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BACKGROUND AND PURPOSE: Stem cell transplantation (SCT) in patients with hematological cancers results in longstanding physical changes. Commonly reported symptoms include chronic fatigue, global weakness, interference with activities of daily living (ADLs) and aerobic deconditioning. Aside from the sequela of symptoms experienced post SCT, these patients remain in an immunosuppressed state for several months following discharge from the hospital. Patients are often advised by their medical team to isolate themselves unless to attend follow-up outpatient clinic appointments. With the COVID-19 pandemic, this functional gap in the continuum of care worsened. As a result, SCT patients are both hesitant and discouraged to pursue outpatient or home health physical therapy even when these services are warranted. Thus, there is great need for options to safely optimize function for people post-SCT that are suitable in today's ever-changing environment. The purpose of this case series is to describe the functional impact of incorporating telehealth into the continuum of care for post SCT patients. CASE DESCRIPTION: 9 patients post inpatient admission for SCT were triaged to telehealth PT based on their scores on the Short Physical Performance Battery (SPPB) and the Activity Measure for Post Acute Care (AM-PAC) at the time of discharge from inpatient care. Scores on the SPPB ranged from 5-11, and AMPAC scores ranged from 21-24, demonstrating physical impairment. Patients were scheduled to receive telehealth twice a week. Sessions consisted of therapeutic exercises monitored via secure video software. Lab values were monitored via electronic medical record to assess appropriateness for therapy prior to each session. Rating of perceived exertion (RPE) scale and patientowned pulse oximeter were used to monitor patient fatigue levels. Patients' progress was assessed via Lower Extremity Functional Scale (LEFS), Brief Fatigue Inventory (BFI) and 5-times sit to stand (5xSTS) scores. OUTCOME(S): One year post telehealth implementation, patients reported improved independence and achievement of selfselected goals. Notable patient quotes include, "I feel less fearful in climbing up and down the stairs, and I feel more independent with laundry and cooking.which was very important for me." Additionally, patients reported a decrease in LEFS and BFI scores. Initial LEFS scores averaged 40% and dropped to 20% by discharge. Similarly, BFI scores dropped by 2 points at discharge, reflecting improved self-reported functional performance and a return to pre transplant fatigue levels. 5xSTS scores decreased by greater than 3 seconds in 6 of 9 patients, with one patient performing where previously unable. DISCUSSION: Telehealth services provide an additional method of care delivery to those unable to seek it in the traditional sense. For the severely immunocompromised, physical therapy via telehealth provides direct connection to providers trained in oncology rehabilitation serving as a feasible bridge between inpatient and outpatient care for amelioration of side effects associated with SCT.
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PR is a highly effective intervention comprising exercise therapy, disease education, behaviour change and psychological support. Recent guidelines have attempted to define PR, but the multicomponent character of the intervention means the precise content and delivery of PR is open to interpretation. Robust quality control (QC) and quality assurance (QA) processes measured against evidence-based quality standards or indicators can ensure that clinical care is provided to a high-quality standard. Providing transparent evidence of the quality of service to patients, referrers and health policy makers will assist the enhancement of referral rates and PR availability known to be poor in many countries and many healthcare settings. The presence of robust QC and QA will also permit the rapid development and evaluation of innovations in the delivery of PR services, such as have been required, for example, during the COVID-19 pandemic.Copyright © ERS 2021.
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Persistent complex bereavement/complicated grief occurs when, after a period of 12 months following a death, there remains an ongoing intense yearning and sorrow for the deceased, preoccupation with the death and its circumstances, difficulty accepting its reality, and disruption in personal identity. This case study illustrates the successful application of Complicated Grief Treatment (CGT), a manualized research-supported intervention, with a husband and wife each receiving individual therapy simultaneously with separate clinicians. The core of CGT involves graded completion of imaginal and situational revisiting (i.e., exposure) exercises. To target maladaptive rumination and counterfactual thinking more explicitly, strategies from a research-based treatment for trauma, Cognitive Processing Therapy, were also incorporated for one member of the couple. To our knowledge, CGT has not been examined with couples receiving individual therapy delivered simultaneously. As such, practitioners have little information about how to proceed with cases where multiple members of the same family are experiencing complicated grief. We will detail the treatment provided, outlining the course of care for each member of the couple, highlighting unique adjustments made to tailor implementation to each individual and to deliver the intervention simultaneously. Quantitative and qualitative data show the effects of treatment on symptoms of complicated grief, depression, and relationship satisfaction.Copyright © The Author(s) 2022.
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The main question in the field of exercise and rehabilitation medicine is whether physical activity and therapeutic exercise are suitable activities for CoVid-19 patients who are recovering at home. There have been few public health guidelines provided about what people can do in relationship with exercise and respiratory care. For this reason, it is necessary that physical therapists give some recommendations concerning safe respiratory and physical exercises that could be executed by people with confirmed, suspected, or probable CoVid-19 who stay at home.Copyright © 2022 University School of Physical Education in WrocAaw. All rights reserved.
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Introduction: SARS-CoV-2 infection frequently causes neurological symptoms. Cognitive alterations are among the most frequent symptoms, and may persist beyond the acute phase of infection. Method(s): We conducted a narrative review of the literature. Result(s): Hospitalised patients, and especially critically ill patients, are at greater risk of developing cognitive symptoms. Post-COVID-19 cognitive symptoms, unlike those associated with other viral illnesses, have been observed in patients with mild infection, and present some atypical features. Cognitive symptoms may last longer in COVID-19 than in other infectious processes, and more frequently affect young people. Post-COVID-19 cognitive symptoms share common features with those described in chronic fatigue syndrome, including a similar profile with affective symptoms. Brief screening tests for cognitive impairment present suboptimal diagnostic performance, and standardised criteria are needed to ensure correct diagnosis. Post-COVID-19 cognitive impairment can have a significant impact on the patient's quality of life and functional independence, regardless of other post-COVID-19 symptoms. Currently, no specific treatments have been approved for post-COVID-19 cognitive impairment, although cognitive stimulation may be useful in some patients. Conclusion(s): Post-COVID-19 cognitive symptoms are common and are often associated with other systemic symptoms. Neuropsychological evaluation may be useful for diagnosis and to quantify their severity and long-term prognosis. Detailed, and individualised assessment of cognitive impairment may enable the design of treatment plans.Copyright © 2021 Sociedad Espanola de Neurologia
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PURPOSE/HYPOTHESIS: Individuals with Long COVID experience a variety of symptoms (cardiopulmonary, neurological, musculoskeletal, and psychological) for 12 weeks or more after being infected with COVID-19. Preliminary evidence suggests exercise to be beneficial in alleviating short-term COVID-19 symptoms. The purpose of this investigation is to assess the impact of a progressive therapeutic exercise program on individuals with Long COVID. NUMBER OF SUBJECTS: Ten participants (8 females, 2 males) with Long COVID (age=49 +/- 5 yrs, mass = 89 +/- 6 kg, BMI = 30.2 +/- 1.9 kg/m2) were enrolled in the study. MATERIALS AND METHODS: Before and after the intervention participants were assessed for 6-minute walk distance (6MWD), 5-times sit to stand (5XSTS), gait speed, grip strength, perceived quality of life (SF-12), and general fatigue (visual analog fatigue scale, VAFS). Participants then completed a progressive, individualized exercise program (;8 weeks) designed to improve cardiovascular fitness, muscle strength, and endurance. Modes of exercise used to facilitate improvement in cardiorespiratory fitness included the treadmill, NuStep, semirecumbent bike, semi-recumbent elliptical, and standup elliptical. Heart rate (HR), blood pressure (BP), O2saturation, and rating of perceived exertion (RPE) were regularly monitored during aerobic exercise. Dumbbell exercises targeted at large muscle groups were used to challenge muscular strength and endurance. Progression of exercise intensity and duration was based on symptom response to exercise. Paired t-tests were used to evaluate changes in outcome measures following the intervention. RESULT(S): 6MWD (pre = 469 +/- 19 m, post=529 +/- 18 m, P = .001), 5XSTS (pre=11.4 +/- 1.1 s, post=9.4 +/- 0.9 s, P = .012), gait speed (pre=1.24 +/- 0.05m/s, post=1.35 +/- 0.07m/s, P = .029), and right (pre=69.8 +/- 4.2lbs, post=73.6 +/- 4.4lbs;P = .041) and left (pre=64.7 +/- 3.5lbs, post=68.8 +/- 3.1lbs;P = .041) grip strength improved following the intervention. Similarly, both the physical component (pre=44.4 +/- 3.1, post=50.76 2.4, P = .006) and mental component (pre=43.9 +/- 2.9, post=51.4 +/- 2.0, P = .007) of SF-12 improved, while VAFS (pre54.86 0.5, post52.86 0.6, P5.005) was reduced following the intervention. CONCLUSION(S): A progressive individualized exercise program can be effective at improving physical function and perceived quality of life in Long COVID patients. CLINICAL RELEVANCE: Many physicians are referring patients out to be treated for Physical Therapy, but there is currently limited reference of evidence-based practice to treat these individuals and some concern that exercise may exacerbate symptoms. The majority of APTA clinical guidelines for COVID-19 focus on short-term COVID-19 symptoms and do not address treatment methods for Long COVID symptoms. While functional status has been demonstrated to be negatively impacted in Long COVID patients, little guidance is available for treatment strategies in this population. This investigation provides physical therapists with a generalized strategy to improve physical function and quality of life in Long COVID patients.
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Background: During the pandemic of COVID-19 most hospitals significantly reduced non-emergency admissions and services due to the increased risk of viral infection. As a result, the recommended self-isolation for cancer patients during pandemic may lead to physical inactivity and prolonged sitting time. In addition to the negative side effects of treatment, this lack of physical activity and exertion has further negative implications for their health, such as decrease in physical performance and health related quality of life. Method(s): To address this problem the OTT (Onkologische Trainings-und Bewegungstherapie) of the University Hospital Cologne located in the Center for Integrated Oncology (CIO) implemented a Hygienic Concept to ensure safe training session with the physical therapists during COVID -19 pandemic situation Result: The need of physical exercise for cancer patients on the one hand, and protection against the spread of coronavirus on the other hand, infection control had to be given priority. Although the hygienic concept was used in the time between September 2020 till August 2021, also during lock down situation in Cologne. 260 oncologic patients have taken part in the oncologic exercise therapy. None of the training patients infected himself with coronavirus during that time period. Discussion(s): The hygienic concept was proven safe. Taking into account the current infection situation and the above-mentioned objectives, the resumption of regular exercise therapy for cancer patients is necessary but must take place in another Hygienic Concept compared to non-pandemic situations. Conclusion(s): It should be noted that essential hygiene and infection protection measures must continue to be observed by all persons involved in the clinical setting. In addition, it is important to recognize emerging chains of infection at an early stage and to prevent their spread. It is safe for cancer patients to use exercise therapy during pandemic situations when used adapted hygienic concepts.
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INTRODUCTION. The global spread of the new coronavirus infection COVID-19 determines the relevance of studying the clinical features and long-term consequences of the disease in children. Respiratory tract lesions in COVID-19 are the most common symptoms in the pediatric population. At the same time, the possibility of the development of gastrointestinal, neurological and psychological disorders has now been established, which is important to consider when designing medical rehabilitation programs for such patients. RESULTS AND DISCUSSION. The article describes modern approaches to the organization of 3-stage medical rehabilitation of patients who have undergone a new coronavirus infection COVID-19. Medical rehabilitation of such patients is aimed at restoring the ventilation function of the lungs, improving bronchial patency and drainage function of the respiratory tract, normalizing the functional state of the cardiovascular system, gastrointestinal tract, muscle tone, increasing exercise tolerance and the defenses of the child's body. The most important component of rehabilitation measures, in addition to drug therapy and physiotherapy methods carried out for such patients, is physical rehabilitation, that is, the use of physical exercises for therapeutic, preventive and rehabilitative purposes. The authors describe the main tasks, means and forms of physical therapy, motor modes and intensity of load for each stage of medical rehabilitation, the principles of a differentiated approach to the selection of basic physical rehabilitation measures taking into account the target organ, the stage of medical rehabilitation are presented. CONCLUSION. Physical rehabilitation is a mandatory component of the individual medical rehabilitation program for children who have suffered COVID-19. The differentiated application of physical rehabilitation, taking into account the target organ, the severity of the disease, the stage of medical rehabilitation, makes it possible to achieve an earlier and complete restoration of the impaired functions of various organs and systems. © 2022, Maria S. Petrova, Maya A. Khan, Natalya A. Mikitchenko This is an open article under the CC BY license.
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INTRODUCTION. To date, one of the important tasks of Russian healthcare is the development and improvement of sanatorium treatment. The article highlights topical issues of development and improvement of sanatorium treatment of children in institutions subordinate to the Administrative Department of the President of the Russian Federation. It presents the data on the peculiarities of the functioning of the II and III stages of medical rehabilitation in the conditions of health resort institutions on the basis of the rehabilitation department of the children's sanatorium "Polyany”, where a wide range of innovative technologies of physiotherapy and kinesiotherapy are successfully applied. The high availability of sanatorium-resort treatment for children registered at a dispensary in a Children's medical center is shown. Data are published on the effective use of the bed capacity of health resort institutions subordinate to the Administrative Department of the Russian Federation, primarily for the treatment and medical rehabilitation of children with chronic diseases. The article describes the organization and modern technologies of medical rehabilitation of children with diseases of musculoskeletal system, respiratory organs, digestion, genitourinary system, in institutions subordinated to the Administrative Department of the President of the Russian Federation. There are data on the organization of medical rehabilitation of children who have had COVID-19. A 3-stage system of restorative treatment, indications and non-drug technologies of medical rehabilitation of such patients are shown. AIM. To assess the current state of the health resort care for children in institutions subordinate to the Administrative Department of the President of the Russian Federation. CONCLUSION. In order to further improve the sanatorium treatment of children in institutions subordinate to the Administrative Department of the President of the Russian Federation, there are of the necessity: a personalized approach to the development of sanatorium-treatment programs for children, an optimization of the II and III sanatorium stages of medical rehabilitation of children, an introduction of innovative technologies of medical rehabilitation of children in the practical activities of sanatoriums, an integration of research results into the practice of s-anatorium treatment of children and continuous professional development of specialists, working in health resorts. © 2022, Maria S. Petrova, Maya A. Khan This is an open article under the CC BY license.
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BACKGROUND: Coronavirus disease 19 (COVID-19) infection has been a global pandemic since late 2019. Even though most COVID-19 patients recover fully from the disease, approximately 5–10% experience prolonged symptoms for several months following the acute COVID-19 phase, defined as long COVID-19 syndrome. Most of the sequelae are respiratory sequelae. Rehabilitation therapy is needed to overcome their respiratory sequelae and to improve their functional capacity. AIM: This systematic review discusses rehabilitation therapy for long COVID-19 syndrome with respiratory sequelae. METHODS: Using PubMed and Cochrane library, a systematic review was conducted based on PRISMA guidelines. The subject of this research was long COVID syndrome with respiratory sequelae. For rehabilitation therapy for long COVID-19 patients with respiratory sequelae, inclusion criteria were studied. Exclusion criteria were letters to the editor, editorial or commentary reports, and studies not available in full-text and not in English or Bahasa. RESULTS: Nine studies are included in this systematic review comprising two consensus statements or recommendations, one cohort retrospective study, two case studies or case reports, one review, and three experimental studies. The recommended rehabilitation program pathway using a three-tier model depends on the severity of the disease. Several rehabilitation exercises for long COVID patients with respiratory sequelae include cardiorespiratory exercise, breathing exercise, therapeutic exercise, and even traditional Chinese fitness models such as Liuzijue exercise. CONCLUSION: Rehabilitation therapy exercise helps to improve the breathing effort, improving dyspnea, and respiratory muscle strength in long COVID patients with respiratory sequelae.
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Short- and long-term postacute sequelae of SARS-CoV-2 infection (PASC) includes a constellation of clinical symptoms that persist following recovery from COVID-19. The precise pathophysiology of PASC is unknown but likely multifactorial, and intervention strategies to combat PASC are lacking. Our aim was to investigate whether homebased exercise training (HBExT) enhances recovery of and/or improves exercise capacity, pulmonary function, symptoms, and overall health-related quality of life (HRQoL) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO) and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed before and after 8-weeks of HBExT in three adults (2 males, 48 and 40 years old;1 female, 37 years old) with PASC. Symptoms (via standard questionnaire) and HRQoL (via EQ-5D-3L questionnaire) were also assessed before and after HBExT. HBExT consisted of 3-to-4 aerobic (duration 25-40 min, intensity 60-80% heart rate reserve) and 2-to-3 resistance (7 exercises, 8-12 repetitions, 2-3 sets) sessions per week, and was prescribed and tracked in each participant using a mobile application (Connected mHealth) integrated with a heart rate monitor (Polar H7). RESULTS: Time from initial SARS-CoV-2 infection to enrollment in the study (in months) and adherence rate to HBExT was 8 and 66%, 4 and 71%, and 3 and 100% for the three participants. Before to after HBExT, there was a 13 ± 7% increase in exercise time (12.6 ± 2.0 vs. 14.1 ± 1.3 min) and a 14 ± 9% increase in peak O2 uptake (V̇O2peak;27.6 ± 2.8 vs. 31.5 ± 2.5 ml/kg/min) during the CPET. Neither the heart rate nor the pulmonary gas exchange (V̇E/V̇CO2, PETCO2, SpO2) response to CPET was different before vs. after HBExT. Conversely, peak-exercise breathing reserve was lower (13 ± 16 vs. 30 ± 11 L/min) and O2pulse was greater (16.3 ± 1.2 vs. 13.8 ± 0.2 ml/beat) following HBExT. No remarkable changes in pulmonary function or DLCO were noted after HBExT;however, there was a 16 ± 12% increase in MIP from before to after HBExT (74 ± 21 vs. 85 ± 18 cmH2O). After HBExT, a fraction of the participants reported resolution of persistent fatigue (n = 1), breathlessness (n = 2), chest tightness (n = 1), palpitations (n = 1), and dizziness (n = 2), and overall health score (via EQ-5D-3L) was increased (42 ± 34 vs. 81 ± 6;100 = ‘best health imaginable’). CONCLUSIONS: Prescribed exercise training may increase exercise capacity and inspiratory muscle strength, alleviate persistent symptoms of fatigue and breathlessness, and improve overall HRQoL in people with PASC. CLINICAL IMPLICATIONS: Exercise-based therapy may improve functional capacity and partially alleviate persistent symptoms in people with PASC, strengthening calls for cardiopulmonary rehabilitation as a potential therapeutic intervention in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Isabel Cortopassi No relevant relationships by Igor Fernandes No relevant relationships by Scott Helgeson No relevant relationships by Elizabeth Johnson No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Patricia Mergo No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support
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The aim of the study was to evaluate the effectiveness of including remaxol in the medical rehabilitation of elderly and senior patients with COVID-19-associated pneumonia and changes in liver enzyme activity. Material and methods: 116 patients (56 men and 60 women) were examined. All patients underwent a complex of medical rehabilitation on an outpatient basis on the 10–12th day after discharge from the hospital and in the presence of 2 negative results of PCR tests for SARS-CoV-2, which included, in addition to the recommended measures (drug therapy and exercise therapy), vacuum labile massage according to the author's methodology and a course of hepatoprotective drugs. Depending on the latter, the patients were divided into two groups: I — the main group (n=60) — received remaxol in the drug treatment regimen: 400 ml, intravenously, drip, in a course of 10 days, II – comparison (n=56) — ademetionine: 400 ml, intravenously, drip, in 0.9% saline, in a course 10 days. Before rehabilitation and at its end, the following tests were carried out: Stange and Genchi tests;quality of life was assessed using the SF-36 questionnaire. Laboratory studies included determination of the following indicators levels: ALT, AST, their ratio, alkaline phosphatase, GGT, total and direct bilirubin, LDH, albumin and total protein levels. Results. The inclusion of hepatoprotectors in the medical rehabilitation of the patients of this group contributes to a decrease in cytolytic and cholestatic syndromes, which is more pronounced in patients who received remaxol: (a decrease in AST by 1.5 times (from 35.4±1.4 to 23.5±l), and ALT — by 1.8 times (from 38.7±1.3 to 21.5±0.4 IU/l), as well as normalization of bilirubin metabolism: a decrease of total bilirubin by 2.1 times (from 32.1± 0.6 to 14.8±0.9 µmol/l) and of direct — by 2.5 times (from 7.1±0.6 to 2.8±0.1 µmol/l). A pronounced increase in resistance to hypoxia was noted during the therapy with the drug (according to Stange and Genche), which contributed to an improvement in psychophysiological indicators of patients’ quality of life (according to the SF-36 questionnaire). The obtained results, along with the safety of the drug, allow us to recommend its use in patients with this pathology.
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Background: During the COVID-19 pandemic, the patients with rheumatic disease in the biopsychosocial perspective have been adversely affected by social isolation, uncertainty, and the thought that their chronic disease will worsen and increase in their symptoms. ACR/EULAR (American College of Rheumatology/European League Against Rheumatism) defnes recommendations about continuing current pharmacotherapy and the signifcance of the biopsychosocial approach and exercise for patients with rheumatic diseases during a COVID-19 infection 1, 2. Objectives: This study aims to investigate the effectiveness of the biopsychoso-cial exercise performed by telerehabilitation on biopsychosocial status, general health status, and anxiety-depression levels in the patients with infammatory and non-infammatory rheumatic diseases. Methods: Fourteen patients with infammatory rheumatic diseases (rheumatoid arthritis: 4;ankylosing spondylitis: 4;sjogren's syndrome: 3;polymyalgia rheumatica: 2;and vasculitis: 1) and eight patients with non-infammatory rheumatic diseases (fbromyalgia: 6;and osteoarthritis: 2) performed a biopsychoso-cial-based exercise model (named as 'Bilişsel Egzersiz Terapi Yaklaşimi'-(BETY) in original;'Cognitive Exercise Therapy Approach' in English) via telerehabilita-tion continued for three sessions per week for 12 months 3. Outcome measures were Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), and BETY-Biopsychosocial Questionnaire (BETY-BQ) 4. All outcomes were measured baseline and at the 12th month. The Wilcoxon's test was used for statistical analysis. Results: All of the 22 patients were female. The mean age was 57.4 and 55.8 years in the infammatory and non-infammatory rheumatic diseases groups respectively, and they had a mean BMI of 25.9 and 25.3 kg/m2. There was no signifcant difference by time for HAQ score (p = 0.125), HADS anxiety and depression (p = 0.916 and p = 0.663, respectively), and BETY-BQ score (p = 0.753) between the baseline and at the 12th month follow-up in the patients with infammatory rheumatic diseases. Similarly, in the patients with non-in-fammatory rheumatic diseases, there was no signifcant difference by time for HAQ score (p = 0.546), HADS anxiety and depression (p = 0.343 and p = 0.527, respectively), and BETY-BQ score (p = 0.068) between the baseline and at the 12th month follow-up. Conclusion: This study showed that biopsychosocial-based exercise through real-time telerehabilitation was able to maintain their conditions before pandemic in biopsychosocial status, general health, and anxiety-depression levels on the patients with infammatory and non-infammatory rheumatic diseases during COVID-19 pandemic period in one-year follow-up.
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The proceedings contain 40 papers. The topics discussed include: graft failure, revision ACLR, and reoperation rates after ACLR with quadriceps tendon versus hamstring tendon autografts;meniscal surgery or exercise therapy in alleviating patient-reported mechanical symptoms in young adults with a meniscal tear;'it's second best': mixed-methods evaluation of the experiences of people with musculoskeletal pain towards physiotherapist delivered telehealth during COVID-19 pandemic;outcome predictors for recovery of rotator cuff tendinopathy: an international prospective cohort study;are patients satisfied? a systematic review and meta-analysis of exercise therapy in the management of tendinopathy;numerous treatments are efficacious for patellofemoral pain: a systematic review and meta-analysis;and a single bout of eccentric exercise increases the gene expression of nestin and osteocrin in human myotendinous junctions.
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BACKGROUND AND AIMS: The number of patients requiring home dialysis in Japan is increasing due to COVID-19 and the aging of the population. Home haemodialysis has been performed in Japan since the 1960s. However, as of March 2019, there were 720 home haemodialysis patients in Japan, which is only 0.2% of the total number of dialysis patients. The possible causes are as follows. The number of home haemodialysis patients has not increased markedly due to safety concerns as home haemodialysis patients perform dialysis at home, and the out-ofpocket costs are high. In addition, patients and caregivers must be able to manage themselves, and the burden on both patients and caregivers is heavy. Therefore, the Ministry of Health, Labour and Welfare (Japan) has advocated the need for home patients to share information with medical institutions to improve their quality of life, including COVID-19 measures. We have built a system to support home dialysis patients. Here, we have added an exercise therapy function to this system to encourage patients to continue exercising. METHOD: The items recorded/displayed in the patient's home peritoneal dialysis support system included records such as time, blood pressure, blood glucose level, urine volume, meal content, replacement start time, dialysate/plasma ratio, drainage volume, injection volume, water content and water removal and drainage. These inputs were entered via drop-down menus and displayed visually in graphs or by uploading images. The medical staff could see photographs of the affected areas and of meals entered by the patient. Patients could also share their opinions and treatment schedules with the medical staff at the medical institution. In addition, when exercising, the patients used an ergometer that allowed them to sit or lie down. The developed system incorporates records of the patient's exercises. Data were captured directly from the ergometer into the developed system in CSV format and could also be entered manually via drop-down menus. RESULTS: Using the developed system, we were able to enter and view patients' vital data and display photographs showing the color and volume of the drainage pack. By viewing these photographs, the medical staff could confirm the photographs of the affected areas, the color of the packs and the contents of the patients' meals. In addition, displaying the patient's vital records in a graph allowed for visual evaluation over time, which was useful when giving advice to patients. Using the two-way communication function, patients were also able to share their opinions and treatment schedules with the medical staff of the medical institution. Patients can now consult with medical staff, making their homes more like part of the hospital and giving them greater peace of mind. Figure 1 shows an example of the display of the developed system. Figure 2 shows an example of the patient's pedaling exercise results input from the ergometer. The amount of pedal movement performed by the patient was conserved through the dynamo and used to charge mobile devices. This allows the patient to charge their mobile devices while exercising, thus encouraging them to continue exercising. CONCLUSION: We have developed a support system for home haemodialysis patients that allows the input and display of patients' vital records and consultation with medical staff online. We have added a function to the system to encourage home haemodialysis patients to continue exercising. By using the developed system, patients can now perform home dialysis, including continuous exercise safely and with peace of mind, and healthcare professionals can access all medical information of patients, including changes over time. (Figure Presented).
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Knee osteoarthritis (KOA) among obese people is a common joint pain with loss of physical functioning, disability and reduction in quality of life QoL). This study aimed to compare the effect of aquatic and Thera-band exercise on pain intensity and QoL among obese people with KOA. A total of 45 KOA participants with BMI ≥ 27.5 kg.m-² were randomly recruited and randomly assigned into three groups;aquatic (AQG), Thera-band exercise (TBG) and control (CG);carried out the exercise program, two times weekly, 60 minutes per session, for eight weeks. Quality of life was measured using modified KOOS questionnaire with five sub-domains;pain, symptoms, activities of daily living (ADL), sports/ recreation and knee-related QoL. The results showed no significant difference in age, weight, BMI, and KOA involvement background in all groups. The MANCOVA results displayed a significant interaction of group×time effect on all sub-domains of QoL;pain, symptoms, ADL, sports/recreation and total QoL. In addition, pairwise comparisons between groups among QoL sub-domains revealed that there was significant difference between AQG and TBG in all dimensions of QoL (pain, symptom, ADL and knee-related QoL) exception in sports/recreation domain. For overall aquatic exercise could reduce pain and improve QoL greater that Thera-band exercise after eight weeks of the exercise program. As a conclusion, this progressive aquatic exercise program had a superior effectiveness to reduce all dimensions of QoL, although Thera-band exercise cannot be ignored as an effective, simple and inexpensive method to create a self-exercise program among obese people who suffering from KOA.
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Introduction: A novel coronavirus (COVID-19), caused a series of acute atypical respiratory syndrome termed as SARS CoV-2. It has a varying degrees of symptoms like headache, high fever, dizziness, generalized weakness, diarrhoea and vomiting. But primarily it affects the respiratory system causing breathlessness and sometimes may be fatal. People recovered from the illness had variety of physical and mental illness. Aims: To find the effectiveness of virtual therapeutic exercises and mindfulness programme among the subjects recovering from COVID-19. Materials and methods: A total number of 32 male subjects aged between (55 - 70) years were included in this study. The subjects were included based on the prescription of a medical officer/ Curved length of Aortic Knuckle (AKC), total length of Left Heart Border (LHBT) and Aortic Knuckle Index (AKI) were measured. Statistical analysis was carried out with the help of IBM-SPSS (IBM Corporation) and Microsoft Excel. Results: AKC and AKI were measured,and correlated with total lenght of LHBT. A positive correlation between AKC, AKI and LHBT was noted. Conclusion: Simple measurement of aortic knob in PA chest x-ray may help in predicting cardiovascular disorder. pulmonologist. The duration of the study was eight weeks. Fitness assessment scale, hamilton stress anxiety scale and modified respiratory assessment scale was used. The study was conducted in the Symbiosis Medical College for Women, Pune. Results: The statistical analyses were done using the SPSS software version 18 executed at a 95% confidence interval. A paired t-test was done to find the effectiveness of the therapeutic exercises. The level of significance in all tests was set to p < 0.05. Positive changes were observed in health-related fitness among the subjects. Conclusion: This study reports about finding that virtual therapeutic training also provides the best results in physical and mental health among the patients recovering from COVID-19.
ABSTRACT
Purpose: Osteoarthritis (OA) affects more than 300 million people worldwide with the knee and hip joints among the most clinically prevalent. Pain, stiffness, and physical disability are hallmark symptoms that impair quality of life. Good Life with osteoArthritis from Denmark (GLA:D®) is an evidence-based program providing education and exercise-therapy for people with knee and hip OA, now offered in 8 countries. A key barrier to GLA:D® is the need to attend 14 in-person sessions over 8-weeks, particularly for those in rural areas or with substantial occupational or family caring responsibilities. In the COVID-19 pandemic we expanded implementation support for GLA:D®in Australia to provide it via telehealth. The aim of this mixed methods project was to evaluate the implementation of GLA:D® via telehealth in Australia using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Methods: Quantitative: People with knee or hip OA who reported completing GLA:D® via telehealth-only or a hybrid model of in-person and telehealth (minimum 3 telehealth sessions) at 3-month follow-up from March 2020-October 2021 were identified from the GLA:D®Australia registry. RE-AIM dimensions were examined descriptively. For the effectiveness domain mean differences [MD, (95% confidence intervals (CI)), effect size (ES)] from baseline to 3-month follow-up were calculated for pain (visual analogue scale, 0-100) and joint-related quality of life (knee injury and osteoarthritis outcome score or hip disability and osteoarthritis outcome score -quality of life sub-scales). Participants rated perceived recovery on a global rating of change (scale -3 to 3;1-3=recovered) and how satisfied they were with the GLA:D® program (scale 1-5;4,5=satisfied) at 3-month follow-up. Qualitative: One-on-one semi-structured interviews were conducted with 23 GLA:D® trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings. Interviews were transcribed and analysed using a reflexive thematic approach guided by the RE-AIM QuEST framework. Results: Reach: 138 people (39 telehealth-only and 99 hybrid model;69% female) completed GLA:D.® Mean (SD) age and BMI were 64 (9) years 29.8 (5.5) kg/m2, respectively. Key themes on patient barriers and enablers for telehealth reach were technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions limiting access to in-person GLA:D® was an enabler. Effectiveness: For telehealth-only, average pain [MD=-10 (95%CI=-16, -4), ES=-0.54] and joint-related quality of life [MD=9 (95%CI=3, 14), ES=0.51] improved significantly. This was similar for hybrid model with average pain [MD=-11 (95%CI=-16, -6, ES=-0.43)] and joint-related quality of life [MD=12 (95%CI=8, 16, ES=0.65)] also improved. At 3-months, 81% of participants reported recovery and 88% were satisfied with GLA:D®. Most physiotherapists who adopted GLA:D® telehealth believed it was as effective as in-person for most patients and felt patients were better able to continue exercising at home upon completion. Adoption: 92 physiotherapists (74 health services) delivered GLA:D® via telehealth. Most physiotherapists who had adopted GLA:D® via telehealth stated it had become a normal part of their practice. Barriers to adoption included preferring, and greater confidence with providing, in-person GLA:D®. Implementation: Both education sessions were attended by 70% (n=96) of participants and 91% (n=125) attended more than 10 exercise-therapy sessions. GLA:D® telehealth implementation involved program modifications, including to assessment, exercise instruction, equipment modifications, and reduced fee structures. Maintenance: GLA:D® telehealth participants completed 3-month follow-ups throughout the entire study timeframe, with 16 (12%) in the final 2 months of evaluation, indicating ongoing participant engagement. Physio herapists stated GLA:D® telehealth was an opportunity for increased program access to immunocompromised, rural, and working patients. Barriers to sustainability identified included lack of personnel capacity, low patient demand, and a need for future telehealth training and support. Conclusions: Telehealth delivery of GLA:D® in Australia during the pandemic was most used as part of a hybrid model, combined with in-person delivery. Patient outcomes following GLA:D® via telehealth were comparable to published data related to in-person delivery, indicating it is an effective method to implement group-based care for OA. Yet, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. This evaluation will guide new strategies and training to support GLA:D via telehealth as a viable mode of program delivery in the future in Australia and internationally.