Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness.

Objective: Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Design: Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Setting: Intensive care unit in a public hospital. Participants: 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Interventions: Not applicable. Results: Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; p = 0.025), rectus femoris (-20%; p < 0.001) and total quadriceps (-16%; p < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, p < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Conclusion: Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.

30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors.

INTRODUCTION: After hospitalization, early detection of musculoskeletal sequelae might help healthcare professionals to improve and individualize treatment, accelerating recovery after COVID-19. The objective was to determine the association between the 30s sit-to-stand muscle power (30s-STS) and cross-sectional area of the chest muscles (pectoralis) in COVID-19 survivors. METHOD: This cross-sectional study collected routine data from COVID-19 survivors one month after hospitalization: 1) a chest computed tomography (CT) scan and 2) a functional capacity test (30s-STS). The pectoralis muscle area (PMA) was measured from axial CT images. For each gender, patients were categorized into tertiles based on PMA. The 30s-STS was performed to determine the leg extension power. The allometric and relative STS power were calculated as absolute 30s-STS power normalized to height squared and body mass. The two-way ANOVA was used to compare the gender-stratified tertiles of 30s-STS power variants. RESULTS: Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years, 30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant differences between the PMA tertiles in absolute STS power (p = .002) and allometric STS power (p = .001). There were no significant gender x PMA tertile interactions (all variables p > .05). The high tertile of PMA showed a higher allometric STS power compared to the low and middle tertile, p = .002 and p = .004, respectively. Absolute STS power and allometric STS power had a moderate correlation with the PMA, r = 0.519 (p < .001) and r = 0.458 (p < .001) respectively. CONCLUSION: The 30s-STS power is associated with pectoralis muscle thickness in both male and female COVID-19 survivors. Thus, this test may indicate global muscle-wasting and may be used as a screening tool for lower extremity functional capacity in the early stages of rehabilitation planning in COVID-19 survivors.

The Impact of Charlson Comorbidity Index on the Functional Capacity of COVID-19 Survivors: A Prospective Cohort Study with One-Year Follow-Up.

OBJECTIVE: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. METHODS: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). RESULTS: A total of 41 patients were included (mean age 58.8 ± 12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: ß = -18.7, 95% CI = -34.7 to -2.6, p < 0.05; (ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: ß = -23.0, 95% CI = -39.1 to -6.8, p < 0.05. CONCLUSIONS: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.

The Impact of Charlson Comorbidity Index on the Functional Capacity of COVID-19 Survivors: A Prospective Cohort Study with One-Year Follow-Up

Objective: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. Methods: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). Results: A total of 41 patients were included (mean age 58.8 ±12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: β= −18.7, 95% CI = −34.7 to −2.6, p < 0.05;(ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: β= −23.0, 95% CI = −39.1 to −6.8, p < 0.05. Conclusions: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.

Safety and effectiveness of telerehabilitation program in people with severe haemophilia in Chile. A qualitative study.

INTRODUCTION: Little is known about how people with haemophilia (PWH) perceive and assess the usefulness, safety and effectiveness of telerehabilitation. OBJECTIVE: To describe usefulness, safety, effectiveness and limitations of a telerehabilitation program applied in people with severe haemophilia implemented during the COVID-19 pandemic in Chile. DESIGN AND METHODS: A qualitative study was conducted based on a focus group. Four analytical categories were predefined, three of which involved elements of Donabedian's model for quality assessment in health care (structure, process and results). RESULTS: One of the most important aspects according to all of the participants is the sense of safety they experienced while being taken care of by a physiotherapist specializing in PWH rehabilitation. This facilitated trust in the professional and adherence to treatment. All participants reported improvements in their physical condition and sense of well-being. The lack of adequate equipment at home, the limited length of the sessions, the perception that the physiotherapist may not be able to perform an appropriate physical examination and the lack of direct supervision were described as disadvantages. CONCLUSIONS: The findings underscored that telerehabilitation had high satisfaction among PWH. Telerehabilitation was perceived by PWH as a safe and effective intervention to improve physical condition. Telerehabilitation could be further supported and improved, and coverage could be enhanced, including rural and remote areas, which suffer from chronic inequalities in access to rehabilitation. The lack of face-to-face supervision and physical examination were perceived as the principal disadvantages. These results may help to improve telerehabilitation programs in PWH elsewhere.