ABSTRACT
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
Subject(s)
COVID-19/rehabilitation , Exercise Therapy/methods , Stroke Rehabilitation/methods , Stroke/therapy , COVID-19/complications , COVID-19/physiopathology , Clinical Decision-Making , Delivery of Health Care , Humans , SARS-CoV-2 , Stroke/complications , Stroke/physiopathologyABSTRACT
1) To identify challenges for conducting ongoing and future rehabilitation research during and after the COVID-19 pandemic, and 2) to develop strategies that can support ongoing and future rehabilitation research. A two-hour facilitated online workshop with guided discussion. Online workshop synchronously recorded via Zoom. Trainees (14 doctoral;2 MSc students;1 post-doctoral fellow) and research faculty (5 physiotherapy;3 occupational therapy), School of Rehabilitation Science, McMaster University, Canada. Not applicable. Workshop transcript and field notes were cross-compared by 4 workshop facilitators from which 3 main categories emerged: 1) pandemic protocol adjustment, 2) participant accessibility, and 3) knowledge dissemination. 1) Pandemic protocol adjustment: Workshop participants identified concerns with transitioning pre- to post-pandemic research, such as variations in intervention protocols and psychometric properties of virtually guided outcome assessments. Strategies identified: Delivering toolkits containing equipment needed for virtually guided assessments, and their comprehensive psychometric evaluation prior to use. 2) Participant accessibility: Virtually guided rehabilitation research may present barriers to participation for some populations due to a lack of internet access and proficiency. Strategies identified: Including community stakeholders in the decision-making process to help guide the development of safe and feasible study protocols, and simplifying protocols to maintain participants' adherence. 3) Knowledge dissemination: Virtually delivered conferences have required additional preparation time due to requirements of pre-recorded presentations, and hinder important conversations between conference attendees. Strategies identified: Researchers should account for delays in knowledge translation plans for funding applications, and conference organizers should consider hosting networking events for attendees. This workshop served as a catalyst for creative solutions to complex methodological challenges that can be integrated within existing and future rehabilitation-focused studies during the COVID-19 pandemic and beyond. None.
ABSTRACT
Objective(s) 1) To discuss the implications of COVID-19 for exercise in the setting of stroke rehabilitation and 2) to guide and inform the clinical implementation of evidence-based aerobic exercise in stroke rehabilitation. Data Sources A literature search was conducted using 4 databases: MEDLINE, EMBASE, PsycINFO, and AMED Allied and Complementary Medicine, from inception to January 27th, 2021. Study Selection We utilized keywords related to COVID-19, exercise, rehabilitation, and included published athletic return to play after COVID-19 infection and clinical practice guidelines on exercise-based recommendations for COVID-19. Out of 391 published articles, none were related to exercise recommendations and stroke rehabilitation in the context of the COVID-19 pandemic. Data Extraction In the absence of stroke-specific guidance, we drew upon pre-COVID clinical practice aerobic exercise guidelines for stroke (n=2) and COVID-19 exercise recommendations for other populations (e.g., athletic [n=6], pulmonary [n=1] and cardiac rehabilitation [n=2]). Data Synthesis Clinical considerations were developed for hospital and out-patient settings to outline safety considerations to reduce the risk of viral transmission and implementation strategies for pre-participation screening, prescription, and progression of aerobic exercise for symptomatic and asymptomatic cases of COVID-19. Based on limited evidence, we suggest that cardiopulmonary exercise stress testing with electrocardiography be conducted following COVID-19 infection and identify subjective and physiological measures to guide decision making regarding the suitability and prescription of aerobic exercise. Finally, we recommend that clinicians and researchers stay abreast with the literature to implement evidence-based practice relating to stroke, aerobic exercise, and COVID-19. Conclusions Using a patient and clinician approach, we have developed COVID-19 specific guidance as a framework for restoring aerobic exercise implementation in stroke rehabilitation settings. Author(s) Disclosures No conflicts of interest.