The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis.

Objective: The global spread of the COVID-19 pandemic has affected all aspects, including orthopedic trauma surgery. This study aims to investigate whether COVID-19-positive patients who underwent orthopedic surgery trauma had a higher risk of postoperative mortality. Methods: ScienceDirect, the Cochrane COVID-19 Study Register, and MEDLINE were searched for original publications. This study adhered to the PPRISMA 2020 statement. The validity was evaluated using a checklist developed by the Joanna Briggs Institute. Study and participant characteristics, as well as the odds ratio, were extracted from selected publications. Data were analyzed using RevMan ver. 5.4.1. Results: After applying the inclusion and exclusion criteria, 16 articles among 717 total were deemed eligible for analysis. Lower-extremity injuries were the most common condition, and pelvic surgery was the most frequently performed intervention. There were 456 COVID-19-positive patients (6.12%) and 134 deaths among COVID-19-positive patients, revealing a mortality escalation (29.38% vs. 5.30% among COVID-19-negative patients; odds ratio, 7.72; 95% confidence interval, 6.01-9.93; P<0.00001). Conclusion: Among COVID-19-positive patients, the postoperative death rate increased by 7.72 times. It may be possible to improve prognostic stratification and perioperative care by identifying risk factors.

Ups and Downs of Trampoline Use by Children: Risks and Current Recommendations

The widespread increase in the recreational use of trampolines by children can be partially explained by the recent need to stay indoors during lockdowns due to the coronavirus disease 2019 pandemic. At the same time, there was a global increase in the number of pediatric accidents resulting from the domestic use of these devices. The resulting injuries may be severe, especially in younger age groups. Although the use of trampolines by children is discouraged in safety recommendations published by several scientific societies and some recent studies, there is still concern about the lack of knowledge about the risks of trampoline-related injuries. In this regard, this review article aimed to highlight the unique role of the pediatrician and/ or family physician advising parents and caregivers as well as the general population to prevent trampoline-related accidents involving children. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2023.

Epidemiology of musculoskeletal injuries and injury mechanism in Iranian elite veteran athletes

BACKGROUND: In recent years, the study of the epidemiology of injuries of athletes during their sports career has been accelerated by researchers and responsible national and international institutions. Repetitive and continuous patterns and types of injuries with mechanisms of micro trauma and overuse and macro trauma and impact are some of the most important reasons that can leave an unpleasant legacy from sports during retirement for veteran athletes. METHODS: A researcher-made questionnaire was used to record the musculoskeletal injuries of retired elite athletes. Overall, 276 athletes in three sports — volleyball (N.=86), soccer (N.=107) and basketball (N.=80) — contributed in this study. In this questionnaire, three important and severe injuries during sports of veterans were selected based on priority by the athlete himself. Injury registration was done according to the injury location, damaged structure and mechanism of injury. RESULTS: Kruskal-Wallis Test to check the amount of injury per 1000 hours of training among the studied groups showed not significant difference between groups (P≥0.202). The most common injury location in all three groups was the foot and leg, this rate in volleyball athletes was 40.4%, in soccer athletes was 45.8%, and in basketball athletes was 35%. The results showed a significant difference in the most common injury location between the three studied groups (P≤0.008). Ligament injuries were the most common type of injury in athletes. The results showed a significant difference between the 3 studied groups (P≤0.008). Results showed a significant difference in the mechanism of injury between the three studied groups (P=0.008). CONCLUSIONS: Presenting the profile of musculoskeletal injuries of veteran athletes with the aim of explaining preventive strategies to reduce and eliminate injuries needs more studies. Especially since the present study was conducted during the corona pandemic period. The necessity of systematic screening and completing the rehabilitation process of athletes at the right time will reduce the risk of permanent and chronic injuries and will increase his physical, mental and social health during retirement. COPYRIGHT © 2023 EDIZIONI MINERVA MEDICA.

Telehealth consultation before inter-hospital transfer after falls in a subacute hospital (the PREVENT-2 study).

OBJECTIVE: Inter-hospital transfers are increasingly common due to the regionalisation of healthcare, but are associated with patient discomfort, high costs and adverse events. The aim of the present study was to evaluate the effectiveness of a trauma outreach service for preventing inter-hospital transfers to a major trauma centre. METHODS: This was an observational pre- and post-intervention study over a 12-month period from 1 October 2020 to 30 September 2021. Eligible patients sustained a fall at Caulfield Hospital, a subacute care hospital specialising in community services, rehabilitation, geriatric medicine and aged mental health. The intervention was delivery of site-specific education at Caulfield Hospital and a trauma outreach service by specialist trauma clinicians at The Alfred Hospital who provided remote assessment, assisted with clinical management decisions and advised on appropriateness of transfer. RESULTS: The present study included 160 patients in the pre-intervention phase and 203 after the intervention. The primary outcome of transfer occurred in 19 (11.9%) patients in the pre-intervention phase and 4 (2.0%) in the post-intervention phase (P < 0.001). In the subgroup of patients without pelvis or long bone fractures, pre-intervention transfer occurred for 17 (10.9%) patients and post-intervention transfer occurred for 4 (2.0%) patients (P < 0.001). CT imaging was performed for 54 (33.8%) patients in the pre-intervention and 45 (22.2%) patients in the post-intervention group (P = 0.014). CONCLUSIONS: Telehealth consultation with a trauma specialist was associated with significant reduction of inter-hospital transfers, and significant reduction of CT imaging. This supports continuation of the service with scope for expansion and evaluation of patient-centred outcomes.

The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation.

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.

Comparing epidemiologic features, outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran.

PURPOSE: To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic. METHODS: This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX). RESULTS: Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p < 0.001). In the ≤15 years and ≥65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.02. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001). CONCLUSION: The pandemic affected the epidemiology of traumatic patients in terms of gender, age groups, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Low Prevalence but High Impact of COVID-19 Positive Status in Adult Trauma Patients: A Multi-institutional Analysis of 28 904 Patients.

BACKGROUND: Few large investigations have addressed the prevalence of COVID-19 infection among trauma patients and impact on providers. The purpose of this study was to quantify the prevalence of COVID-19 infection among trauma patients by timing of diagnosis, assess nosocomial exposure risk, and evaluate the impact of COVID-19 positive status on morbidity and mortality. METHODS: Registry data from adults admitted 4/1/2020-10/31/2020 from 46 level I/II trauma centers were grouped by: timing of first positive status (Day 1, Day 2-6, or Day ≥ 7); overall Positive/Negative status; or Unknown if test results were unavailable. Groups were compared on outcomes (Trauma Quality Improvement Program complications) and mortality using univariate analysis and adjusted logistic regression. RESULTS: There were 28 904 patients (60.7% male, mean age: 56.4, mean injury severity score: 10.5). Of 13 274 (46%) patients with known COVID-19 status, 266 (2%) were Positive Day 1, 119 (1%) Days 2-6, 33 (.2%) Day ≥ 7, and 12 856 (97%) tested Negative. COVID-19 Positive patients had significantly worse outcomes compared to Negative; unadjusted comparisons showed longer hospital length of stay (10.98 vs 7.47;P < .05), higher rates of intensive care unit (57.7% vs 45.7%; P < .05) and ventilation use (22.5% vs 16.9%; P < .05). Adjusted comparisons showed higher rates of acute respiratory distress syndrome (1.7% vs .4%; P < .05) and death (8.1% vs 3.4%; P < .05). CONCLUSIONS: This multicenter study conducted during the early pandemic period revealed few trauma patients tested COVID-19 positive, suggesting relatively low exposure risk to care providers. COVID-19 positive status was associated with significantly higher mortality and specific morbidity. Further analysis is needed with consideration for care guidelines specific to COVID-19 positive trauma patients as the pandemic continues.

Enhancing healthy skin and wound prevention outcomes in the Intensive Care Unit -- changing practice...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Objectives: The aim of the study was to explore the impact of a healthy skin and wound prevention programme by measuring nursing staff knowledge and patient wound prevalence in the Intensive Care Unit (ICU) pre and post intervention. A secondary aim was to identify the impact of the education and implementation program on pressure injury (PI), skin tear (ST) and incontinence associated dermatitis (IAD) prevalence and incidence rates in the ICU. Methods: A prospective quality improvement project based on the plan-study-do-act methodology included three phases: 1. Pre-Intervention Data Collection (December 2020) - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz 2. Intervention Phase -- Staff Education, Evidence Based Protocol Implementation & Evidence based products available in units 3. Post-Intervention Data Collection - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz Results: Pre-intervention data demonstrated two thirds of ICU patients had one or more wound. ICU Pressure Injury prevalence was 37.5%, IAD prevalence 12.5% and ST prevalence was 4%. ICU PI incidence reporting rate was 11%. Device Related PI rate was 56% of all PIs identified. Staff knowledge about wound prevention averaged 50%. Conclusions: As a result of the Covid-19 surge, post implementation data will be collected in May 2022 and the data will be presented as comparative outcomes.

Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations.

BACKGROUND: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients' health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. OBJECTIVE: This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. METHODS: Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. RESULTS: Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). CONCLUSIONS: In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient's recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most-but plausibly not yet all-end users in trauma care will value. This study could inspire the trauma care community.

Impact of COVID-19 Outbreak on Pediatric Trauma Cases in a Tertiary Trauma Center

Objective: To evaluate the change in the severity, frequency, and characteristics of pediatric trauma patients presented to the emergency department (ED) during the coronavirus disease-2019 (COVID-19) outbreak. Methods: A retrospective corn parative study was conducted in the ED of a tertiary trauma center in Istanbul, Turkey. Trauma patients aged under 18 years who presented to the ED between May 1st and June 30st, 2020 were included. The same dates of the previous year were included as a control group. Comparison of Manchester Triage Scale (MTS), disposition, injury characteristics, the location of the injury, region of injury, and ED length of stay (LOS) was done. Results: 2,779 patients were included. There were a 60% reduction in total ED visits and a 50% reduction in daily ED visits. MTS orange code patients (1.1% vs 1.8%) did not change while MTS green code (69.6% vs 41.8%) decreased significantly. Arrival by ambulance (5.8% vs 11.5%) increased (p<0.001). Penetrating (7.2% vs 27.3%), in-home (48.1% vs 65.1%), and upper limb (27.1 vs 34.4%) injuries increased (p<0.001). Fracture (19.0% vs 14.1%) and blunt trauma (90.7% vs 70.9%) frequency, and fall from ground level (64.5% vs 49.3%) injuries decreased significantly. The ward and intensive care unit (ICU) admissions did not change and ED LOS decreased (p<0.001). Conclusion: We highlighted that there was no change in critical pediatric trauma visits during the COVID-19 pandemic. There is still a need for ward and ICU beds for pediatric trauma patients. The change in injury severity and injury characteristics should be kept in mind while pandemic rearrangements were planned.

Diagnosis and Treatment of TBI and Polytrauma during Ground and High-Altitude Evacuation using Liquid Biopsy and Extracorporeal Life Support

TBI alone and in combination with polytrauma and lung injury caused up to 83 percent of nonsurvivable combat-related deaths. There is no accurate diagnosis method or viable therapeutic intervention for these casualties primarily due to the severity of injury, which can be unrecognized early on. Our proposal will address these unmet needs via utilization of a model of TBI with targeted descriptors of injury severity derived from bedside cell free DNA (cfDNA) testing, and then via addition of polytrauma and lung injury with subsequent testing of therapeutic intervention via extracorporeal life support (ECLS).

Mesenchymal Stem Cells for Treatment of ARDS Following Trauma

The acute respiratory distress syndrome (ARDS) is a life-threatening medical condition in which the lung is injured or inflamed to the degree that it cannot properly exchange gases and oxygenate the body. ARDS can be caused by a variety of conditions including trauma, severe blood loss, multiple or large volume blood transfusions, burns, and infections. The development of therapeutics that can limit the severity and/or progression of lung injuries that lead to ARDS and death is an immediate clinical need in both military and civilian sectors. Experimental studies carried out in small and large animals have demonstrated that specialized cells called mesenchymal stromal cells (MSC) can effectively reduce inflammation in multiple diseases including ARDS. The overall objective of this proposal is to carry out a randomized, blinded, placebo-controlled, multicenter phase 2b trial to test the therapeutic potential of allogeneic bone-marrow derived MSC for treating ARDS, with a major focus on civilian trauma patients. The specific aims of this project are: Specific Aim 1. To test the clinical efficacy of intravenously delivered allogeneic human MSC in patients with ARDS. Specific Aim 2. To test the mechanisms by which MSC reduce acute lung injury in patients with ARDS.

Gut Microbiome and Posttraumatic Epilepsy: Biomarker and Mechanistic Implications

The project examines the role of gut dysbiosis in post-traumatic epilepsy (PTE). Using a rat model of PTE - lateral fluid percussion injury (LFPI), the project tests the hypothesis that natural premorbid variations and/or post-LFPI perturbations of gut microbiome contribute to PTE. The goals Year 1 were to (i) obtain administrative approvals (Task 1);(ii) generate rats with LFPI and sham LFPI (iii) collect samples for, and perform longitudinal analysis of microbiome, blood and brain biomarkers of inflammation, biomarkers of intestinal barrier (IB) and blood-brain barrier (BBB) permeability (iv) gather and analyze data of chronic epilepsy after LFPI;(v) collect microbiome samples for subsequent microbiome transfer to recipients for Aim 2/Task 3 (ii-v - Task 2). According to plan, by the end of Year 1, Task 2 is to be 66 percent completed. By the end of the reporting period, generating of experimental subjects and sample collection is on schedule. Sample processing is behind schedule due to the COVID-19 - related research shutdown. Analysis of samples and specimens processed up to-date shows that after LFPI (i) 1/3 of experimental subjects develop PTE;(ii) there are robust changes in microbiome composition (i.e., dysbiosis);(iii) there is significant increase of plasma inflammatory cytokines, which points to peripheral inflammation;(iv) there are disruptions of intestinal and blood-brain barrier;(v) there is pronounced of microglia activation which points to central inflammation. Overall the results confirm the hypothesis on the dysbiosis-PTE connection.

Evaluating Impact of Cerebral Contusions on Brain Network Dysfunction and Epileptogenesis Among Patients with Traumatic Brain Injuries

The funding for study EP170034 was granted to LSU Health Sciences Center (LSUHSC (Shreveport on September 15th, 2018. The study protocol was approved by the U.S. Army Medical Research and Materiel Command (USAMRMC), Office of Research Protections (ORP), Human Research Protection Office (HRPO) on June 7th, 2019. Dr. Hai Sun accepted the job offer from Rutgers University. He resigned from LSUHSC effectively on August 31st and began serving as an Associate Professor in the Department of Neurosurgery at RWJMS at Rutgers University (RU) on September 9th, 2019. The DOD and CDMRP granted the permission to transfer the study from LSUHSC to RWJMS at RU. The transfer was completed in March, 2020. Then the COVID-19 pandemic has resulted the suspension of all research effort in March. Currently RU is undergoing Phase 3 reopening and the current regulation still prohibits any research study involving face-to-face interaction with human subjects. EP170034 falls in this category. In the meantime, the IRB committee at RWJMS at RU has approved our study protocol on July 8, 2020. This continuing review of this study protocol was submitted to the USAMRDC, ORP, and HRPO on July 15, 2020. We are waiting for the permission from RU to resume research studies involving face-to-face interaction with human subjects. We have necessary study infrastructure to begin subject recruitment as soon as the permission is granted.

Mechanisms and Treatment of Deployment-Related Lung Injury: Repair of the Injured Epithelium

Since 2001, more than 2.8 million military personnel, DoD contractors, and US government and NGO employees supporting the war effort have been deployed to Southwest Asia. They have been exposed to a variety of hazardous conditions during deployment including direct physical lung injury from explosions as well as chronic exposures from inhalation of airborne PM and other harmful chemicals, including smoke from burn pits, sand, and geogenic dust containing potentially toxic metals such as titanium, cadmium, aluminum, and lead. Exposure to cigarette smoke is an additional risk factor for respiratory disease in these individuals. Consequently, mounting evidence demonstrates that military personnel returning from Southwest Asia have increased rates of respiratory symptoms compared to non-deployed military personnel.

Mobility Toolkit: Electronically Augmented Assessment of Functional Recovery Following Lower-Extremity Trauma

The Mobility Toolkit (MTK) is a single chest mounted device that utilizes inertial measurement units (IMUs) to assess gait quality. The purpose of this project is to test the implementation of the Mobility Toolkit in multiple trauma centers around the country and generate normative data on lower-extremity injuries common among military and civilian patients. The long-term goal is for this to be a clinical tool for evaluating recovery progress. This study is an important first step in establishing feasibility and in creating a normative set against which patient progress can be measured.

Lung Injury Etiology, Risk Factors, and Morbidity of Single and Repeated Low-Level Blast Overpressure Exposure

Cardiopulmonary symptoms of shortness of breath and decreased exercise tolerance after return from deployment are a major concern for many veterans of Iraq and Afghanistan. While much of the focus has been on burn pit exposure and particulate matter as causal factors, there is growing evidence supporting a contributing role of blast-related lung injury. Acute blast overpressure (BOP) lung injury resulting in gross injury is well established. This project will address the less known, possible long-term, or latent effects of less severe BOP lung injuries. We plan to target veterans deployed to Iraq and Afghanistan with exposure to blast injuries of varying severity and invite them to participate in a multi-day cardiopulmonary evaluation. Specifically, we hope to characterize the severity and burden of mild BOP lung injury in Iraq/Afghanistan veterans and determine the association between BOP exposure with physiological, peripheral blood, and CTbased markers of cardiopulmonary function.

RSTNCOVID Burns: A multi-centre service evaluation and stakeholder survey of the impact of COVID-19 on burns care in England, Wales and Northern Ireland.

As the UK entered the first wave of the COVID-19 pandemic, the National Health Service published consensus guidance to the UK burns services advising changes to the acute management of burns to allow the continuation of safe care while protecting limited hospital resources. We aimed to describe the demographics of burns service users, changes to clinical pathways and experiences of the burns team during the first wave of the COVID-19 pandemic. All burns services in the UK were invited to participate in a national collaborative, trainee-led study supported by the Reconstructive Surgery Trials Network. The study consisted of (1) a service evaluation of patients receiving burns treatment during the COVID-19 pandemic; (2) a multidisciplinary team survey. Analyses were descriptive and narrative depending on data types. Collaborators from 18 sites contributed data from burns MDT surveys and 512 patients. Patient demographics were consistent with typical burns patterns in the UK. The delayed presentation occurred in 20% of cases, with 24 patients developing complications. MDT surveys indicated substantial adaptations and challenges as a result of the pandemic. Access to theatres and critical care were limited, yet a comprehensive acute burns service was maintained. Telemedicine was utilised heavily to reduce patient footfall. Adaptations in the provision of burns care, including greater outpatient care and telemedicine, have emerged out of necessity with reported success. The impact of reduced scar therapy and psychological interventions for burns patients during the pandemic requires longer-term follow-up. Lessons from the UK experience can be used to strategise for future pandemics.

Impact of telerehabilitation after sports injuries on psychological outcomes during the COVID-19 pandemic

BACKGROUND: The Italian government imposed a national lockdown from March to May 2020 aimed at preventing the spread of SARS-CoV-2 but causing psychological distress in patients who had already started a rehabilitation program after sports injuries. METHODS: Because of the impossibility of continuing the in-presence rehabilitation, patients attended a telerehabilitation program of mixed supervised and self-administered sessions. An on-line survey created to evaluate psychological characteristics was carried out after the start of the lockdown (T1) and after one month, when lockdown ended (T2). RESULTS: Fifty-three patients replied at T2 (50% of the initial sample). Self-efficacy showed a significant decrease (P=0.037). High levels of resilience (4.0/5 at T1;3.9/5 at T2) and perception of support from physiotherapists (4.4/5 at T1;4.3/5 at T2) were found. Perception of support from physiotherapists was significantly related to self-efficacy, optimism and adherence. Negative mood states were inversely associated with resilience, self-efficacy, optimism, and motivation. No significant difference was found between age and sport activity groups. Women had significantly higher levels of depressive (P=0.027) and post-traumatic stress symptoms (P=0.042) at T1 and more tension (P=0.021) at T2 than men. CONCLUSIONS: The telerehabilitation program carried out during the emergency, was effective in promoting clinical improvements, maintaining almost all psychological outcomes stable and preventing the worsening of psychological distress. This is due to the influence of high levels of perception of support from physiotherapists, resilience, and low levels of bad moods.