ABSTRACT
Background Objective Methods Results Conclusions Physical activity used in rehabilitation can trigger post-exertional malaise (PEM) in people with Long COVID. Concerns remain if the STOP-REST-PACE approach promoted by patient communities and professional organizations can be safely administered and contributes to return to usual activities.(1) To observe PEM over 12 weeks of telerehabilitation based on the STOP-REST-PACE approach. (2) To describe the changes in health-related quality of life (HRQoL), respiratory symptoms, fatigue and return to work.This was an observational prospective cohort of participants with Long COVID referred to a telerehabilitation service. Participants received up to 14 h of physiotherapy and occupational therapy over 12 weeks based on the STOP-REST-PACE approach. Frequency was personalized, up to two sessions weekly. An independent coordinator assessed PEM, HRQoL, respiratory symptoms, fatigue and return to work.Thirty-four participants were included and 30 completed the 12 weeks of telerehabilitation. Participants had an average of eight impairments. We found PEM in all participants at baseline. After 12 weeks, PEM remained present for 19 out of 30 participants. Respiratory symptoms significantly improved (COPD Assessment Test: 19.2 ± 7.3 vs 13.8 ± 7.7, p < .001). Fatigue and HRQoL did not significantly improve (p = 0.32 and p = 0.20, respectively). Only four participants were able to work full time.PEM persisted for close to two-third of participants despite learning the STOP-REST-PACE approach through physical and occupational therapy sessions over 12 weeks. Respiratory symptoms improved, but we did not observe a difference in fatigue and HRQoL. Return to work was out of reach for most participants. [ FROM AUTHOR] Copyright of Fatigue: Biomedicine, Health & Behavior is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
PURPOSE: A significant number of people will experience prolonged symptoms after COVID-19 infection that will greatly impact functional capacity and quality of life. The aim of this study was to identify trajectories of health-related quality of life (HRQOL) and their predictors among adults diagnosed with COVID-19. METHODS: This is a retrospective analysis of an ongoing prospective cohort study (BQC-19) including adults (≥18y) recruited from April 2020 to March 2022. Our primary outcome is HRQOL using the EQ-5D-5L scale. Sociodemographic, acute disease severity, vaccination status, fatigue, and functional status at onset of the disease were considered as potential predictors. The latent class mixed model was used to identify the trajectories over an 18-month period in the cohort as a whole, as well as in the inpatient and outpatient subgroups. Multivariable and univariable regressions models were undertaken to detect predictors of decline. RESULTS: 2163 participants were included. Thirteen percent of the outpatient subgroup (2 classes) and 28% in the inpatient subgroup (3 classes) experienced a more significant decline in HRQOL over time than the rest of the participants. Among all patients, age, sex, disease severity and fatigue, measured on the first assessment visit or on the first day after hospital admission (multivariable models), were identified as the most important predictors of HRQOL decline. Each unit increase in the SARC-F and CFS scores increase the likelihood of belonging to the declining trajectory (univariable models). CONCLUSION: Although to different degrees, similar factors explain the decline in HRQOL over time among the overall population, people who have been hospitalized or not. Clinical functional capacity scales could help to determine the risk of HRQOL decline.
ABSTRACT
BACKGROUND: Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. OBJECTIVE: This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists' adoption, service wait times, families' perception of service quality, and costs. METHODS: This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists' adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. RESULTS: Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. CONCLUSIONS: This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. TRIAL REGISTRATION: ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40218.
ABSTRACT
BACKGROUND: Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician. OBJECTIVE: This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy. METHODS: This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention). RESULTS: A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants. CONCLUSIONS: The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.
ABSTRACT
As telecommunications technology progresses, telehealth frameworks are becoming more widely adopted in the context of long-term care (LTC) for older adults, both in care facilities and in homes. Today, robots could assist healthcare workers when they provide care to elderly patients, who constitute a particularly vulnerable population during the COVID-19 pandemic. Previous work on user-centered design of assistive technologies in LTC facilities for seniors has identified positive impacts. The need to deal with the effects of the COVID-19 pandemic emphasizes the benefits of this approach, but also highlights some new challenges for which robots could be interesting solutions to be deployed in LTC facilities. This requires customization of telecommunication and audio/video/data processing to address specific clinical requirements and needs. This paper presents OpenTera, an open source telehealth framework, aiming to facilitate prototyping of such solutions by software and robotic designers. Designed as a microservice-oriented platform, OpenTera is an end-to-end solution that employs a series of independent modules for tasks such as data and session management, telehealth, daily assistive tasks/actions, together with smart devices and environments, all connected through the framework. After explaining the framework, we illustrate how OpenTera can be used to implement robotic solutions for different applications identified in LTC facilities and homes, and we describe how we plan to validate them through field trials.
ABSTRACT
As telecommunications technology progresses, telehealth frameworks are becoming more widely adopted in the context of long-term care (LTC) for older adults, both in care facilities and in homes. Today, robots could assist healthcare workers when they provide care to elderly patients, who constitute a particularly vulnerable population during the COVID-19 pandemic. Previous work on user-centered design of assistive technologies in LTC facilities for seniors has identified positive impacts. The need to deal with the effects of the COVID-19 pandemic emphasizes the benefits of this approach, but also highlights some new challenges for which robots could be interesting solutions to be deployed in LTC facilities. This requires customization of telecommunication and audio/video/data processing to address specific clinical requirements and needs. This paper presents OpenTera, an open source telehealth framework, aiming to facilitate prototyping of such solutions by software and robotic designers. Designed as a microservice-oriented platform, OpenTera is an end-to-end solution that employs a series of independent modules for tasks such as data and session management, telehealth, daily assistive tasks/actions, together with smart devices and environments, all connected through the framework. After explaining the framework, we illustrate how OpenTera can be used to implement robotic solutions for different applications identified in LTC facilities and homes, and we describe how we plan to validate them through field trials.
ABSTRACT
PURPOSE: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. METHODS: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants' attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. RESULTS: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. CONCLUSION: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease.