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Related Articles Comment on: https://www.jmir.org/2021/4/e23446 Comment in: https://www.jmir.org/2022/5/e37413/
ABSTRACT
Related Articles Comment on: https://www.jmir.org/2022/5/e34437 Comment on: https://www.jmir.org/2021/4/e23446
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COVID-19 , Social Media , Humans , Oxygen , Physical Therapy Modalities , Positive-Pressure RespirationSubject(s)
COVID-19 , Social Media , Humans , Oxygen , Physical Therapy Modalities , Positive-Pressure RespirationABSTRACT
BACKGROUND: With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. OBJECTIVE: The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. METHODS: In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. RESULTS: Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. CONCLUSIONS: It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. TRIAL REGISTRATION: ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923.
Subject(s)
COVID-19/therapy , Oxygen Inhalation Therapy/methods , Physical Therapy Modalities , Positive-Pressure Respiration/methods , Telemedicine/methods , Adult , COVID-19/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2/isolation & purification , Treatment Outcome , Young AdultABSTRACT
Implementing emergency department (ED) and hospital patient throughput management coupled with at-home medical and tele-management upon discharge may increase surge capacity during national emergencies and pandemics. This novel intensive transitional care management (ITCM) intervention presents the opportunity to optimize hospital bed capacity through prevention of inpatient admissions for patients who could be discharged home safely with appropriate in-home medical support and tele-management. This observational cohort intervention was conducted between April 7, 2020 and April 30, 2020, at the 4 largest inpatient facilities of RWJBarnabas Health System in New Jersey. The intervention group included a convenience sample of 192 patients who were evaluated in the ED, monitored in the observation unit, or admitted to the hospital with a diagnosis of mild-to-moderate COVID-19 infection. Their outcomes were compared to a matched comparison group of 593 patients who were admitted with the same COVID-19-related diagnosis and severity. The primary outcome was the reduction in inpatient days as a result of the intervention that included provision of at-home oxygen supplementation therapy, expanded home care services, and tele-management sessions. Secondary outcomes were re-encounters with the health system in the ED, observation unit, or inpatient readmissions. A total of 481.6 hospital patient days were avoided for 78 patients who had been discharged from the ED or observation unit stays. Secondary analysis included hospital readmission rates. The ITCM intervention demonstrated a feasible strategy for improving throughput of patients with COVID-19, resulting in increased hospital bed capacity.