been systematically studied but worse mobility and quality of life have been reported. To elucidate this question, 12 mild to moderate PD patients were assessed in March 2020 before and after two months of isolation as part of a clinical study that had to be interrupted due to the pandemic and the implementation of COVID19 mobility restrictions. METHODS: Twelve patients were systematically evaluated before and after the lockdown period as part of a larger cohort that previously underwent thermal water rehabilitation. Clinical outcomes were the Body Mass index, the Mini-Balance Evaluation Systems Test, the MDS-Unified Parkinson's Disease Rating Scale part III, the 6 Minute Walking Test and the New Freezing of Gait Questionnaire. Global cognition was evaluated with the Montreal Cognitive Assessment scale. The impact of COVID-19 restrictions on quality of life and functional independence was evaluated with The Parkinson's disease Quality of life (PDQ-39), the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living questionnaires (IADL) and the Parkinson's disease cognitive functional rating scales (PD-CFRS). RESULTS: After two months of isolation the Mini-BESTest score worsened (p=0.005), and four patients reported one or more falls during the lockdown. BMI increased (p=0.031) while the remaining clinical variables including quality of life did not change. CONCLUSION: We observed moderate worsening at Mini-BESTest, greater risk of falls and increased body weight as consequence of prolonged immobility. We believe negative effects were partially softened since patients were in contact with our multidisciplinary team during the lockdown and had previously received training to respond to the needs of this emergency isolation. These findings highligh the importnace of patient-centered interventions in PD management.

Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy.

BACKGROUND: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O2-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. METHODS: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study's primary endpoint was the intubation rate during the stay in the RICU. RESULTS: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6-75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. CONCLUSIONS: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate.

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.