Investigating the Role of Psychological Stubbornness and Tendency to Exercise in Predicting Health Anxiety During the Coronavirus Disease 2019 Epidemic

Background: Given the pandemic status of coronavirus disease 2019 (COVID-19), which affects almost all important economic, political, and social aspects, it is important to discuss the psychological effects of this disease on the mental health of individuals at different levels of society. The aim of this study was to investigate the role of psychological stubbornness and exercise tendency in predicting health anxiety during the COVID-19 epidemic. Methods: The present correlational analytical-cross-sectional study was performed on all citizens of Khorramabad, Iran, in 2020. 352 people were selected through available sampling. The instruments used included Kiamarsi et al.'s Ahvaz Hardiness Inventory (AHI), Zarandieh Tendency to Exercise Questionnaire, and Health Anxiety Inventory (HAI) of Salkovskis et al. Data were analyzed using Pearson correlation coefficient and stepwise regression analysis via SPSS software. Findings: There was a significant negative correlation between mental stubbornness (r =-0.574) and tendency to exercise (r =-0.407) with health anxiety (P < 0.010). Findings of stepwise multiple regression analysis also showed that the variables of mental stubbornness (β = 0.318, P < 0.010) and tendency to exercise (β= 0.460, P < 0.001) were significant predictors of health anxiety. Conclusion: Given the importance of the role of mental stubbornness and tendency to exercise in predicting health anxiety, it is possible to take an effective step in reducing health anxiety during the COVID-19 epidemic by strengthening mental stubbornness as well as filling leisure time with various sports activities. © 2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.

Application of Remote Patient Monitoring Technology in Medical Rehabilitation Programs

AIM. To develop an original information technology for remote monitoring and to conduct a scientific justification for its use for monitoring and evaluating the motor regimen and the main physiological parameters of patients in a rehabilitation center. MATERIAL AND METHODS. The original architecture of the software and hardware complex was used (certificate of state registration of the computer program No. 2022611766 of February 1, 2022), allowing to the attending physician's PC and wearable devices (smart watches) of the patient with the function of the 24-hour registration of motor activity and heart rate indicators of users. The study involved 21 patients, who underwent medical rehabilitation courses in a round-the-clock hospital. 11 patients underwent cardiorehabilitation programs for the diagnosis of chronic coronary heart disease, myocardial infarction in the past (I25.2 according to ICD-10);10 patients due to a condition after COVID-19 (U09.9 according to ICD-10). RESULTS AND DISCUSSION. When comparing the motor characteristics of the 2 study groups, it was found that the average number of steps per day was 9004.6 in the group of patients with a diagnosis of I25.2, which equals the distance of 6.6±2.63 km, and 10072.4 steps per day and 7.45±3.12 km in the group with a diagnosis of U09.9, respectively (p<0.001). In both groups, during the course of medical rehabilitation, as a rule, 3 peaks of an increase in motor load were observed – on days 2-3, 5-6 and 8. The period of physical activity in group I25.2 averaged 5:45±0:33 hours, and in group U09.9 – 5:30±0:23 hours. The total density of motor load in both groups corresponded to ≈ 35-36%. However, the average time of motor load spent on active physical rehabilitation procedures in the group with a diagnosis of I25.2 was 1:45±0:17 hours, and in the group U09.9 only 1:05±0:14 (p<0.01). In this connection, the motor density of the motor load of rehabilitation measures in the groups corresponded to 26.6% and 19.8%. CONCLUSION. The software package for remote monitoring of the motor regime and the main physiological parameters of patients has demonstrated the possibility of its use in medical practice, namely for patients at the 2nd stage of medical rehabilitation in a round-the-clock hospital and can be recommended for inclusion in programs of spa treatment. © 2022 National Medical Research Center of Rehabilitation and Balneology of the Ministry. All rights reserved.

Telerehabilitation as a Therapeutic Exercise Tool versus Face-to-Face Physiotherapy: A Systematic Review.

Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed. METHODS: We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group. RESULTS: a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction. CONCLUSION: this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients' satisfaction and adherence, being values equivalent to traditional rehabilitation.

Utilising telehealth to support exercise and physical activity in people with Parkinson disease: a program evaluation using mixed methods.

BACKGROUND: Physical activity and exercise play a key role in managing Parkinson disease. This study aimed to: 1) determine if physiotherapy supported by telehealth helped people with Parkinson disease (PwP) to adhere to a home-based exercise program and maintain their physical activity; and 2) understand their experiences of using telehealth during the COVID-19 pandemic. METHODS: A mixed methods program evaluation involving a retrospective file audit from a student-run physiotherapy clinic and semi-structured interviews exploring participants' experiences of telehealth. Ninety-six people with mild to moderate disease received home-based telehealth physiotherapy for 21 weeks. The primary outcome was adherence to the prescribed exercise program. Secondary outcomes were measures of physical activity. Interviews were conducted with 13 clients and seven students and analysed thematically. RESULTS: Adherence to the prescribed exercise program was high. The mean (SD) proportion of prescribed sessions completed was 108% (46%). On average clients spent 29 (12) minutes per session, and 101 (55) minutes per week exercising. Physical activity levels were maintained, with clients taking 11,226 (4,832) steps per day on entry to telehealth, and 11,305 (4,390) steps per day on exit from telehealth. The semi-structured interviews identified important features of a telehealth service required to support exercise; a flexible approach of clients and therapists, empowerment, feedback, a therapeutic relationship, and mode of delivery. CONCLUSIONS: PwP were able to continue exercising at home and maintain their physical activity when physiotherapy was provided via telehealth. The flexible approach of both the client and the service was imperative.

No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside cluster randomized controlled trial.

BACKGROUND: A stratified approach to exercise therapy may yield superior clinical and economic outcomes, given the large heterogeneity of individuals with knee osteoarthritis (OA). OBJECTIVE: To evaluate the cost-effectiveness during a 12-month follow-up of a model of stratified exercise therapy compared to usual exercise therapy in patients with knee OA, from a societal and healthcare perspective. METHODS: An economic evaluation was conducted alongside a cluster-randomized controlled trial in patients with knee OA (n = 335), comparing subgroup-specific exercise therapy for a 'high muscle strength subgroup', 'low muscle strength subgroup', and 'obesity subgroup' supplemented by a dietary intervention for the 'obesity subgroup' (experimental group), with usual ('non-stratified') exercise therapy (control group). Clinical outcomes included quality-adjusted life years - QALYs (EuroQol-5D-5 L), knee pain (Numerical Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score in daily living). Costs were measured by self-reported questionnaires at 3, 6, 9 and 12-month follow-up. Missing data were imputed using multiple imputation. Data were analyzed through linear regression. Bootstrapping techniques were applied to estimate statistical uncertainty. RESULTS: During 12-month follow-up, there were no significant between-group differences in clinical outcomes. The total societal costs of the experimental group were on average lower compared to the control group (mean [95% confidence interval]: € 405 [-1728, 918]), albeit with a high level of uncertainty. We found a negligible difference in QALYs between groups (mean [95% confidence interval]: 0.006 [-0.011, 0.023]). The probability of stratified exercise therapy being cost-effective compared to usual exercise therapy from the societal perspective was around 73%, regardless of the willingness-to-pay threshold. However, this probability decreased substantially to 50% (willingness-to-pay threshold of €20.000/QALY) when using the healthcare perspective. Similar results were found for knee pain and physical functioning. CONCLUSIONS: We found no clear evidence that stratified exercise therapy is likely to be cost-effective compared to usual exercise therapy in patients with knee OA. However, results should be interpreted with caution as the study power was lower than intended, due to the Coronavirus disease (COVID-19) pandemic.

Feasibility and outcomes of a real-world regional lung cancer prehabilitation programme in the UK.

BACKGROUND: Prehabilitation, or multimodality patient optimisation before major treatment, has demonstrated meaningful improvements in patients' outcomes. In the setting of lung cancer surgery, postoperative complications and length of hospital stay are reduced, but there is currently limited access to prehabilitation. Prehab4Cancer (P4C) is an innovative regional programme serving all areas of Greater Manchester (GM). METHODS: The lung cancer P4C service commenced in 2019 as a collaboration between the GM Cancer alliance and 12 leisure and community organisations. Patients planning surgical resection could be referred to receive exercise, nutrition, and well-being assessment and interventions before surgery. We evaluated the programme's feasibility, uptake, and outcomes during the 11 months before COVID-19 restrictions. RESULTS: In total, 377 patients were referred to the lung cancer P4C service from all 11 hospitals in GM. Of the patients reached by telephone, 80.0% (n=280/348) attended initial P4C assessment, which occurred a median of 8 days (inter-quartile range [IQR]: 4-14) after referral. In addition, 74.3% (n=280/377) attended for baseline assessment and 47.7% (n=180/377) completed prehabilitation, attending a median of six sessions (IQR: 4-9). Statistically significant improvements in all objective physiological and subjective functional assessments were observed preoperatively, including a mean increase in the incremental shuttle walk test of 50 m (95% confidence interval: 25-74; P<0.001). CONCLUSIONS: The P4C programme demonstrated feasibility at scale, high uptake, and promising impact on the status of patients with lung cancer before surgery. P4C is the first regional prehabilitation service internationally, and this evaluation provides a framework for implementing similar services in other regions.

INCLUSION OF REAMBERIN INTO COMPREHENSIVE OUTPATIENT REHABILITATION SCHEME FOR PATIENTS WITH SARS-CoV-2 ASSOCIATED PNEUMONIA

Effectiveness of the inclusion of reamberin in the complex rehabilitation of patients suffering of pneumonia caused by SARS-CoV-2 was evaluated at the outpatient stage. The data of 162 patients who received the rehabilitation treatment including, in addition to pharmacological benefits, exercise therapy and vacuum labile massage, were analyzed. In addition, patients of the main group (n = 82) received reamberin (1.5%, intravenously in a volume of 500 mL) for 10 days. The biochemical parameters of blood were studied in dynamics, and the blood oxygenation was monitored by the Stange and Genchi tests and the pulse oximetry. The quality of life was assessed in terms of the SF-36 questionnaire. The inclusion of reamberin in the complex rehabilitation contributed to improvement of the main biochemical parameters of blood (the levels of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase decreased 1.2, 1.7, and 1.9 times, respectively, p0.5) and caused a more pronounced increase in the external respiration function (on the average by 8.4 sec according to the Stange test and by 9.1 sec according to the Genchi test), which was accompanied by positive trends in the quality of life indicators (according to the SF-36 questionnaire) in terms of physical functioning (by 5.1 points) and general health status (by 3.76 points. The obtained clinical and laboratory data, together with good tolerance of the drug, allow us to recommend the inclusion of reamberin in rehabilitation regimens for patients with pneumonia caused by SARS-CoV-2. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

Sensorimotor training at home in elderly people with Parkinson's Disease during the period of confinement due to COVID-19: A pilot study

The pandemic caused those therapeutic activities associated with people with Parkinson's disease to be suspended (PD) with the aim of preventing COVID-19 infections by increasing motor and non-motor symptoms, due to social isolation and stress. Therefore, there was a rise of care based on telemedicine to continue the treatment in the context of a health emergency, promoting training at home. The objective of this experimental research was to document the effects of a sensorimotor training program (NM-FITT) in people with PD through weekly telematic follow-up during the COVID-19 pandemic. A quasi-experimental study was carried out with pre, inter and post test evaluations that characterized the physical, functional condition and quality of life, in an intervention group (n=5) and a control group (n=5) of elderly people (69.5 +/-4.5 years) with PD in Hoehn & Yahr stages 1 to 3, for 18 weeks, through an exercise manual, video calls and telephone follow-up. Favorable and significant effects were demonstrated on all the parameters studied after the application of the intervention in detriment of the health condition of the persons who did not participate in the home training program. Copyright © 2022 Fundacion para la difusion neurologica en Ecuador - FUNDINE. All rights reserved.

Clinical feasibility and preliminary outcomes of a novel mixed reality system to manage phantom pain: a pilot study.

BACKGROUND: To assess the clinical feasibility of a virtual mirror therapy system in a pilot sample of patients with phantom pain. METHODS: Our Mixed reality system for Managing Phantom Pain (Mr. MAPP) mirrors the preserved limb to visualize the amputated limb virtually and perform exercises. Seven patients with limb loss and phantom pain agreed to participate and received the system for 1-month home use. Outcome measures were collected at baseline and 1 month. RESULTS: Four (of seven recruited) participants completed the study, which was temporarily suspended due to COVID-19 restrictions. At 1 month, in-game data showed a positive trend, but pain scores showed no clear trends. Functioning scores improved for 1 participant. CONCLUSIONS: Mr. MAPP is feasible and has the potential to improve pain and function in patients with phantom pain. TRIAL REGISTRATION: Clinical Trials Registration, NCT04529083.

Does m-health-based exercise (guidance plus education) improve efficacy in patients with chronic low-back pain? A preliminary report on the intervention's significance.

BACKGROUND: The utilization of mobile health (m-health) has rapidly expanded during the COVID-19 pandemic, and there is still a lack of relevant clinical data pertaining to chronic low-back pain (CLBP) management. This study was designed to compare the effectiveness of m-health-based exercise (via guidance plus education) versus exercise (via guidance) during CLBP management. METHODS: Participants (n = 40) were randomly assigned to intervention and control groups. The intervention group received m-health-based exercise (via guidance plus education), whereas the control group received m-health-based exercise (via guidance). The exercise prescription video and educational content were sent to participants by the application (app), Ding Talk. Repeated-measures analysis of variance was used to test the baseline's intervention effects, 6-week follow-up, and 18-week follow-up. We selected function (Roland and Morris Disability Questionnaire) and pain intensity (current, mean, and most severe Numeric Rating Scale in the last 2 weeks) as the primary outcomes, changes of negative emotion (depression, anxious), and quality of life as the secondary outcomes. RESULTS: Time's significant effect was found in pain, function, and health-related quality of life in both groups, but time did not show significant interaction effects. Participants were able to use m-based education with their anxiety and depression after treatment, but the relief only lasted until week 6. No differences were found on the aspect of mental health-related quality of life. CONCLUSION: Preliminary findings suggest that m-health-based exercise (via guidance) may be a convenient and effective method to treat CLBP. However, additional health education didn't help more. More rigorous controlled trials are needed to improve the therapeutic effect in future studies. TRIAL REGISTRATION: Chinese Clinical Trials Registry Number ChiCTR2000041459 . Registered on December 26, 2020.

Rehabilitation therapy for a severe case of coronavirus disease 2019: a case report.

BACKGROUND: Patients with severe coronavirus disease 2019 (COVID-19) infection require a long period of time to return to work and society due to significant physical weakness even after recovery. Here we report a patient with a history of nephrectomy who developed severe COVID-19 infection associated with muscle weakness but was able to return to society after rehabilitation therapy. CASE PRESENTATION: A Japanese man in his 40s was admitted to the hospital with PCR-based COVID-19 diagnosis. The respiratory condition worsened rapidly and was treated with extracorporeal membrane-assisted ventilation in the intensive case unit. On admission to the Rehabilitation Department on day T + 30 [T: day patient became febrile (38 °C)], he was unable to stand for a long time and used a walker. Rehabilitation therapy was postponed to prevent COVID-19 spread, but the patient was encouraged to exercise during isolation to improve trunk and lower extremity muscle strength. Physical therapy commenced on day T + 49 to improve gait and trunk and lower limb muscle strength. He was able to walk independently and later returned to work following discharge on day T + 53. A computed tomography scan showed an increase in psoas muscle volume from 276 before to 316 cm3 after physical therapy, together with a decrease in whole-body extracellular water:total body weight ratio from 0.394 to 0.389. CONCLUSIONS: We have described the beneficial effects of rehabilitation therapy in a patient with severe COVID-19 infection. In addition to exercise, we believe that nutrition is even more important in increasing skeletal muscle mass. Rehabilitation therapy is recommended to enhance the return of severely ill COVID-19 patients to routine daily activity.

Post-COVID: effects of physical exercise on functional status and work ability in health care personnel.

PURPOSE: Post-COVID fatigue significantly limits recovery and return-to-work in COVID-19 survivors. We aimed to assess the effects of physical exercising on post-COVID-19-symptoms, physical/mental capacities and workability within a workplace-health-promotion project in health-care personnel. MATERIALS AND METHODS: Thirty-two HCWs were enrolled in two groups based on Post-COVID-Functional Scale (PCFS) scores: (1) severe (SSG, n = 11) and (2) mild (MSG, n = 21) symptoms. The participants underwent an eight week exercise intervention program consisting of two supervised resistance exercise sessions per week plus individual aerobic exercise recommendations. Primary outcome-parameter for physical fitness was VO2peak. Further, physical function (6MWT, 30 s sit-to-stand test (30secSTS)), mental health (anxiety (GAD-7), depression (PHQ-9), stress (PSS-10), fatigue (BFI), resilience (BRS)), cognitive capacity (MoCA) and workability (WAI) were assessed at baseline, after 4 weeks and after completion of exercise intervention. RESULTS: VO2peak improved significantly in the SSG by 2.4 ml/kg/min (95% CI [1.48; 3.01], adj.p < 0.001) and non-significantly in the MSG by 1.27 ml/kg/min (adj.p = 0.096). Both groups significantly improved their 30secSTS (p = 0.0236) and 6MWT (p = 0.0252) outcomes in both follow-ups (4 weeks and 8 weeks after inclusion). The SSG improved more than the MSG in VO2peak and 6MWT both after 4 and 8 weeks, respectively, although not statistically significant; findings were vice versa for the 30secSTS. 30secSTS outcomes correlated significantly with mental health outcomes and workability. CONCLUSIONS: Post-COVID exercise intervention improved physical fitness, psychological outcomes and workability in HCWs. Cases with severe fatigue showed higher benefit levels compared to those with mild symptoms. The safe and highly feasible 30secSTS correlated well with physical and mental outcomes and better workability in COVID-19 survivors.Implications for rehabilitationPhysical exercising showed to be an effective intervention method in the rehabilitation of COVID-19 survivors suffering from post-COVID syndrome by positively affecting both physical and mental health.In health care workers suffering from post-COVID syndrome, increases in physical performance are directly related to improvements in work ability.The 30 s sit-to-stand test (30secSTS) showed promising results as clinical assessment tool.The results of this study indicate that physical exercising will need to play a large and substantial role over the next years in the rehabilitation of COVID-19 survivors suffering from post-COVID-19-syndrome as it positively affects both physical and mental dimensions of the post-COVID-19-syndrome as well as work ability.

The Effect of Exercise-Based Pulmonary Rehabilitation on Quality of Life in Recovered COVID-19 Patients; a Quasi-Experimental Study.

Introduction: The coronavirus disease 2019 (COVID-19) is associated with a variety of physical and emotional disorders, and subsequently lower Quality of Life (QOL). This study aimed to investigate the effect of a 2-week exercise-based pulmonary rehabilitation on clinical characteristics and QOL of severe COVID-19 patients after discharge from intensive care unit (ICU). Methods: In this quasi-experimental study, eligible severe COVID-19 cases, who had survived and were discharged from ICU were selected using convenience sampling method. O2 saturation (SpO2), pulse rate, dyspnea, and QOL were evaluated and compared before and after two weeks of exercise-based pulmonary rehabilitation (PR). Results: 35 cases with the mean age of 57.86 ± 11.73 (18-75) years were studied (51.4% female). The mean SpO2 increased from 90.41 ± 3.97 to 95.11 ± 1.96% after two weeks of pulmonary rehabilitation (p<0.0001). In addition, the mean pulse rate (98.97±16.23 to 88.91±14.03 pulse/minute; p<0.001) and the mean dyspnea severity (5.6±1.97 to 3.45±1.97; p<0.0001) decreased after two weeks of intervention. Besides, the mean total QOL and its dimensions, including general health (p<0.0001), physical status (p<0.0001), emotional status (p = 0.036), and social function (p<0.0001) of patients, had significantly increased after intervention. Conclusion: Based on the findings of this study, it seems that two-week exercise-based pulmonary rehabilitation could be effective in increasing the SpO2, decreasing dyspnea and pulse rate, and improving the QOL of patients with severe COVID-19 after discharge from ICU.

Patients' and clinicians' experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study.

BACKGROUND: We have developed a model of stratified exercise therapy that distinguishes three knee osteoarthritis (OA) subgroups ('high muscle strength subgroup', 'low muscle strength subgroup', 'obesity subgroup'), which are provided subgroup-specific exercise therapy (supplemented by a dietary intervention for the 'obesity subgroup'). In a large clinical trial, this intervention was found to be no more effective than usual exercise therapy. The present qualitative study aimed to explore experiences from users of this intervention, in order to identify possible improvements. METHODS: Qualitative research design embedded within a cluster randomized controlled trial in a primary care setting. A random sample from the experimental arm (i.e., 15 patients, 11 physiotherapists and 5 dieticians) was interviewed on their experiences with receiving or applying the intervention. Qualitative data from these semi-structured interviews were thematically analysed. RESULTS: We identified four themes: one theme regarding the positive experiences with the intervention and three themes regarding perceived barriers. Although users from all 3 perspectives (patients, physiotherapists and dieticians) generally perceived the intervention as having added value, we also identified several barriers, especially for the 'obesity subgroup'. In this 'obesity subgroup', physiotherapists perceived obesity as difficult to address, dieticians reported that more consultations are needed to reach sustainable weight loss and both physiotherapists and dieticians reported a lack of interprofessional collaboration. In the 'high muscle strength subgroup', the low number of supervised sessions was perceived as a barrier by some patients and physiotherapists, but as a facilitator by others. A final theme addressed barriers to knee OA treatment in general, with lack of motivation as the most prominent of these. CONCLUSION: Our qualitative study revealed a number of barriers to effective application of the stratified exercise therapy, especially for the 'obesity subgroup'. Based on these barriers, the intervention and its implementation could possibly be improved. Moreover, these barriers are likely to account at least partly for the lack of superiority over usual exercise therapy. TRIAL REGISTRATION: The Netherlands National Trial Register (NTR): NL7463 (date of registration: 8 January 2019).

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial.

BACKGROUND: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. OBJECTIVE: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. METHODS: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. RESULTS: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; η2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05). CONCLUSIONS: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04713-4.

Outcome of survivors of COVID-19 in the intermediate phase of recovery: A case report.

Introduction: Coronavirus disease 2019 (COVID-19) is a viral respiratory disease and is associated with significant morbidity in the intermediate and chronic phases of recovery from the disease. The health benefits of respiratory and extremity muscle strengthening exercise therapy are well-described for those with cardiac failure and interstitial lung disease and are suggested to improve functional ability for patients recovering from COVID-19. The aim of this case report is to share the effects of standard physiotherapy management on exercise endurance, respiratory function and return to work, implemented for patients with COVID-19 in the intermediate phase of their recovery. Patient presentation: Two cases of COVID-19 were admitted to a private healthcare facility in Johannesburg. They presented with shortness of breath and decreased endurance. One had COVID-19 myocarditis and the other chronic post-COVID-19 organising pneumonia with pulmonary fibrosis. Management and outcome: Both patients were admitted to ICU, provided oxygen therapy and supportive care as well as physiotherapy management in hospital and after hospital discharge. Physiotherapy management included inspiratory muscle training therapy, and cardiovascular and resistance exercise therapy. Improvements in peak expiratory flow rate and six-minute walk distance were observed for both cases at 6- and 7-months follow-up, respectively. Conclusion: Our case report illustrates the value of ongoing physiotherapy management, utilising progressive exercise therapy prescription, to aid the return to optimal functioning for survivors of COVID-19 in the intermediate phase of their recovery.

Impact of a Remotely Supervised Motor Rehabilitation Program on Maternal Well-Being During the COVID-19 Italian Lockdown.

COVID-19 Lockdown was particularly challenging for most mothers of people with intellectual disabilities, including those with Rett syndrome (RTT), leading to feelings of abandonment from healthcare services of their children. Within those days, telerehabilitation has represented a valid alternative to support physical activity and treatment, supporting parents in structuring their children's daily routine at home. This article aims to describe the well-being level of two groups of mothers of girls and women with RTT who were involved in a home-based remotely supervised motor rehabilitation program, respectively, before and during the COVID-19 Italian lockdown. Forty participants with classic RTT were recruited before the lockdown and randomly assigned to two groups that performed the intervention immediately before (Group 1) and during (Group 2) the lockdown, respectively. The intervention included an individualized daily physical activity program carried out for 12 weeks by participants' parents and fortnightly supervised throughout Skype contacts to plan, monitor, and accommodate individual activities in the participant's life at home. The short form Caregivers Well-Being Scale was collected for the mothers in each group 12 weeks before intervention (T1), at intervention initiation (T2), immediately after intervention termination (T3), as well as at 12 weeks after intervention termination (T4). Mothers of participants in the Group 1 showed a stable level of well-being across all four evaluations with a slight improvement during the lockdown, without significant change. Similarly, the well-being level of mothers in the Group 2 showed a statistically significant increase in their well-being between T2 and T3 (during the lockdown) and its reduction to the pre-intervention level between T3 and T4 (after the lockdown). The results suggest that the lockdown did not negatively affect the participants' mothers' well-being, leading to its improvement. Moreover, the proposed intervention could have supported the mothers in managing the new daily routine at home, positively affecting maternal well-being.

PHYSICAL REHABILITATION AND COVID-19

Exercise therapy is an independent medical discipline that applies its means in the recovery of work capacity. In respiratory conditions, it constitutes an entity within the rehabilitation process, not proven, on patients with COVID-19. The objective of the study was to provide theoretical support on early physical function rehabilitation therapies in COVID-19. A review study was assumed, Databases were consulted: EMBASE Elsevier BV, HINARI, MedicLatina: EBSCO Group, MEDLINE, SciELO, SCOPUS, Journal Citation Reports and Science Citation Index Expanded. The descriptors used were [physical exercise-respiratory conditions], [respiratory physiotherapy], [Exercise therapy-COVID-19], [Physical rehabilitation-COVID-19 systematic reviews], [physical exercise PosCOVID-19 systematic review]. 248,000 articles were processed, 14 met the search and inclusion criteria for review and analysis. It was evidenced: few intervention, clinical and preclinical studies that confirm the relationship between physical rehabilitation and COVID-19. It was concluded that there are numerous studies that theoretically support the importance of physical exercise, as an element to take into account in the rehabilitation of conditions respiratory diseases, but there are not enough arguments to confirm its recovery effect in patients with COVID-19. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

Evaluation of a mHealth-supported Home Exercise Program for Patients with Knee Osteoarthritis (mhexos) Usability, User Experience and Outcome

Background Knee osteoarthritis is one of the main causes of disability and mobility impairment in the elderly population. This is associated with suffering and high medical costs. Non-surgical therapy such as exercise therapy, physical activity interventions and self-management support can reduce pain and improve function and health-related quality of life. Home exercise programs are considered an important component of therapy, but adherence is often insufficient. Digital health applications are a promising option, especially under the conditions of the current COVID-19 pandemic to reduce this barrier. Objective To investigate the feasibility of implementing a mHealth home exercise program for patients with knee osteoarthritis in terms of usability, user experience, user behaviour and outcome. Method Patients with knee osteoarthritis carried out the mHealth home exercise program (mhexos) for 4 weeks. The program was implemented via tablet computer with a total of 39 exercise videos on strengthening, balance and coordination, which could be configured in 3 difficulty levels. Data on pain intensity and self-perceived exertion were recorded via the app. Guided interviews were conducted and questionnaires were used to assess usability and user experience as well as health-related outcomes at 2 measurement points. Results 10 patients and 7 therapists were included. The mHealth home exercise programme could be implemented in the practice and the everyday life of the subjects. The app was predominantly rated as user-friendly and motivating, adherence to therapy was high with an exercise frequency of 2.7 times per week (SD 0.6). The health-related outcomes showed small, statistically non-significant and clinically not relevant changes following the intervention. Conclusion The mhexos seems to be suitable to support home exercise programs for knee osteoarthritis under given conditions. Controlled studies are needed to assess its effectiveness.