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1.
Crit Care ; 25(1): 382, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506095

ABSTRACT

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Disabled Persons , Recovery of Function/physiology , Return to Work/trends , Aged , Aged, 80 and over , Australia/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cohort Studies , Critical Illness/therapy , Female , Follow-Up Studies , Health Status , Humans , Male , Middle Aged , Mortality/trends , Prospective Studies , Time Factors , Treatment Outcome
2.
Physiotherapy ; 2021 Aug 14.
Article in English | MEDLINE | ID: covidwho-1437558

ABSTRACT

Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aimed at reducing SARS-CoV-2 susceptibility and COVID-19 severity, is a goal consistent with contemporary physiotherapy practice. Physiotherapists have a long tradition of managing a , thus, managing CLGSI is a logical extension. Improving patients' lifestyle practices also reduces their NCD risks and increases activity/exercise capacity, health and wellbeing - all principal goals of contemporary physiotherapy. The COVID-19 pandemic lends further support for prioritising health and lifestyle competencies including smoking cessation; whole food plant-based nutrition; healthy weight; healthy sleep practices; and stress management; in conjunction with reducing sedentariness and increasing physical activity/exercise, to augment immunity as well as function and overall health and wellbeing. To support patients' lifestyle change efforts, physiotherapists may refer patients to other health professionals. The authors conclude that immuno-modulation with lifestyle behaviour change to reduce susceptibility to viruses including SARS-CoV-2, is consistent with contemporary physiotherapy practice. Immuno-modulation needs to be reflected in health competencies taught in physiotherapy professional education curricula and taught at standards comparable to other established interventions.

3.
Hong Kong Physiother J ; 41(2): 119-125, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1209478

ABSTRACT

Background: Since the outbreak of the SARS-CoV-2 virus in December 2019, the COVID-19 pandemic continues to threaten global stability. Transmission of SARS-CoV-2 is mostly by respiratory droplets and direct contact but viral RNA fragments have also been detected in the faecal waste of patients with COVID-19. Cleanliness and effective sanitation of public toilets is a concern, as flushing the toilet is potentially an aerosol generating procedure. When the toilets are of the squatting type and without a cover, there exists a risk of viral contamination through the splashing of toilet water and aerosol generation. Objective: This study aims to determine whether the cleanliness of public toilets was a concern to the general population during the COVID-19 pandemic, and whether a squatting toilet was preferred to a seated design. Methods: A questionnaire was designed and posted on "WeChat" contact groups of the investigators. Results: The survey showed that 91% of participants preferred squatting toilets, but that 72% were apprehensive of personal contamination when using public toilets. Over 63% of the respondents had encountered an incidence of water splash and would prefer public toilets to be covered during flushing and 83% of these respondents preferred a foot-controlled device. Conclusion: This survey suggests that consideration should be given to the installation of a simple foot-controlled device to cover public squatting toilets to help restrict potential COVID-19 contamination and to meet hygienic expectations of the public.

4.
Preprint | SciFinder | ID: ppcovidwho-5314

ABSTRACT

A review. In early 2020, coronavirus disease 2019 (COVID-19) occupies the public health vanguard for all governments across the world. In China, where the virus was first identified and where to date the greatest numbers of infected people are located, significant efforts are being made to address the public health threat posed by the disease, and to identify methods to treat the disease. One method being used is ultra-shortwave diathermy (USWD). This paper reviews relevant aspects of this form of electromagnetic energy to elucidate its risks and any potential benefits in acute infective conditions of the lung. When managing patients with COVID-19, the hazards to staff and patients of cross contamination by equipment and the risks of unintentional viral spread must first be considered. Further, in any application of electrotherapy modality to a patient, procedures involving assessment of reliability of machine output and normal skin sensation of the patient must be ascertained. In patients with COVID-19, the risk of passing a current close to the heart must be considered. A review of evidence on the uses of reduction of such content in physiotherapy entry-level curricula. There is no evidence of a clin. benefit of USWD in China, there is a lack of reports that describe proper randomization methods, consideration of electrode placements, and essential safety measure procedures. The long-term effect on lung function should be contemplated. In conclusion, the authors highlight the need for structured gathering of data to investigate the role of USWD on acute and chronic effect on lung lesion prior to endorsing an unconstrained application of USWD to patients with COVID-19.

5.
Phys Ther ; 101(1)2021 01 04.
Article in English | MEDLINE | ID: covidwho-913228

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines, including physical therapists, are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and are limited in many hospitals. This article reports a physical therapy service specially commissioned by the Health Commission of Sichuan Province to manage COVID-19 during patients' stay in the intensive care unit (ICU) at the Public Health Clinical Center of Chengdu in China. METHODS: Patients diagnosed with COVID-19 were classified into 4 categories under a directive from the National Health Commission of the People's Republic of China. Patients in the "severe" and "critical" categories were admitted to the ICU irrespective of mechanical ventilation was required. Between January 31, 2020, and March 8, 2020, a cohort of 16 patients was admitted to the ICU at the Public Health Clinical Center of Chengdu. The median (minimum to maximum) hospital and ICU stays for these patients were 27 (11-46) and 15 (6-38) days, respectively. Medical management included antiviral, immunoregulation, and supportive treatment of associated comorbidities. Physical therapist interventions included body positioning, airway clearance techniques, oscillatory positive end-expiratory pressure, inspiratory muscle training, and mobility exercises. All patients had at least 1 comorbidity. Three of the 16 patients required mechanical ventilation and were excluded for outcome measures that required understanding of verbal instructions. In the remaining 13 patients, respiratory outcomes-including the Borg Dyspnea Scale, peak expiratory flow rate, Pao2/Fio2 ratio, maximal inspiratory pressure, strength outcomes, Medical Research Council Sum Score, and functional outcomes (including the Physical Function in Intensive Care Test score, De Morton Mobility Index, and Modified Barthel Index)-were measured on the first day the patient received the physical therapist intervention and at discharge. RESULTS: At discharge from the ICU, while most outcome measures were near normal for the majority of the patients, 61% and 31% of these patients had peak expiratory flow rate and maximal inspiratory pressure, respectively, below 80% of the predicted value and 46% had De Morton Mobility Index values below the normative value. CONCLUSION: The respiratory and physical functions of some patients remained poor at ICU discharge, suggesting that long-term rehabilitation may be required for these patients. IMPACT: Our experience in the management of patients with COVID-19 has revealed that physical therapist intervention is safe and appears to be associated with an improvement in respiratory and physical function in patients with COVID-19 in the ICU.


Subject(s)
COVID-19/rehabilitation , Critical Care , Physical Therapy Modalities , Adult , Aged , Aged, 80 and over , China , Cohort Studies , Female , Hospitalization , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Patient Selection , Respiration, Artificial
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