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Aims: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post-COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. Method(s): A total of 150 patients with obesity and diabetes who were followed every 4-6 weeks either in-person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight-based daily protein intake from protein supplements and food, an activity/sleep schedule-based meal times, and an aerobic exercise goal of a 2000-calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth-based follow-up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no-show rates, number of visits, program duration, and drop-out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). Result(s): Mean age was 47.2 +/- 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 +/- 7.7-39.7 +/- 6.7 kg/m2 (p < 0.0001). Mean program duration was 189.4 +/- 169.3 days. An HbA1c% unit decline of 1.3 +/- 1.5 was achieved with a 10.1 +/- 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in-person appointments (10.6% +/- 5.1 vs. 9.6% +/- 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in-person follow-up (213.8 +/- 194 vs. 159.3 +/- 127, p = 0.019). The mean annual telehealth and in-person no-show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 +/- 3.0 vs. 8.6 +/- 5.1) and drop-out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 +/- 267.5 min vs. 200.6 +/- 110.8 min), PLT (28.9 +/- 17.5 min vs. 3.1 +/- 1.6 min), and PST (1033 +/- 628 min vs. 113.7 +/- 61.4 min) were significantly longer (p < 0.0001) for the in-person group. Conclusion(s): Telehealth offered comparable %TBWL and HbA1c decline as in-person follow-up, but with a shorter follow-up, fewer appointments, and no-shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.Copyright © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.
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Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.
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Post COVID-19 patients have been suffering from persistent symptoms even after long periods. The physiopathology of these clinical manifestations still has a lack of knowledge. The objective was to evaluate the total expression of metabolites and spittle biological pathways in patients with 60 days post COVID-19. We included 30 post-hospital discharge patients and we compared seven non COVID-19 patients control. All COVID-19 patients were assessed by demographic characteristics, pulmonary function, exercise capacity, quality of life and body composition. The metabolomic analysis was performed in the patient's splits. From the total of post COVID-19 patients, 66% were male, 60+/-14 years. The lean body mass was 30+/-7kg and fat mass 34+/-13kg. Spirometry mean severity showed FVC of 4+/-1L, FEV1 3+/-1L. Pimax and Pemax values were 90+/-31(cmH2O) and 97+/-31(cmH2O), respectively. The quality of life evaluated by the SGRQ questionnaire showed a mean percentage of magnitude of symptoms 32+/-15, activities 41+/-25, impact 13+/-11 and total of 24+/-15. Physical capacity was measured by the distance in the 6MWT, and presented an average of 413+/-131. The metabolomic analysis showed 19 metabolites statistically significant difference between groups. We observed 3 metabolites overexpressed and 16 with lower expression in post COVID19 patients. From those metabolites, we can have attention to Sphinganine(p=0.03), Piperenol A triacetate(p=0.02) and 1-Monopalmitin(p=0.03) were lower expressed in control group. The creatin was one of the non-expressed metabolites in post hospital discharge COVID-19 patients compared to the control group. Thus, metabolomic analysis can demonstrate different metabolites in post COVID-19 patients to answer persistent symptoms.
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About a third of COVID-19 patients experience ongoing symptoms that have been referred to as long-COVID. In cooperation with Rehabilitation Medicine and Psychology departments, we developed a protocol for evaluation and further referral of the long-COVID patients that sought our Emerging Infectious Diseases (EID) consultation. The aim was to characterize the symptoms according to their frequency and to develop a screening tool that allows referral to intervention programs. Long-COVID was defined as persistent or new-onset symptoms 12 or more weeks after initial infection. In our EID consultation all patients answered a questionnaire regarding the evolution and impact on daily activities of the persistent symptoms, using a 6-point Likert scale. Participants (n=42) had a mean age of 44.8 years (IQR 18.8) and 76% were female. Ninety-five percent of the patients had a mild to moderate course of acute infection. Fatigue (78.6%), physical capacity impairment (74%), brain fog (62%), anxiety and sleep disorders (52% each) were the most frequently reported symptoms. Regarding the impact of persistent symptoms, 50% of the patients with anxiety disorders, 69% of the ones reporting brain fog and 71% of those with physical capacity impairment reported being moderately or more affected on their daily activities by that symptom. When asked "Did you recover your previous health status?" all patients answered no. As the number of new infections continues to rise worldwide, long-COVID will be a challenging burden to healthcare systems and societies. Establishing a follow-up protocol and a reliable screening tool will allow us to reach a wider population and also promote a better and patient-centered use of medical resources.
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Introduction: Physical conditioning develops conditional and coordinative capacities to improve physical performance through exercise. The 6-minute walk test (PC6M) assesses in an integrated manner the response of the respiratory, cardiovascular, metabolic, musculoskeletal, and neurosensory systems to the stress imposed by exercise. Functional integration is analyzed by the maximum distance an individual can cover during six minutes of walking as fast as possible. Objective(s): To evaluate the effect of physical conditioning on the physical capacity of subjects recovered from COVID 19. Method(s): Clinical trial in subjects recovered from COVID-19 who required hospitalization during the acute phase, > 18 years were included. Subjects with musculoskeletal lesions were excluded. Physical capacity was assessed by PC6M. The intervention had a duration of 20 sessions of physical conditioning on cycle ergometer for arms and legs, treadmill and elliptical trainer. Result(s): Forty-two patients were evaluated, 56.41% of whom were men, with a mean age of 53.48 +/- 14.3 years. After 20 physical conditioning sessions, increase the physical capacity (434.58 +/- 89.10 vs. 546.63 +/- 101.34;p < 0.001), assessing dyspnea, fatigue, and saturation where no significant differences were found observed. Conclusion(s): An improvement in functional capacity was observed after 20 sessions.
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Background and Aims Sarcopenia can be defined as loss of muscle mass, strength and function and has been shown to be associated with increased morbidity and mortality in the adult population. Sarcopenia has been assessed by decreased psoas muscle surface area (PMSA) on Computer tomography (CT) and has been validated in paediatric studies. The impact of Sarcopenia in children with end stage liver disease and oncological conditions is now being recognised. There is scarce literature on the effect of sarcopenia on motor function. CT imaging exposes children to radiation and hence is done in a select group of children at the time of transplant assessment. The aim of this audit was to assess the prevalence of Sarcopenia in children undergoing liver transplant assessment and its relationship on laboratory variables, functional activity and clinical outcomes. Methods Retrospective single centre case review of patients with liver disease undergoing transplant assessment and CT imaging between 2018-2020. Psoas muscle was analysed at the level of L4/L5. The z-Scores were calculated using ageand gender-specific reference values. Sarcopenia was defined as tPMA z score less than -2. We assessed the relationship of Sarcopenia to the biochemical parameters, nutritional status, effect on motor delay/physical abilities (assessed by a range of age appropriate standardised developmental and physical assessments due to COVID pandemic isolation restrictions) and post-transplant complications. Results Thirty one children that met the inclusion criteria were included. Sarcopenia was prevalent in 17 children (6 males: 11 females), with a median age of 3.5 years (SD = 4.9). The common conditions were biliary atresia (n= 11, 35%), hepatoblastoma (n=6, 19%), Autoimmune hepatitis (n=3) etc. Twenty- four patients required additional nutritional support (77% nasogastric feeding, 13% PN and 6% oral supplementation). Mean tPMA z-score was -2.27. Data for the assessment of physical abilities/functional activity was available in 21 children. Impairment of motor skills/physical abilities was overall noted in 14/21 children (67%);9/13 (69%) in the sarcopenic group (6 significant impairment) vs 5/8 (63%) in non sarcopenic group (4 significant impairment). Sarcopenia was associated with increased complications (27 vs 7, p = 0.005) and hypoalbuminaemia (p=0.01), but was not statistically significant (p> 0.05) for the overall length of stay (total and intensive care). Discussion Sarcopenia was commonly identified in children with liver diseases undergoing transplant assessment. Reduction in physical abilities/functional activity was observed in both groups which may be a consequence of loss of muscle mass in children secondary to liver diseases or underlying oncological conditions leading to delay in gross motor skills. Although there was no statistical difference in the duration of stay or impairment of motor skills, complications were higher in the sarcopenic group. Conclusion In this pilot study, sarcopenia is prevalent in children being assessed for liver transplantation and was associated with increased complications. Better non-invasive methods (aside from CT scan) of assessing sarcopenia needs to be developed and validated for the paediatric age group, which would help to better characterise the true incidence and prevalence of sarcopenia in children with chronic liver disease. There is a need to offer nutritional support and assess physical function early in the pre transplant period in order to initiate appropriate physiotherapy interventions to halt and even reverse the progression of sarcopenia.
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Workers, especially healthcare workers, are exposed to an increased risk for SARS-CoV-2 infection. However, less is known about the impact of rehabilitation on health outcomes associated with post-COVID. This longitudinal observational study examined the changes in physical and neuropsychological health and work ability after inpatient rehabilitation of 127 patients (97 females/30 males; age 21-69 years; Mean = 50.62) who acquired COVID-19 in the workplace. Post-COVID symptoms, functional status, physical performance, neuropsychological health, employment, and work ability were assessed before and after rehabilitation. Group differences relating to sex, professions, and acute COVID status were also analyzed. Except for fatigue, the prevalence of all post-COVID symptoms decreased after rehabilitation. Significant improvements in physical performance and neuropsychological health outcomes were determined. Moreover, healthcare workers showed a significantly greater reduction in depressive symptoms compared to non-healthcare workers. Nevertheless, participants reported poor work ability, and 72.5% of them were still unable to work after discharge from rehabilitation. As most participants were still suffering from the impact of COVID-19 at rehabilitation discharge, ongoing strategies in aftercare are necessary to improve their work ability. Further investigations of this study population at 6 and 12 months after rehabilitation should examine the further course of post-COVID regarding health and work ability status.
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COVID-19 , Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , COVID-19/epidemiology , SARS-CoV-2 , Workplace , Health Personnel/psychology , EmploymentABSTRACT
In this paper, we will look at some of the strategies that managers and team leaders can use to support themselves as they grapple with the effects of the demands being placed on them in the post-pandemic health or social care workplace. In the next paper in this series, we will consider how managers can support their teams and promote a sense of wellbeing. Copyright © 2022, OmniaMed Communications Ltd. All rights reserved.
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Background and Aims: Floorball training induces positive effects on health among untrained older adults. However, the effect of long-term participation (>2 years) in floorball training among elderly males has not been investigated. The aim of the present study was to examine the effect of 5 years of floorball training on risk factors for lifestyle diseases, fitness, physical function, and social capital of elderly males and compare to a control group that continued their usual lifestyle. Methods: Twenty-nine recreationally active elderly men aged 75.1 ± 3.3 (mean ± SD; range: 69-81) years with a height, body mass, and body mass index of 1.78 ± 0.06 m, 79.8 ± 10.9 kg, and 25.8 ± 4.1 kg/m2, respectively, volunteered to take part in follow-up investigations about 5 years after participating in a study on the effect of 12 weeks of floorball or petanque training. At the end of the parental study 15 subjects chose to participate in floorball training (floorball group [FG]) whereas 14 subjects (control group [CG]), resumed their usual lifestyle. FG participated in small-sided floorball training 1 h ~1.75 times/week for 5 years in a local sports club. Results: From baseline to 5 years, FG had reduced fat percentage, android, and visceral fat, increased total and leg bone mineral density, leg extension maximal voluntary contraction, maximal walk distance in 6 min and 30 s sit-to-stand repetitions, decreased time for 5 sit-to-stand repetitions and Timed Up and Go (p < 0.05). These changes were all different from less favorable changes in CG (p < 0.05). In FG there was a decline in maximum oxygen uptake which was smaller than the decline in CG (p < 0.05). In addition, FG had developed social capital through the 5 years strengthening their social connectedness and group cohesion. Conclusion: In conclusion, both from a sociological and physiological perspective, small-sided floorball training can be considered a health-promoting activity for older men.
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OBJECTIVE: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. METHODS: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). RESULTS: A total of 41 patients were included (mean age 58.8 ± 12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: ß = -18.7, 95% CI = -34.7 to -2.6, p < 0.05; (ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: ß = -23.0, 95% CI = -39.1 to -6.8, p < 0.05. CONCLUSIONS: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.
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COVID-19 , Physical Functional Performance , Aged , COVID-19/complications , COVID-19/diagnosis , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , SurvivorsABSTRACT
Introduction A global trial is currently investigating the impact of high-intensity interval training (HIIT) on survival in advanced prostate cancer (the INTERVAL trial). To ensure greater accessibility, we designed a parallel trial (EXACT), to determine the feasibility of exercise in those contraindicated to HIIT. Methods Men with metastatic castrate-resistant prostate cancer being actively treated with androgen deprivation therapy and a novel hormone therapy (abiraterone acetate or enzalutamide) are eligible to participate in 12- weeks of home-based walking and strengthening. Participants complete physical (e.g. 6-min walk test and timed sit-to-stand) and quality of life (e.g. BPI-SF;EQ-5D-5L;FACIT-fatigue;FACT-P) outcomes at baseline (T1), 12 (T2) and 24 weeks (T3). This trial was adapted to enable remote recruitment and delivery during the COVID-19 pandemic. Results To date, 118 patients have been screened, with 33 approached by their clinician to participate. 25 patients have consented, with 12 completing the trial without any intervention-related adverse events and 6 withdrawn. Recruitment and trial delivery was operational throughout the COVID-19 pandemic. Currently positive trends are evident for physical and quality of life outcomes at T2 and T3. Conclusions Although this trial is ongoing, early trends suggest this intervention is safe and feasible for men with advanced castration resistant prostate cancer and could improve physical capacity and quality of life.
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Background: COVID-19 disease can cause a wide variety of long-term health problems, including impaired lung function, reduced exercise performance, and decreased quality of life. Objectives: Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild / moderate and severe / critical course of the disease. Methodology: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective and observational cohort study, 43 patients were included in the study (20 with mild / moderate COVID and 23 with severe / critical COVID-19). Main measures: Several measures of exercise performance, 6-minute walking distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-format health survey (SF-36 )). Results: Results: At admission, the patients had a reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m;severe: 108 m, 84-132 m), a deteriorated FVC (mild: 72 % ,;severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points. The patients received sessions adjusted to their physical capacities, the patients of both subgroups improved in the test of 6 minute walk (mild / moderate: +54 m, severe / critical: +117 m, both p <0.002), FVC (mild / moderate: + 8.9%, p = 0.004;severe / critical: + 12, 4%, p <0.003) and mental component SF-36 (mild / moderate: +6.8 points, p = 0.062;severe / critical: +16.7 points, -p <0.005). Conclusions: An exercise program Well structured results in a benefit in the areas of aerobic capacity, lung volumes and quality of life, in this sense it is recommended to expand population samples to be able to apply our protocol to other centers in charge in the rehabilitation of COVID-19 patients. Key Words: Exercise, Coronavirus, Rehabilitation.
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Objective: This study aimed to test the effectiveness of an 'integrated microfinance/livelihood and community-based rehabilitation (CBR)' (IMCBR) program in improving quality of life and physical ability of children with cerebral palsy (CP), mental health of primary caregivers and social/economic capital of ultra-poor families of children with CP in rural Bangladesh. Design: Open-label pragmatic randomized controlled trial (registration: ACTRN12619001750178). Method: Children with CP aged ≤5 years were recruited in three arms: Arm-A: IMCBR, Arm-B: CBR, and Arm-C: control (i.e. care as usual). Each arm had eight clusters of 10-14 child-caregiver dyads. Caregivers recruited in the Arm-A received livelihood support (e.g., goat/lamb/poultry) and their children with CP received CBR once a week. The child-caregiver dyads in Arm-B received CBR only. The control Arm did not receive any intervention. However, CBR was stopped at 2.5 months of intervention due to COVID-19 pandemic and weekly phone follow-up was completed for home-based CBR. TNO-AZL Preschool children Quality of Life (TAPQoL), Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) were used to assess quality of life, motor function and communication of children, respectively. Depression, Anxiety, Stress Scale-Short Form-21 (DASS-21) was used to assess depression, anxiety and stress of primary caregivers. Results: Out of 251 children with CP and their caregivers recruited at baseline, 233 children and primary caregivers (Arm-A: n = 74, Arm-B: n = 77, and Arm-C: n = 82 dyads) completed the 12 month trial. The mean values of livelihood items given per family in Arm A increased from ∼USD66 to ∼USD79 between 0month(m) and 12m (p = 0.066), respectively. The mean TAPQoL score for physical functioning significantly increased between 0m and 12m in all three Arms (p < 0.001, p = 0.017 and p < 0.001 in Arm A, Arm B and Arm C, respectively), however, the improvement in the score was highest in Arm A. Similarly, significant improvement in the GMFCS level was observed between 0m and 12m in all three Arms with the highest improvement in Arm A (p < 0.001). Children's CFCS levels deteriorated slightly at 12m follow up in all three Arms. The depression, anxiety and stress levels among primary caregivers of children reduced significantly between the 0m and 12m in all three Arms (p ≤ 0.001 for all). Conclusion: Our findings suggest that the IMCBR is effective in enhancing quality of life and motor functions of children with CP, mental health of primary caregivers and economic status of ultra-poor families.
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Introduction: The measures taken to combat the pandemic, such as travel restrictions, closed borders and gathering bans, led to cancellations of many conferences, meetings and workshops, forcing the scientific community to identify new ways of disseminating scientific knowledge. This resulted in the transition from traditional face-to-face meetings, where practitioners and academics meet to exchange knowledge, network and develop collaborations, to the development of new events in digital formats. This study aimed at investigating the impact of the spreading of virtual conferences on the field of research. Materials and Methods: We made a SWOT analysis to evaluate strengths, weaknesses, opportunities and threats of this new way of organizing scientific conferences, as compared to face-to-face conferences in terms of effectiveness of result dissemination, networking opportunities, and policy development. Results: Among the biggest opportunities of virtual conferences, revealed by the SWOT analysis, there are larger accessibility, equity (in terms of sex, ethnicity, geographical setting, physical ability, health, and career stage) reduced expenses, environmental sustainability and a better work-life balance. On the contrary, reduction in network building and in research capacity/cooperation, lower interest of local stakeholders and “digital exclusion” represent the most important threats. Conclusions: Organizing a virtual conference does not mean concentrating only on the offline or the online side of the event, but rather to integrate the two sides in order to offer the participants the opportunity to choose how to parti
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Introduction: Coronavirus disease 2019 (COVID-19) has become one of the more dramatic health problems in the century. This disease has enormous consequence for the health care worldwide. In addition to high mortality rate, patients recovered from COVID-19 present short and long-term cardiovascular sequelae including chest pain, myocardial dysfunction, arrhythmia, dyspnea, breathlessness, postural tachycardia syndrome, and thrombotic complications. The explanations for these clinical manifestations are still uncertain but can involve a constellation of physiological alterations. Hypothesis: To test if COVID-19 survivors have augmented sympathetic outflow, diminished endothelial function, elevated aortic stiffness, and reduced physical capacity compared to healthy individuals. Methods: Nineteen COVID-19 survivors [age: 47.0±2.3 years, BMI: 30.1±1.2 Kg/m2] and eighteen well-matched healthy controls (age: 44.0±2.0 years, BMI: 28.4 ±1.2 Kg.m2] were included in study. COVID-19 survivors were evaluated within 6 months of original diagnosis by RT-PCR. Muscle sympathetic nerve activity (MSNA) from fibular nerve (Microneurography), brachial artery flowmediated dilation (BAFMD;Doppler-Ultrasound), carotid-femoral pulse wave velocity (cf-PWV;Complior), beat-to-beat blood pressure (Peripheral BP;Finometer), heart rate (HR;Electrocardiography) and peak oxygen uptake (VO2peak, Cardiopulmonary exercise testing) were measured in both groups. Results: MSNA was higher in COVID-19 survivors compared to controls (33.0±1.0 vs. 22.0±1.0 bursts/min, p=0.001). Both BAFMD and VO2peakwere lower in COVID-19 survivors compared to controls (4.6±0.7 vs. 8.2 ±0.8%, p=0.005 and 22.2±1.5 vs. 29.7±1.6 mL/Kg/min p=0.001, respectively). Although COVID-19 survivors had greater cf-PWV than controls (8.6±0.5 m/s vs. 7.4±0.4 m/s, p=0.03), BP and HR were not different between groups. Conclusions: Our study revealed that patients recently recovered from COVID-19 have abnormal neurovascular control, vascular alterations and reduced physical capacity. These findings strongly indicate the need of further long-term investigations to uncover cardiovascular sequelae provoked by COVID-19.
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[Formula presented] Background In spite of the improvements in clinical care of children with Sickle Cell Disease (SCD), painful vaso-occlusive (VOC) crises, recurrent admissions and long hospital stays contribute to the disruption of the social and school life of children and adolescents with SCD causing a poor QoL. Limited information is available regarding QoL of children, adolescents and young adults with SCD and their caregivers during standard of care and after bone marrow transplantation in Italy even though Italian patients participating in international meetings or global surveys highlighted the importance to improve QoL (Strunk C. BMC Proc. 2020, Osunkwo I. Am J Hematol. 2021). Moreover, no mention is given to QoL in the current AIEOP Recommendations for the Management of Children with SCD in Italy. The availability of new treatment options for SCD highlights the need to improve QoL evaluation before and after treatments. Our Center decided, therefore, to include QoL evaluation as part of comprehensive care for patients with SCD. This study has the following aims: to describe the QoL of children, adolescents and young adults with SCD undergoing standard care or after disease curative treatments (bone marrow transplantation) and the QoL of their caregivers;to evaluate the correlation of QoL with clinical-haematological and therapeutic variables. Methods Health Related QoL was examined with the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires in Italian: Parent Proxy Profile-49 v2.0, Pediatric Profile-49 v2.0 and 57 Profile v2.1, exploring 8 domains: Pain, Fatigue, Anxiety, Depression, Physical Abilities, Peer Relations, Sleep Disorders, Pain Interference. An English version was available for English speaking parents. Patients and caregivers accessing the SCD Clinic starting May 2021 were given the paper version of the questionnaires;due to the COVID pandemic and the limited access to the SCD Outpatient Clinic, a link to a Google online version of the questionnaires was provided to all teenagers and young adults, through their mobile devices. PROMIS Scores were standardized through the Health Measures Scoring Service (healthmeasures.net). For the descriptive analysis, the T-score was obtained, for each patient and for each PROMIS domain (symptom or function), classifying impairment in each domain as normal, mild, moderate, or severe. The Student T Test for comparisons of the means among samples and the Wilcoxon Test for the sum of ranks were used in the statistical analysis of normal and non-normal continuous variables. For the correlation analysis between continuous variables of which at least one is not normal, the Spearman Correlation Test was used. The values with p<0.05 were considered statistically significant. Results All patients and parents approached accepted to perform the questionnaire. The study involved 18 caregivers and 50 patients (25% F, mean age 16.4 years, 74% HbSS, 76% from Africa): 41 undergoing standard care (7 no therapy, 34 Hydroxyurea or chronic transfusion) and 9 who received HSCT. 37 patients (74%) and 8 parents (44%) completed the online Google version of the questionnaire. The standard of care patients displayed mild to severe symptoms in various domains (Figure 1A);in the transplant population there was impairment in QoL, with less severe impairment in most of the domains, especially in the pain domains, than what was in the standard of care group. (Figure 1B). Anxiety levels and depressive symptoms were greatest between the ages of 14-26, compared to younger ages (p 0.018). Parents do not have the same perception of the disease as their children: they appeared to overestimate the domain of pain and fatigue and underestimate anxiety and depression (p <0.001). Sleep quality was impaired in both affected and HSCT patients. The number of hospital admissions in the previous year correlated with worse QoL (p 0.04), while the number of painful VOC showed a tendency towards significance (p 0.07);there was no difference with the other domains. Update results will be presented. Conclusions Our data show the feasibility of evaluating QoL during routine visits and also remotely. Impairment of QoL is already present in a subgroup of young patients. Even after HSCT, QoL is not optimal but personal, social, and economic reasons need to be taken into account to adequately interpret the results. Longitudinal assessment to look at QoL will be important. [Formula presented] Disclosures: Biffi: BlueBirdBio: Consultancy, Other: Advisory Board. Colombatti: Global Blood Therapeutics: Consultancy;BlueBirdBio: Consultancy;NovoNordisk: Consultancy;Novartis: Consultancy;Forma Therapeutics: Consultancy;Addmedica: Consultancy;Global Blood Therapeutics: Research Funding;BlueBirdBio: Research Funding.
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In many health systems, it is difficult to carry out traditional rehabilitation programs as the systems are stressed. We evaluate the effectiveness of a telerehabilitation program conducted in primary care in post-COVID-19 patients. An observational, prospective study was conducted in seven primary care centers in Chile. We included adult patients (>18 years) with a previous SARS-CoV-2 infection. The telerehabilitation program consisted of 24 sessions of supervised home-based exercise training. The efficacy was measured by the 1-min sit-to-stand test (1-min STST), the 36-Item Short Form Health Survey (SF-36), fatigue, and dyspnea symptoms before and after intervention. We included 115 patients (55.4% female) with a mean age of 55.6 ± 12.7 years. Fifty-seven patients (50%) had antecedents of hospitalization, and 35 (30.4%) were admitted to the ICU. The 1-min STST was improved after the intervention from 20.5 ± 10.2 (53.1 ± 25.0%predicted) to 29.4 ± 11.9 (78.2 ± 28.0%predicted) repetitions (p < 0.001). The SF-36 global score improved significantly from 39.6 ± 17.6 to 58.9 ± 20.5. Fatigue and dyspnea improved significantly after the intervention. Although limited by the absence of a control group, this report showed that a telerehabilitation program applied in primary health care is feasible and was effective in improving physical capacity, quality of life and symptoms in adult survivors of COVID-19.