Validity, inter-rater reliability, and feasibility of the Chelsea Physical Assessment Tool for assessing physical function in post-acute COVID-19 patients: A cross-sectional study.

BACKGROUND: Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. OBJECTIVE: This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. METHODS: Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48 hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen's Kappa (κ) coefficient and weighed Kappa (κw) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) (p< 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p< 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71-0.98). κ and κw analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests (n= 4) and MRC sum score (n= 14). CONCLUSION: CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.

Impact of Rehabilitation on Fatigue in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis

The post-COVID-19 syndrome may affect patients after the COVID-19 post-acute phase. In particular, the 69% of patients reported persistent fatigue at the discharge. To date, no clear data are available regarding the most effective rehabilitative approaches for the treatment of this condition. Thus, this systematic review aimed to evaluate the rehabilitation treatment's efficacy on fatigue in post-COVID-19 patients. We systematically searched PubMed, Scopus, and Web of Science databases to find longitudinal study designs presenting: post-COVID-19 patients as participants;a rehabilitative approach aimed to reduce post-COVID-19 syndrome as intervention;and fatigue intensity assessed through an evaluation tool that quantified the perceived exertion (i.e., fatigue severity scale, FSS;Borg Scale (BS);Borg Category Ratio 10, CR10;Checklist Individual Strength (CIS) fatigue scale;FACIT (Functional Assessment of Chronic Illness Therapy) fatigue scale). The present systematic review protocol was registered on PROSPERO (registration number CRD42021284058). Out of 704 articles, 6 studies were included. Nearly all patients showed COVID-19-related fatigue, and after the rehabilitation treatment, only 17% of subjects reported the persistency of symptoms. The overall effect size reported a −1.40 decrease in Borg Category Ratio 10 with a SE of 0.05 and a 95% CI between −1.50 and −1.30 (p < 0.001). The present systematic review and meta-analysis underlines the rehabilitation role in the fatigue reduction in patients affected by post-COVID-19 syndrome.

Physicians´ perceptions of working in mass vaccination sites during COVID-19 pandemic.

BACKGROUND: This survey was aimed to obtain the characteristics of physicians operating in mass vaccination sites (MVS), emphasizing their motivation to work there. METHOD: We conducted a nationwide cross-sectional internet-based survey involving physicians operating in MVS during the COVID-19 pandemic. The questionnaire comprised demographic characteristics and questions regarding the perception of physicians working in MVS. RESULTS: In total, 140 questionnaire responses were analysed. There were 98 female (70 %) and 42 male (30 %) physicians. Fifty-five were residents (39.3 %), and 85 were attending physicians (60.7 %). As the main motivation for participating in MVS, residents (43.6 %) reported a financial benefit, while moral responsibility was more common in attending physicians (50.6 %), (p0.05). Physician burnout was more prevalent (32 %) in those study participants, who worked in MVS as part of their work duty. 48 % of these physicians expressed no willingness to work in MVS in the future. All the respondents, who reported the professional experience as their main motivation to work in MVS expressed their will to work in MVS again. CONCLUSIONS: The financial aspect was the most important motivational factor among residents, while moral responsibility was decisive for the attending physicians. Physicians, who participated in MVS as a work duty presented both the most prevalent self-perceived burnout syndrome (32 %) and the hesitancy (48 %) to work in MVS again in the future (Tab. 4, Ref. 15) Keywords: mass vaccination site, COVID-19; healthcare workers, vaccination, SARS-CoV-2, coronavirus.

A Telerehabilitation Approach to Chronic Facial Paralysis in the COVID-19 Pandemic Scenario: What Role for Electromyography Assessment?

There is a lack of data on patient and diagnostic factors for prognostication of complete recovery in patients with peripheral facial palsy. Thus, the aim of this study was to evaluate the role of a telerehabilitave enhancement through the description of a case report with the use of short-wave diathermy and neuromuscular electrical stimulation combined to facial proprioceptive neuromuscular facilitation (PNF) rehabilitation in unrecovered facial palsy, in a COVID-19 pandemic scenario describing a paradigmatic telerehabilitation report. A 43-year-old woman underwent a facial rehabilitation plan consisting of a synergistic treatment with facial PNF rehabilitation, short-wave diathermy, and neuromuscular electrical stimulation (12 sessions lasting 45 min, three sessions/week for 4 weeks). Concerning the surface electromyography evaluation of frontal and orbicularis oris muscles, the calculated ratio between amplitude of the palsy side and normal side showed an improvement in terms of movement symmetry. At the end of the outpatient treatment, a daily telerehabilitation protocol with video and teleconsultation was provided, showing a further improvement in the functioning of a woman suffering from unresolved facial paralysis. Therefore, an adequate telerehabilitation follow-up seems to play a fundamental role in the management of patients with facial palsy.

Impact of COVID-19 lockdown on the epidemiology of soccer muscle injuries in Italian Serie A professional football players.

BACKGROUND: The aim of this study was to evaluate the influence that COVID-19 lockdown had on the epidemiology of soccer musculoskeletal injuries during 2019/2020 Italian First Football League Serie A in professional football players. METHODS: In this retrospective study we analyzed records from media-based platform (Trasfermarkt, https://www.transfermarkt.com), describing the epidemiology of muscle injuries before and after the first COVID-19 lockdown phases in Italian professional football players. We also classified the severity of the injury as the number of missing days from participation. RESULTS: We assessed a lower prevalence of post-lockdown injuries, albeit showing a similar injury rate at 1000 game-hours (prelockdown: 16.9 [13.0-20.7], post-lockdown: 15.5 [9.9-21.1]; RR=0.92 [0.46-1.8]). All risk ratios for injury rate were not significantly different (P>0.05) between pre- and post-lockdown. CONCLUSIONS: The incidence of muscle injuries has not significantly changed after the first COVID-19 lockdown in Italian professional soccer players. Recognizing injury rates might be crucial for physician to evaluate adequate preventive measures.

Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ±188 vs. 152 ±106);VM (363 ±192 vs. 140 ±96);BF (229 ±60 vs. 150 ±63);MH (231 ±88 vs. 203 ±89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

Rehabilitation and COVID-19: rapid living systematic review by Cochrane Rehabilitation Field - third edition. Update as of June 30th, 2021.

INTRODUCTION: This paper updates and summarizes the current evidence informing rehabilitation of patients with COVID-19 and/or describing the consequences of the disease and its treatment. EVIDENCE ACQUISITION: Studies published from May 1st to June 30th, 2021 were selected, excluding descriptive studies and expert opinions. Papers were categorized according to study design, research question, COVID-19 phase, limitations of functioning of rehabilitation interest, and type of rehabilitation service involved. From this edition, we improved the quality assessment using the Joanna Briggs Institute checklists for observational studies and the Cochrane Risk of Bias Tool for randomized-controlled clinical trials (RCTs). EVIDENCE SYNTHESIS: Twenty-five, out of 3699 papers, were included. They were three RCTs, 13 cross-sectional studies and nine cohort studies. Twenty studies reported data on symptom prevalence (N.=13) or disease natural history (N.=7); and five studies reported intervention effectiveness at the individual level. All study participants were COVID survivors and 48% of studies collected information on participants 6 months or longer after COVID-19 onset. The most frequent risks of bias for RCTs concerned weaknesses in allocation concealment, blinding of therapists, and lack of intention-to-treat analysis. Most analytical studies failed to identify or deal with confounders, describe or deal with dropouts or eventually perform an appropriate statistical analysis. CONCLUSIONS: Most studies in this updated review targeted the prevalence of limitations of functioning of rehabilitation interest in COVID-19 survivors. This is similar to past review findings; however, data in the new studies was collected at longer follow-up periods (up to one year after symptom onset) and in larger samples of participants. More RCTs and analytical observational studies are available, but the methodological quality of recently published studies is low. There is a need for good quality intervention efficacy and effectiveness studies to complement the rapidly expanding evidence from observational studies.

Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers.

The COVID-19 pandemic has had a strong impact on healthcare workers (HCWs), affecting their physical and mental health. In Italy, HCWs have been among the first exposed to unprecedented pressure, dealing with large numbers of infections during the first pandemic wave. However, the severe psychological consequences on HCWs find little evidence in the literature, especially in terms of comparison to the status quo ante pandemic. The aim of this study was to provide an assessment of the mental health burden in a cohort of Italian HCWs during the COVID-19 pandemic, comparing their condition with that before the emergency, to direct the promotion of mental well-being among HCWs worldwide. In this retrospective study, we included physicians, physical therapists, and nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and Rehabilitation Unit from a Southern Italy University Hospital. All study participants underwent a battery of psychological tests, aimed at verifying their state of mental health during the COVID-19 emergency and before it. Depressive, anxiety, and burnout symptoms were assessed using the following questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7. Depressive, anxiety, and burnout clinical relevance symptoms were present in HCWs during the COVID-19 pandemic more than those before the emergency. Fifty percent of the HCWs obtained a score clinically significant during the emergency. Moreover, a depersonalization factor showed a statistically significant increase in average scores (p < 0.0001). The PHQ-9 scale showed that 47.1% of the operators reported depressive state presence. The number of operators scoring above the cut-off for the anxiety scale tripled during the emergency (p < 0.0001). The female gender conferred greater risks for depression. Taken together, the findings of this study showed that our sample of Italian HCWs showed a greater risk for depression, anxiety, and stress during the COVID-19 pandemic. These data might be a starting point to plan mental health monitoring and prevention programs for HCWs, thus ensuring patients receive the best possible care performances even during healthcare crises such as the current pandemic.

Vitamin D Serum Levels in Subjects Tested for SARS-CoV-2: What Are the Differences among Acute, Healed, and Negative COVID-19 Patients? A Multicenter Real-Practice Study.

Vitamin D might play a role in counteracting COVID-19, albeit strong evidence is still lacking in the literature. The present multicenter real-practice study aimed to evaluate the differences of 25(OH)D3 serum levels in adults tested for SARS-CoV-2 (acute COVID-19 patients, subjects healed from COVID-19, and non-infected ones) recruited over a 6-month period (March-September 2021). In a sample of 117 subjects, a statistically significant difference was found, with acute COVID-19 patients demonstrating the lowest levels of serum 25(OH)D3 (9.63 ± 8.70 ng/mL), significantly lower than values reported by no-COVID-19 patients (15.96 ± 5.99 ng/mL, p = 0.0091) and healed COVID-19 patients (11.52 ± 4.90 ng/mL, p > 0.05). Male gender across the three groups displayed unfluctuating 25(OH)D3 levels, hinting at an inability to ensure adequate levels of the active vitamin D3 form (1α,25(OH)2D3). As a secondary endpoint, we assessed the correlation between serum 25(OH)D3 levels and pro-inflammatory cytokine interleukin-6 (IL-6) in patients with extremely low serum 25(OH)D3 levels (<1 ng/mL) and in a subset supplemented with 1α,25(OH)2D3. Although patients with severe hypovitaminosis-D showed no significant increase in IL-6 levels, acute COVID-19 patients manifested high circulating IL-6 at admission (females = 127.64 ± 22.24 pg/mL, males = 139.28 ± 48.95 ng/mL) which dropped drastically after the administration of 1α,25(OH)2D3 (1.84 ± 0.77 pg/mL and 2.65 ± 0.92 ng/mL, respectively). Taken together, these findings suggest that an administration of 1α,25(OH)2D3 might be helpful for treating male patients with an acute COVID-19 infection. Further studies on rapid correction of vitamin D deficiency with fast acting metabolites are warranted in COVID-19 patients.

Psychological Distress and Work Environment Perception by Physical Therapists from Southern Italy during COVID-19 Pandemic: The C.A.L.A.B.R.I.A Study.

The psychosocial impact of the work environment during the COVID-19 pandemic on health professionals is a growing issue. The present study examined specific psychosocial work environment indicators during the COVID-19 pandemic, through a multiple regression model of a self-administered cross-sectional online survey in a cohort of physical therapists from a region of Southern Italy from March 2020 to May 2021. The questionnaire contained items on work and healthcare issues related to COVID-19. Eighty physical therapists (29 male and 51 female), mean age 32.5 ± 10.1 years, were involved in this survey. The multiple regression analysis showed that "management activity" was significantly correlated to "therapist frustration" during the COVID-19 pandemic (ΔR2 = 0.16; p < 0.03). Findings of this study underline the importance of a healthy psychosocial work environment to enhance job satisfaction of all health professionals and to avoid role conflict and burnout syndrome during the COVID-19 pandemic.

A bond between rheumatic diseases and cancer in the elderly: The interleukin-6 pathway.

Interleukin (IL)-6 is a soluble factor secreted by T lymphocytes, involved in antibody generation by B lymphocytes. The IL-6 pathway has risen as a pivotal pathway implicated in immune regulation and dysregulation in various rheumatic diseases. Nonetheless, elevated IL-6 levels can also play a role in cancer. Targeting the IL-6 pathway has led to innovative therapeutic approaches for rheumatic diseases and for COVID-19, particularly in the elderly. Indeed, tocilizumab, an agent targeting IL-6, has recently amassed significant attention as a promising univocal agent for different conditions. In this viewpoint, we sought to recall and describe the common pathway among osteoarthritis, rheumatoid arthritis, and cancer, suggesting that anti-IL-6 may be considered a jack-of-all-trades against inflammaging in the elderly.

Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading worldwide, with survivors that suffer functional impairments with a consequent key role of rehabilitation in this context. To date, there is a lack of findings on the role of rehabilitation in postacute COVID-19 patients. AIM: Thus, we aimed at describing the role of a patient-tailored rehabilitation plan on functional outcome in hospitalized COVID-19 patients. DESIGN: Real-practice retrospective study. SETTING: Inpatients Rehabilitation Unit. POPULATION: Postacute COVID-19 patients. METHODS: Medical records of patients referred to an Italian COVID-19 Rehabilitation Unit from March 10th, 2020 to April 30th, 2020 were collected. All patients underwent a rehabilitative (30 minutes/set, 2 times/day), aimed to improve gas exchanges, reducing dyspnoea, and improving muscle function. At the admission (T0) and at the discharge (T1), we evaluated as outcome measures: Barthel Index (BI), modified Medical Research Council Dyspnea Scale, 6-Minute Walking Test (6-MWT) and Borg Rating of Perceived Exertion (RPE) scale. We also assessed: type of respiratory supports needed, pulmonary function, coagulation and inflammation markers and length of stay (LOS) in Rehabilitation Unit. RESULTS: We included 41 postacute COVID-19 patients (25 male and 19 female), mean aged 72.15±11.07 years. Their mean LOS in the Rehabilitation Unit was 31.97±9.06 days, as 39 successfully completed the rehabilitation treatment and 2 deceased. We found statistically significant improvement in BI (84.87±15.56 vs. 43.37±26.00; P<0.0001), 6-MWT (303.37±112.18 vs. 240.0±81.31 meters; P=0.028), Borg RPE scale (12.23±2.51 vs. 16.03±2.28; P<0.0001). CONCLUSIONS: These findings suggest that postacute COVID-19 patients might beneficiate of a motor and respiratory rehabilitation treatment. However, further studies are advised to better understand long-term sequelae of the disease. CLINICAL REHABILITATION IMPACT: This study provides evidence on the role of rehabilitation COVID-19 postacute inpatients through a patient-tailored treatment.