Is hybrid cardiac rehabilitation superior to traditional cardiac rehabilitation?

BACKGROUND: The current COVID-19 pandemic imposes changes in the management of cardiac pathologies. Cardiac rehabilitation needs to define new protocols to welcome patients back. In connection with the observations of the European Association of Preventive Cardiology, the choice of cardiac tele-rehabilitation appeared to be unavoidable. AIM: This retrospective research based on data from the Program for the Medicalisation of Information Systems (PMSI) and the electronic medical record analyzes the effect of Hybrid Cardiac Rehabilitation. METHODS: One hundred and ninety-two patients (29 females and 163 males) with an average of 56.9 years old (±10.3) were able to benefit from a Hybrid Cardiac Rehabilitation program. The data concerning the Stress Test and the Wall Squat Test were collected. RESULTS: We have noticed that patients had improved their cardiorespiratory capacity on the initial and final Stress Test 6.6 (±1.8) MET to 8.2 (±1.9) MET (p < 0.0001). We also found that patients improved lower limb muscle strength 75.1 (±44.8) seconds to 105.7 (±49.7) seconds (p < 0.0001). CONCLUSIONS: Hybrid Cardiac Rehabilitation protocols can be set up in this pandemic situation. The programme effectiveness appears to be comparable to the traditional model. However, additional studies are needed to determine the effectiveness of this programme in the long term.

Tele-rehabilitation in Spinal Cord Injury (SCI) in India: An Essential but Uphill Task.

The number of spinal cord injury (SCI) patients is gradually increasing in India. But due to the unavailability of rehabilitation facilities at the grass root level and most of the patient's financial status, institution-based SCI rehabilitation is still not feasible for many of SCI patients. Tele-rehabilitation can help to rehabilitate the SCI patients to a satisfactory extent where providing hospital-based rehabilitation is not possible. During the COVID-19 pandemic, tele-rehabilitation showed its true potential already. Poverty, lack of education, and lack of technical knowledge of the patients can be a major barrier to its implication. However, with the government's support, suitable manpower, and will to serve, we can deliver tele-rehabilitation services for SCI patients in the remotest and poorest areas of India.

Challenges of tele-rehabilitation in children with disabilities in initial education

This research deals with the tele-rehabilitation service for children with disabilities in a post-Covid-19 era. There has been a boom with new working models and adaptation to new challenges and experiences of professionals in rehabilitation therapies. With such services as the most effective way to treat psychomotor deficits in children with disabilities, Rehabilitation Centers have reconfigured their planning by offering hybrid care, but there is a lack of integration of ICT for the delivery of these services through agile approaches. Under an Action-Design methodology, a survey was designed and applied to therapists from five Rehabilitation Centers in Mexico;focused on knowing four relevant aspects: Rehabilitation Teleworking;ICT in therapeutic activity;Communication between parents and Rehabilitation centers;and Patients. From the result, it can be inferred that there is a high level of interest at THE initial education in technological training and a need for higher quality stimulation tools and resources.

Experiences of the Occupational Therapists During the COVID-19 Pandemic: A Scoping Review.

Occupational therapy has been impacted by the worldwide COVID-19 pandemic and has transitioned from a traditional face-to-face therapy method to an online one. In the wake of the pandemic, occupational therapist faced the challenge of providing online services to people with disabilities. The review aimed to identify and synthesize the best available evidence on the experience of occupational therapists in psychiatric rehabilitation settings during the COVID-19 pandemic. Additionally, the challenges posed by changes in the mode of training were examined. Electronic database search included PubMed, PsycINFO, PsycNET, Cochrane Library, Ovid, MEDLINE, CINAHL, SAGE Journals, Elsevier Science Direct, Springer, Wiley Online Library, JAMA Psychiatry, and Society E-Journals. Inclusion criteria were studies describing the experience of the occupational therapists during the COVID-19 pandemic in psychiatric rehabilitation settings. A systematic search identified 8 studies included quantitative, qualitative and mixed methodology conducted between 2020 and 2022. The findings from the reviewed articles revealed that the complexities and challenges faced by occupational therapists during the COVID-19 pandemic were professional, personal, and organizational; innovative practices were implemented in the psychiatric settings. The review findings expressed both positive (accepting a new mode of training, time saving) and negative experiences (problems with interaction & internet) perceived by the rehabilitation professionals. Enhancing the training of occupational therapists will help in easing the access and know-how of using telerehabilitation services for patients and coping with COVID-19-like situations in the future.

Physiotherapy in Neurological conditions: AB No: 81: Tele-rehabilitation program for Balance and Coordination training in Cerebral Palsy Children: A Pilot Study

Purpose: To evaluate the effect of tele-rehabilitation on balance and coordination training in cerebral palsy children. Relevance: COVID-19 pandemic had significant impact on children with disability due to prolonged confinement at home which influenced negative physical status of children. Tele-rehabilitation can play a major role in the maintenance of function, prevention of worsening disability, and follow up of patient. It can proves beneficial to the family by decreasing time and costs related to travelling, family centered service, home based model of delivery of care which leads to being less prone to infection. Participants: 9 Children with cerebral palsy in the age group of 6–12 years with GMFCS level I and II were recruited from the paediatric out-patient department and child developmental centre of a tertiary care hospital and special schools in Belagavi. Methods: In this pre-post pilot study, pre-treatment and post-treatment outcomes were taken by using balance and bilateral coordination subtest of Bruininks Oseretsky Test of motor proficiency 2 (BOT2). The physiotherapy treatment consisted of conventional balance training exercise via tele-rehabilitation through Whats App video call. The intervention was carried out thrice a week for 4 weeks for one hour which was monitored by the therapist and assistance was provided by the parent. Statistical Analysis: The data was analysed using paired t test. Results: The results indicated a significant improvement in balance (P =0.042) with mean difference-4.25 ± 3.20 and coordination with mean difference-4.25 ± 1.50 (P=0.011). Conclusion: This study showed that tele-rehabilitation as a mode of treatment for children with cerebral palsy is useful for training balance and coordination. Implications: Tele-rehabilitation can be considered as an effective mode of delivering rehabilitation for children with cerebral palsy and that the effect must be studied in a larger sample size.

Possibilities of Rehabilitation and Telerehabilitation of Patients with Moderate and Severe Course of COVID-19 Disease Using Virtual Reality

In this paper, we present the possibilities of using virtual reality in the rehabilitation of patients after overcoming COVID-19 disease with a moderate or severe course. We have created a virtual environment with various interactive tasks that help patients in the rehabilitation of especially the musculoskeletal system and cognitive abilities. Patients were divided into groups according to the severity of the course of the disease and the possibility of rehabilitation with a therapist in an outpatient clinic or the possibility of tele-rehabilitation in the home environment was used. Based on the results, we showed that virtual reality was a suitable tool for these types of rehabilitation and provided opportunities for comparing the classical approach and modern methods. Virtual reality had a greater impact on patients' motivation to rehabilitate, especially in cases where patients were using virtual reality for the first time. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Experiences and perceptions of receiving and prescribing rehabilitation in adults with cystic fibrosis undergoing lung transplantation.

BACKGROUND: Rehabilitation is prescribed to optimize fitness before lung transplantation (LTx) and facilitate post-transplant recovery. Individuals with cystic fibrosis (CF) may experience unique health issues that impact participation. METHODS: Patient and healthcare provider semi-structured interviews were administered to explore perceptions and experiences of rehabilitation before and after LTx in adults with CF. Interviews were analyzed via inductive thematic analysis. RESULTS: Eleven participants were interviewed between February and October 2021 (five patients, median 28 (IQR 27-29) years, one awaiting re-LTx, four following first or second LTx) and six healthcare providers. Rehabilitation was delivered both in-person and virtually using a remote monitoring App. Six key themes emerged: (i) structured exercise benefits both physical and mental health, (ii) CF-specific physiological impairments were a large barrier, (iii) supportive in-person or virtual relationships facilitated participation, (iv) CF-specific evidence and resources are needed, (v) tele-rehabilitation experiences during the COVID-19 pandemic resulted in preferences for a hybrid model and (vi) virtual platforms and clinical workflows require further optimization. There was good engagement with remote data entry alongside satisfaction with virtual support. CONCLUSIONS: Structured rehabilitation provided multiple benefits and a hybrid model was preferred going forward. Future optimization of tele-rehabilitation processes and increased evidence to support exercise along the continuum of CF care are needed.

Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study.

BACKGROUND: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. OBJECTIVE: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. METHODS: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. RESULTS: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95% CI -30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95% CI 6933-9584; P<.001) steps. CONCLUSIONS: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship. TRIAL REGISTRATION: ClinicalTrials.gov NCT04663945; https://tinyurl.com/2p969ced.

Telerehabilitation during the COVID-19 pandemic, what are the determinants of satisfaction for chronic diseases? a retrospective study.

Background: During the Covid-19 health crisis, telerehabilitation provided a solution to ensure the continuity of care. Since then, it has been offered as an alternative to face-to-face rehabilitation in chronic conditions. Data measuring satisfaction are essential to adapt and increase the effectiveness of this type of programme. Aim and scope: This research focused on determining the most significant determinants of participant satisfaction in a telerehabilitation programme. Methods: We conducted a retrospective study by analysing the satisfaction questionnaire used from the start of the programme. Result: Two hundred and ten (210) participants completed the programme; 180 questionnaires were filled in and 175 analyzed of which 70 with chronic low back pain (CLBP), 59 for multiple sclerosis (MS) and 22 with parkinson's disease (PD). Satisfaction was high for all participants (scoring out of 10, mean = 8.22 sd = 1.53), but the determinants reported for the three main conditions involved in the programme differed. Main determinant was "benefice" for CLBP (p = 1.23e-05), "home exercises adapted" for MS (p = 0.000679) and "interest in staying at home" for PD (p = 1.84e-05). Conclusion: Depending on the context of the condition/disease, the drivers of satisfaction were not identical. Knowledge of these determinants will allow us to further improve the programme. However, some unresolved questions remain regarding the place of therapists, their role and the skills required for a successful telerehabilitation programme. Further studies are required to understand the impact.

Emergence of Tele-rehabilitation during COVID-19: A Case Report of a Survivor with Multiple Co-morbidities

Coronavirus disease 2019 (COVID-19) survivors experience impaired pulmonary function, reduced muscle strength, and exercise intolerance affecting their activities of daily living. Literature has demonstrated a need for multi-disciplinary approach for their faster recovery. In a pandemic like situation where maintaining social distancing to reduce the risk of transmission had become a norm, telerehabilitation services came to a great rescue of both the patients and health-care providers. At present, there are not any established guidelines for rendering pulmonary rehabilitation through telerehabilitation (TR). Besides, it's effective implementation depends on numerous patient-centric factors such as age, hemodynamic stability, presence of comorbidities, availability of resources, and cognitive level of the patient. We hereby present the case of a 69-year-old female diagnosed with COVID-19 with prolonged hospital stay, having a history of multiple co-morbidities, focusing on the role of 12 weeks of TR in improving her functional outcomes.

ActiveHip+: A feasible mHealth system for the recovery of older adults after hip surgery during the COVID-19 pandemic.

Objective: Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. Methods: Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). Results: The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. Conclusions: The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.

Impact of tele rehabilitation on clinical outcomes in patients recovering from COVID-19: a preliminary investigation

Pulmonary rehabilitation has proven to be an effective therapeutic intervention for people with chronic respiratory disease. Considering the highly contagious nature of coronavirus disease (COVID-19), it becomes imperative to develop a method which can effectively improve clinical disease outcomes of these patients without any physical contact. The purpose of the study was to investigate the impact of tele rehabilitation on dyspnoea, endurance and quality-of-life in patients recovering from COVID 19. Thirty-two participants (age: 42.5 +/- 13.94, height: 165.8 +/- 10.06, weight: 68.5 +/- 9.63, body mass index: 25.0 +/- 3.61) who are recovering from COVID-19 were recruited as per the eligibility criteria. They were randomly allocated into two groups, Tele rehabilitation (n=16) and Control (n=16) by lottery method. All the selected participants were assessed at baseline for perceived dyspnoea, endurance and quality-of-life. Patients in the Tele rehabilitation group received 14 sessions of rehabilitation on alternate days online via google meet over a period of 28 days. Control group received usual care during the study period. Standard statistical tests were employed to test the study hypothesis. Results suggested a significant improvement in both dyspnoea (P=0.001) and endurance (P<0.001) in response to tele rehabilitation. Domains of quality-of-life such as physical role (P=0.02), vitality (P=0.04), emotional role (P=0.03), mental health (P=0.02) and physical components score (P=0.007) also showed significant improvement with tele rehabilitation in patients recovering from COVID-19. Findings of this preliminary study concludes that tele rehabilitation may be considered a treatment of choice in patients recovering from COVID-19 for improving outcomes of dyspnoea, endurance and quality-of-life.

How to Ensure Continuity of AT Assessment Services for Frail People in Times of Pandemics: An Italian Experience

After an initial lock-down phase in 2020, the measures subsequently adopted in Italy to limit the spread of the SARS-CoV-2 virus made it impossible for people residing in nursing homes to have contacts with the outside world. Here we want to report how the DAT (Home automation, Assistive Technology and Occupational Therapy) service of Fondazione Don Carlo Gnocchi in Milan, Italy, was able to give continuity to the provision of assistive technology assessment services for older adults with disability who were not able to reach the DAT premises due to social restrictions. In the period 2020–2021, remote AT assessments were organized using a Tele-rehabilitation platform so that the physiatrist in charge of prescribing the assistive devices, supported by a therapist specialized in AT, could connect remotely from the DAT service to nursing homes in the Milan area. There, a rehabilitation professional would participate to the visit. 94 older adults with disability in 2020 and 2021 were able to take advantage of mobility assistive technology assessments provided remotely by DAT service AT professionals. The assistive devices prescribed were found to be appropriate, only a small percentage needed to be revised or were refused. High levels of satisfaction with the service provided were measured through KWAZO questionnaire among users of the service. 80% of the interviewees declared that it might be useful to keep the possibility of carrying out remote AT assessments in the future, even when the state of emergency for the COVID-19 pandemic will be finished. © 2022, The Author(s).

The effects of supervised and non-supervised upper limb virtual reality exercises on upper limb sensory-motor functions in patients with idiopathic Parkinson's disease.

BACKGROUND: Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe environment and can be used in tele-rehabilitation. This study aimed to investigate the effects of supervised and non-supervised UL virtual reality exercises (ULVRE) on UL sensory-motor functions in patients with idiopathic PD. METHODS: In this clinical trial study, 45 patients with idiopathic PD (29 male) by mean ± SD age of 58.64 ± 8.69 years were randomly allocated to either the control group (conventional rehabilitation exercises), supervised ULVRE or non-supervised ULVRE. Interventions were 24 sessions, 3 sessions/week. Before/after of interventions and follow-up period all assessment was done. Hand Active Sensation Test and Wrist Position Sense Test were used for assessing UL sensory function. Gross and fine manual dexterity were assessed by Box-Block Test and Nine-Hole Peg Test, respectively. Grip and pinch strength were evaluated by a dynamometer and pinch gauge, respectively. RESULTS: The results showed significant improvement in discriminative sensory function (HAST-weight and HAST-total), wrist proprioception, gross manual dexterity and grip strength of both less and more affected hands as well as fine manual dexterity of the more affected hand in the three groups in patients with idiopathic PD (P < 0.05). CONCLUSION: The results of this study indicated that both supervised and non-supervised ULVRE using the Kinect device might potentially improve some aspects of UL sensory-motor functions in patients with PD. Therefore, ULVRE using the Kinect device can be used in tele-rehabilitation, especially in the current limitations induced by the COVID-19 pandemic, for improving UL functions in patients with PD.

Parents' satisfaction of tele-rehabilitation for children with neurodevelopmental disabilities during the COVID-19 pandemic.

BACKGROUND: The use of tele-rehabilitation in children was limited before the COVID-19 pandemic, due to culture, technology access, regulatory and reimbursement barriers. METHODS: The study was conducted according to the CHERRIES (Checklist for reporting results of internet E-surveys) guidelines in order to provide quantitative and qualitative data about experience of patients with disabilities and their caregivers during Phase 1 of the COVID-19 pandemic, and their level of satisfaction. An online survey was developed using Google Forms and sent via email. The outcome measures were rated using a 5-point Likert Scale. Two additional open-ended questions were used to collect qualitative data. RESULTS: One hundred twenty-eight out of 261 families responded to the survey: 80.5% of the caregivers reported they were satisfied with the tele-rehabilitation. More than a half (53%) of the families reported a high level of satisfaction with the involvement they received in defining and sharing of rehabilitation goals. CONCLUSIONS: The implementation of telehealth during the COVID-19 lockdown has allowed us to gain more information about the potential of tele-rehabilitation, and resulted in an excellent satisfaction of caregivers. With appropriate education and consistent models of care, an increased use of telehealth may provide advances in remote patient care. TRIAL REGISTRATION: Not applicable.

Application of a home-based exercise program combined with tele-rehabilitation in previously hospitalized patients with COVID-19: A feasibility, single-cohort interventional study

INTRODUCTION Telehealth for COVID-19 patients is still limited. We aimed to assess the clinical effects of a home-based tele-rehabilitation exercise program following hospital discharge during the first lockdown in Greece, April to July 2020. METHODS A pre-and post-intervention design was applied in two stages. Firstly, patients were instructed to use a specially designed for COVID-19, e-book during four tele-health sessions. Afterwards, a 2-month home-based program consisted of self-practice exercise and one-hour supervised tele-rehabilitation exercise sessions every 10 days, was delivered. At baseline and at the end of the program, participants were interviewed about their physical, psychological status and quality of life (QoL) during the post-hospitalization period. The IPAQ-Gr, the HADS and the SF-36 questionnaires were used, respectively, and the participants were functionally assessed via teleconferences, using the 60 sec Sit to Stand Test (60secSTS), the Short Physical Performance Battery (SPPB) and the 3 min Step Test (3MST). RESULTS Seventy-four patients, median age 52.5 (IQR: 43–61) years were included at the first stage. From those, only 22 patients, mean ± SD age 50.1 ± 13.2 years completed the 2-month exercise program. The training program was well tolerated by all 22 patients. The mean number of unsupervised exercise sessions was 18.4 ± 3.5. No adverse effects were observed either during initial and follow-up assessment via tele-communication or during home-exercise sessions. Training improved significantly (p<0.001) lower limb muscle performance [median (IQR) 60secSTS: 22 (20–26) to 31 (25–36)], anxiety [median (IQR) HADS: 9 (6–13) to 4.3 (3.2–9.6)], depression [median (IQR) HADS: 5 (3–8) to 1.8 (0.9–3.7)], QoL [mean ± SD SF-36pcs: 37.5 ± 10.3 to 52.1 ± 6, and mean ± SD SF-36mcs: 42.9 ± 11.6 to 45.5 ± 12.3]. CONCLUSIONS Tele-rehabilitation may be feasible and may improve physical and psychological status of COVID-19 patients after hospital discharge. © 2022 Kortianou E. et al.

EU-Funded Telemedicine Projects - Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic.

The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of "from distance" and "timely delivered" are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic.

A Perspective on Implementation of Technology-Driven Exergames for Adults as Telerehabilitation Services.

A major concern of public health authorities is to also encourage adults to be exposed to enriched environments (sensory and cognitive-motor activity) during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality (XR) which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing the game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases (CNDs). The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility (due to disability, disease, or age), through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies.

MAIN FEATURES OF CARDIOVASCULAR REHABILITATION IN POST-ACUTE COVID-19

The COVID-19 pandemic caused by SARSCoV-2 is a significant challenge worldwide. Cornerstones of in-patient management of this pandemic which harms predominantly the respiratory system are the acute and intensive care. However, the rehabilitation plays a key role in improving the functional status and quality of life of survivors and reducing the impact of complications. As estimated, 40-50% of discharged patients require some form of medical support and 4-5% of them require inpatient rehabilitation. In addition to the respiratory system involvement, cardiovascular effects caused by COVID-19 (heart failure and myocarditis, acute coronary syndrome, arrhythmia, venous thromboembolism) are part of the ongoing systemic inflammatory processes and may affect 7-28% of hospitalized patients and lead to long-term deterioration in quality of life and loss of work capacity. Based on available scientific databases, expert consensus and the recommendations of European professional societies, this summary presents the recommended method, conditions and intensity of post-Covid cardiac rehabilitation including physical training exercises. The summary concerns also the recommended conditions for return to work and sporting activities. Structured exercise training is a very important and low-risk component of cardiac rehabilitation, reducing cardiovascular complications, thromboembolic complications, systemic inflammation and mortality, improving functional recovery and endothelial function. The planning of physical training should be preceded by a complex assessment of patients. Assessments of risk, capacity and function are needed to select the intensity, frequency and mode of individualized training. This should be combined with appropriate secondary preventive medication, monitoring, diet therapy and psychotherapy in accordance with respected principle of gradual progression. Finally, the consensus recommendations suggest that home-based and tele-rehabilitation should play a prominent role, considering the epidemiological and capacity constraints that also affect rehabilitation. © 2022 Literatura Medica Publishing House. All rights reserved.

Tele-Physiotherapy in Iran: Perceived Challenges by Physiotherapists to Its Implementation in COVID19 Outbreak.

Background: COVID-19 pandemic has brought new and fundamental challenges to the healthcare system. Physiotherapists, like other rehabilitation professionals, have been involved in this crisis. One way to protect both the clients and physiotherapists from getting infected and provide physiotherapy services effectively is tele-physiotherapy (TPT). This study investigated the physiotherapists' perception of TPT and the barriers to its practical application during the COVID-19 outbreak. Methods: This cross-sectional, descriptive study was adopted in December 2020, using a newly designed checklist. The checklist had four sections, consisting of physiotherapists' knowledge and awareness, satisfaction, attitude, and also barriers to the use of TPT during the COVID-19 outbreak. The checklist was uploaded to social physiotherapy networks across Iran, and the descriptive data were analyzed statistically. Results: In this study, 192 physiotherapists participated as follows. Before the COVID-19 outbreak, 48.96% of the participants used TPT, while this rate grew to 64.06% during the outbreak. The majority of the participants (65.1%) believed that the use of TPT would improve the relationship among the physiotherapists and their patients. They also had the lowest level of knowledge (27.08%) about one item in the checklist, i.e., "how to consult with TPT". Based on the participants' views, lack of proper familiarity with the use of this method (87.5%), a lack of high-speed internet access (86.45 %), and a lack of awareness of this method and its benefits (84.37%) had the highest frequencies compared to other barriers. Conclusion: The results indicate that during the COVID-19 pandemic in Iran, a significant increase in the use of TPT has developed. The overall physiotherapists' attitude towards TPT was positive, but it was necessary to minimize or eliminate the barriers to applying this effective method. Major recommendations from the participants were: continue to seek physiotherapists' and patients' perspectives, introduce proper educational programs for new students enrolled in professional associations and universities, and support the infrastructures, such as telecommunication and financial assistance from insurance companies.