Gait Device Treatment Using Telehealth for Individuals With Stroke During the COVID-19 Pandemic: Nonrandomized Pilot Feasibility Study.

BACKGROUND: During the COVID-19 pandemic, rehabilitation providers and consumers adopted telehealth practices at unprecedented rates. Multiple prepandemic studies demonstrate the feasibility and comparable efficacy between in-clinic and remote treatment for certain impairments caused by stroke, such as upper extremity weakness and impaired motor function. However, less guidance has been available regarding gait assessment and treatment. Despite this limitation, safe and effective gait treatment is fundamental to optimizing health and well-being after stroke and should be considered a treatment priority, including during the COVID-19 pandemic. OBJECTIVE: This study explores the feasibility of using telehealth to deliver gait treatment using a wearable gait device, the iStride device, to stroke survivors during the 2020 pandemic. The gait device is used to treat hemiparetic gait impairments caused by stroke. The device alters the user's gait mechanics and creates a subtle destabilization of the nonparetic limb; therefore, supervision is required during its usage. Before the pandemic, treatment with the gait device had been provided in person to appropriate candidates using a combination of physical therapists and trained personnel. However, upon the emergence of the COVID-19 pandemic, in-person treatment was halted in adherence to pandemic guidelines. This study investigates the feasibility of 2 remote delivery treatment models with the gait device for stroke survivors. METHODS: Participants were recruited during the first half of 2020 after the onset of the pandemic and included 5 individuals with chronic stroke (mean age 72 years; 84 months post stroke). Four participants were previous gait device users who transitioned to the telehealth delivery model to continue their gait treatment remotely. The fifth participant performed all study-related activities, from recruitment through follow-up, remotely. The protocol included virtual training for the at-home care partner, followed by 3 months of remote treatment with the gait device. Participants were instructed to wear gait sensors during all treatment activities. To assess feasibility, we monitored the safety of the remote treatment, compliance with protocol activities, acceptability of the telehealth treatment delivery, and preliminary efficacy of the gait treatment. Functional improvement was measured using the 10-Meter Walk Test, the Timed Up and Go Test, and the 6-Minute Walk Test, and quality of life was assessed using the Stroke-Specific Quality of Life Scale. RESULTS: No serious adverse events occurred, and participants rated high acceptance of the telehealth delivery. Protocol compliance averaged 95% of treatment sessions, 100% of assessments, and 85% of sensor usage during treatment. After 3 months of treatment, the average improvement in each functional outcome exceeded the minimal clinically important difference or minimal detectable change value. CONCLUSIONS: Remote treatment delivery with the gait device appeared feasible with care partner support. Gait treatment using telehealth may be useful to offset negative immobility impacts for those requiring or preferring remote care during the pandemic or otherwise. TRIAL REGISTRATION: ClinicalTrials.gov NCT04434313; https://clinicaltrials.gov/ct2/show/NCT04434313.

Effects of Covid-19 pneumonia on submaximal exercise tolerance

Introduction: After Covid-19 pneumonia, regular respiratory function assessment is necessary for the subsequent management of patients, including resting respiratory function tests and assessment of submaximal exercise tolerance by six-minute walk (6MW) test. Method(s): Six-minute walk test was undergone for 326 patients about 3 months after Covid-19 pneumonia. Physiological cost of walking (PCW) defined as the difference between maximum heart rate reached at the 6MWT and resting heart rate divided by walking speed was calculated. Result(s): Median age and BMI were respectively 61 [18-95] years-old and 30,4 [18,5-65,2] kg/m2 with a sex-ratio at 1.26. Smoking was reported in 52.8% of cases (12,45 PY). Median 6MW distance was 528 meters [48-832], corresponding of 80% [7-113] of theoric. Median PCW was 0,379 beats/meter [-1.38-5.38]. Low 6MW distance and low saturation during the test were found respectively in 33.1% and 15.2% of cases and were both correlated with DLCO (r=-0.258;p<10-3 and r=-0.423;p<10-3). Chronotropic insufficiency and chronotropic intolerance were found in 13.8% and 7% of cases. PCW was correlated with BMI (r=0.463;p<10-3), FEV1 (r=-0.175;p=0.001), FVC (r=-0.167;p=0.002) and DLCO (r=-0.161;p=0.004). Conclusion(s): Six-minute walk test is an inexpensive, easy and reliable tool that tells us about the global response to submaximal exercise, especially after Covid-19 pneumonia. It is an interesting alternative for patients follow-up, especially when rehabilitation is considered.

Short-term impact of COVID-19 on health-related physical fitness in hospitalized and home-treated patients

Assessment of health-related physical fitness (PF) and body composition (BC) may yield relevant information on body function in patients who have been affected by Coronavirus disease-2019 (COVID-19). Aim of our study was to evaluate the short-term effects of COVID-19 on physical fitness in a real-life cohort of outpatients including hospitalized and home-treated patients. Sixty-four patients (M=36;mean age 56+/-13.5 yrs) previously affected by COVID-19 (25 hospitalized vs. 39 hometreated) in the 3-6 months preceding the study measurements were enrolled. PF was evaluated with the following tests: handgrip strength (HGS), gait speed (GAIT), sit-to-stand (STS), timed up and go (TUG) and Short physical performance battery (SPPB). Phase angle (PhA) was measured by bioelectrical impedance analysis (BIA) as a proxy marker of fat-free mass composition in terms of body cell mass and cell integrity. Poor PF performance was observed in 38% of subjects for HGS, 55% for GAIT, 30% for STS, 38% for TUG, and 70% for SPPB, while low values of PA were observed in 42% of the study sample in comparison with international cut-offs. The presence of 3-5 impaired values out of five was observed in 38% of patients. All PF tests (and even more the number of abnormal PF tests) consistently correlated with PhA. No differences were reported between hospitalized and home-treated patients. In the short-run, COVID-19 causes a worsening of physical fitness regardless of baseline disease severity. More research is required to systematically measure the extent of functional impairments in COVID-19 and to address whether and how rehabilitation can promote post-infection recovery.

The Effect of Exercise Training on Long Covid Patients

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.

The PACE-DM1 tool: An Adapted Home-Based Physical Activity Program for DM1 to Counter Physical Deficiencies

Introduction: Myotonic dystrophy type 1 (DM1) is related to muscle weakness, impaired balance, and a high risk of falls resulting in decreased quality of life and social participation. Indeed, DM1 is considered as a model of premature aging. However, the Covid-19 pandemic has exacerbated these health problems by decreasing the access to rehabilitation services and significantly decrease volunteer total weekly physical activity (PA) level. A pragmatic tool: PACE (Promoting Autonomy through exer-CisE), which has been developed to allow safe and adapted physical activity (APA) practice in older adults at home, could be a solution to counter physical deficiencies and lockdown restrictions in DM1 population. Objectives: 1. To adapt the PACE tool (decisional tree related to 35 APA programs) for the DM1 population (Pace-DM1 tool);2. To evaluate if assessing functional and muscular capacity in remote mode is feasible and valid in the DM1 population compared to in person modality;3. To evaluate the acceptability, feasibility and usability of implementing the PACE-DM1 tool for the health professionals and the patients. Methods: O-1: Two patient-partners, 3 participants who will experience the PACE-DM1 APA program, 2 health professionals from the Neuromuscular Disease Clinic of Jonquière (NMC), 1 NMC manager and 3 researchers were recruited to adapt the PACE tools using a co-creation design. O-2: Participants are assessing functional and muscular capacity [Time Up and Go, 30sec. chair stand test, 5 reps of sit-to-stand, 4-meter gait speed, balance and functional reach test] per and post-intervention (12 weeks) in remote (zoom) and in-person methods. O-3: After co-creation meetings, health professional were asked to evaluate the acceptability (satisfaction assessed via Likert scales;semi-opened questions), usability (System Usability Scale questionnaire) and feasibility (adherence, recruitment rate, etc.) of the PACE-DM1 tool. Results: First, co-creation meetings allowed us to adapt PACE tool (e.g. decisional tree cut points) for DM1 participants. Health professionals found PACE-DM1 tool exercises safe and adapted to the physical deficiencies of the DM1 population. Our preliminary data (n=2) using the adapted decisional tree showed similar results between inperson and remote assessment. More precisely, both assessment modality identified the same physical deficiencies (lower limb cardio-muscular, trunk mobility and stability, and balance) and prescribed the same program difficulty (out of a possible 5 levels). In the pre-intervention phase, implementing the PACE-DM1 tool was considered acceptable, usable and feasible for health professionals. Conclusion: Preliminary results demonstrate that an APA pragmatic, easy-to-use and adapted tool is implementable to prevent care trajectory of people with DM1. Nevertheless, these promising results need to be confirmed and validated with a larger sample.

The Effectiveness of an Outpatient Personalized Multidisciplinary Intervention Model, Guided by Comprehensive Geriatric Assessment, for Pre-Frail and Frail Elderly

Background: Our study evaluates the efficacy of an outpatient personalized multidisciplinary intervention model guided by comprehensive geriatric assessment (CGA), for pre-frail and frail elderly. Methods: A single-arm self-controlled study was conducted at the outpatient departments (OPD) of a medical center in Taiwan. Subjects received personalized multidisciplinary intervention, including physical therapy, psychotherapy, a nutritional consultation, precise medicine, and social resource linkage, as determined by the results of their CGAs. After 3 months of interventions, change in the proportions of the frail status (frail, pre-frail and robust), functional scores, depressive status, cognition, nutritional status, percentage of inappropriate medication used and social resource usage were analyzed. A logistic regression model was applied to determine the predictive factors associated with an improvement in frail severity. Results: A significant improvement in frail status was found (proportion of frail: 44.5% versus 23.1%, p < 0.001). Physical function, depressive and nutritional status were also significantly improved. 18.5% of participants used inappropriate medications, with benzodiazepine hypnotics the most common (40.9%). 24.2% of subjects were successfully linked to social resources. The presence of the frail phenotypes exhaustion was significantly associated with an improvement in frail severity (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.15–6.66, p = 0.023). There was a significant dose response relationship between the improvement of frail status and physical training times (proportion of improved frail status: 23.7%, 40.5% and 47.9% for 0, 1–3, and 4–6 times of physical training, p = 0.03). Conclusion: The reported CGA-based, personalized multidisciplinary intervention model was effective at improving frail severity among pre-frail and frail elderly in OPDs.

Metabolomic Biomarkers Measured at Patient Discharge Predict Long- Term Physical Function in Survivors of Acute Respiratory Failure

RATIONALE: Long-term quality of life is a significant concern for survivors of sepsis and acute respiratory failure (ARF). Financial burdens await as many patients never return to work. Notably, the duration of the ICU stay significantly correlates with the severity of physical impairment and up to 25% of skeletal muscle is lost within one week in the ICU. The recent pandemic due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) is likely to exacerbate these issues. We have previously reported that metabolites related to mitochondrial bioenergetics status can predict acute patient outcomes. Here, we propose that these same metabolomic and mitochondrial biomarkers of mortality also predict physical function in survivors. METHODS: To test this hypothesis, we performed a retrospective analysis of metabolomic changes in ARF survivors using ultrahigh performance liquid chromatography mass spectrometry. Six months after ICU admission, physical function was determined by the short physical performance battery (SPPB), an objective physical function measurement assessing gait speed, balance and lower extremity strength. A total of 70 consecutively enrolled patients were selected, of which 35 had good physical function (SPPB ≥ 7) and 35 had poor physical function (SPPB ≤6). The patients were matched for age, race and sex. Metabolomic analysis of patient's serum was measured at ICU admittance (n=70), 5d-post admittance (n=20) and discharge (n=20). RESULTS: More than 1250 named compounds were identified. There were only 19 metabolites that were significantly different at admittance (ANOVA;p < 0.05), of which seven were bile acids. However at discharge, despite less patient samples tested, 151 metabolites were significantly different (ANOVA;p < 0.05). Specifically, we found that 10 lysophospholipids, eight bile acids, three TCA cycle metabolites, eight kynurenine-related metabolites and nine urea cycle metabolites were significantly different. Many of these pathways have previously been shown to be altered in nonsurvivors of sepsis and ARF. CONCLUSIONS: Findings suggest that bioenergetic abnormalities arising during the acute phase of recovery may be persistent and predict longer-term decrements of physical function in survivors of ARF. Larger retrospective and prospective studies are needed to confirm these preliminary findings;however, predicting poor physical function in survivors as well as identifying the affected metabolic pathways may lead to improved therapies and long-term patient outcomes.

BIOPHYTIS BIO101 IN SARCOPENIA: RESULTS OF THE PHASE 2 SARA-INT STUDY

Backgrounds: Sarcopenia is a geriatric condition characterized by a progressive loss of muscle mass and function, having high personal, social and economic burdens when untreated. Sarcopenia increases risk of falls and fractures;impairs ability to perform activities of daily living;is associated with cardiac and respiratory disease and cognitive impairment;leads to mobility disorders;and contributes to lowered quality of life, loss of independence or need for long-term care placement, and death. It is recognized as one of the five pillars of frailty. As of today, to our knowledge, only exercise and nutrition interventions seem somewhat effective interventions. Objectives: SARA-INT study is a Phase 2 study to develop a viable option to treat community-dwelling seniors suffering from age-related sarcopenia, including sarcopenic obesity. Methods: SARA-INT is a randomized double-blind three-arm study (BIO101 175 mg bid / BIO101 350 mg bid / placebo) with planned treatment duration of 6 Months;due to COVID-related measures, 49 patients continued up to 9 months of treatment. Main eligibility criteria for sarcopenia were meeting FNIH criteria and Short Physical Performance Battery (SPPB) score ≤ 8/12 in men and women aged ≥ 65 years. Primary analysis was the gait speed from the 400-meter walking test (400MWT) at month 6/9 in the FAS with secondary analyses at other timepoints, secondary endpoints were other physical activity assessments, muscle strength, muscle mass and Patient Reported Outcomes (PROs). Results: 233 participants were randomized in the study, 232 and 156 participants were included in the Full Analysis Set (FAS) and Per-Protocol (PP) populations, respectively. Due to COVID-19 pandemic, end-of-treatment assessments are missing for approximately half of the participants, impacting the treatment effect detection. In the primary analysis (at month 6/9 in the FAS population) of the primary parameter, the improvement in 400MWT compared to placebo was not statistically significant (0.0363 (0.03098) m/s and 0.0385 (0.02985) m/s in the BIO101 175 mg and 350 mg groups, p=0.2437 and p=0.2000, respectively). BIO101 350 mg bid treatment after 6 months showed a clinically relevant improvement in the 400MWT of 0.07 m/s in the FAS population (not significant) and of 0.09 m/s in the PP population (nominally statistically significant, p=0.008);this is close to the Minimal Clinically Important Difference (MCID) in sarcopenia (0.1 m/s). BIO101 350mg bid treatment effect on the 400MWT is confirmed in pre-defined sub-populations at higher risk of mobility disability such as slow walkers, obese and those with chair stand sub-score ≤2 from SPPB;trends were observed with other independent endpoints. BIO101 showed no difference in adverse events or safety laboratory parameters versus placebo (), and no severe adverse event associated with BIO101 treatment. Conclusions: After 6 to 9 months of treatment, BIO101 at 350 mg bid showed promising results with a clinically relevant improvement in the 400MWT gait speed, the primary endpoint of the study, confirmed in sub-populations at higher risk of mobility disability. BIO101 showed a very good safety profile at the doses of 175 and 350 mg bid. Biophytis is preparing to start a phase 3 program with BIO101 at 350 mg bid in 2022, targeting a similar patient population. Conflicts of interests: CT, WD, CM, RL, PD, RvM and SV are employees of Biophytis SA, AZ, and SA are employees of Biophytis Inc., JM is president of the Scientific Advisory Board of Biophytis, SDS is employee of BlueCompanion Ltd.

Interdisciplinary physical therapy group for COVID-recovered patients: A case series report

BACKGROUND AND PURPOSE: The novel coronavirus (COVID-19) created a large population of survivors with prolonged post-infection symptoms, impacting their quality of life (QOL) with little known about their long-term recovery. Physical therapy is theorized to reduce mortality rates of patients who have been hospitalized with COVID-19;however, there is limited evidence and a critical need for ongoing research to determine best practice within this large, complex and emerging patient population. The disease process impacts all three domains outlined by the International Classification of Functioning, Disability and Health (ICF) - impairment, activities, and participation. Increased psychological symptoms of fear, uncertainty and guilt are also prevalent due to social isolation and the novelty of the disease process. In order to achieve optimal outcomes, a high level of coordination of services with other healthcare providers is necessary. Highly trained, multidisciplinary teams in rehabilitation settings implementing evidence-based recommendations is crucial for better management of survivors of COVID-19. The purpose of this case series is to describe the novel and successful interdisciplinary team approach in the outpatient rehab clinic setting for individuals post-COVID. CASE DESCRIPTION: In the case series, 4 females and 7 males ages 34-67 participated in an 8-week COVID-19 recovered group while enrolled in an intensive interdisciplinary outpatient rehab clinic setting. All patients were previously hospitalized and completed acute inpatient rehab. Patients participated in one, 55-minute group session per week with co-treating physical therapists (PT), psychologists and occupational therapists. Group participants received two to eight hours of additional PT weekly in the clinic. Within the group, patients participated in moderate intensity cardiovascular exercise through use of the Borg Rating of Perceived exertion (RPE) scale. Interdisciplinary education regarding the disease process, activity pacing, coping strategies and psychological trauma post-COVID-19 were provided with incorporation of peer support. OUTCOMES: Pre- and posttreatment assessments of 6-minute walk test (6MWT) and 10- meter walk test self-selected velocity (10MWT SSV) were performed. 6MWT change of 255.78 feet (paired t-test, P- value = 0.002);10 MWT change of 0.27 m/s (paired t-test, P-value 0.001). Ten patients required an assistive device (AD) at the onset of the group. Ninety percent of participants transitioned to a lesser restrictive device within the eight weeks. DISCUSSION: This case series demonstrates the benefits of an outpatient interdisciplinary program through significant improvements in patient's self selected walking speed, cardiovascular endurance and progression to lesser restrictive AD. In conclusion, the outcome of this case series supports the effectiveness of an interdisciplinary team approach to improve functional mobility in patients who are COVID-19-recovered.

Interval training in the treatment of chronic effects of COVID-19

BACKGROUND AND PURPOSE: The World Health Organization categorized COVID-19 as a pandemic on March 11th, 2020. Since then, maximizing survival of those infected has been the major focus of many health services. Those who suffered from the virus are now experiencing ongoing symptoms that may last several months or more. These symptoms can include fatigue, pain, muscle atrophy, weakness, and functional impairments. Due to the lack of evidence on the long-term effects of COVID-19 healthcare providers may take into account research from other relevant and more extensively studied respiratory illnesses. The purpose of this case report is to highlight the use of available research from SARS-COV in the rehabilitation of a young, previously healthy patient with severe effects of COVID-19. CASE DESCRIPTION: The patient is a 45-year-old male diagnosed with COVID19 in May 2020. He was diagnosed with a severe case and admitted to the Intensive Care Unit with hypoxemia for 4 days. His past medical history included celiac disease, post-traumatic stress disorder, and two pulmonary embolisms from COVID-19 for which he was prescribed Apixaban. He was evaluated by physical therapy in the Veterans Affairs Telehealth system in September 2020. The patient's chief complaint was fatigue and inability to perform his usual functions. This was demonstrated by the inability to ambulate greater than 2 min without rest breaks. At the time of evaluation his gait speed was >35 m/s highlighting his severely deconditioned state. The patient was treated for 12 visits over 6 months using interval training with a rate of perceived exertion progression three days per week utilizing concepts from high intensity interval training. This intervention was based upon available research on treatments of similar respiratory conditions such as SARS-COV. OUTCOMES: The patient's meaningful functional improvements included the following: patient specific functional scale improved from a range of 0-2 to a range of 8-10, 2-minute step test from 93 to 100 steps, 5 times sit to stand from 15 to 11 seconds, and 6 -minute walk test from 540 m to 600 m. Patient's PROMIS score was also taken 4 months into treatment falling into normal ranges with a T-score of 47.7 for the global physical health score. DISCUSSION: Due to limited available evidence on the treatment of long-term effects of COVID19 clinicians may interpret the best evidence for similar conditions such as SAR-COV. In the absence of evidence for effective treatments in outpatient physical therapy for a patient with novel COVID-19, using evidence from conditions with similar physiological effects seemed to be an effective strategy. Interval training reduces the ventilatory demand of exercise and reduces the sense of breathing effort as sustained traditional aerobic exercise may not be tolerated in this population. This case highlights an approach that warrants further study in this population.

Inspiratory muscle training immediately following lung transplantation due to COVID-19: A report of two cases

BACKGROUND AND PURPOSE: Covid-19 is a novel respiratory disease leading to high rates of acute respiratory distress syndrome (ARDS) and causes adverse effects on both the peripheral and respiratory muscles. Despite optimal medical management some patients with severe Covid-19 develop irreversible lung injury. Patients who cannot be weaned from mechanical ventilation (MV) or extracorporeal life support, lung transplantation (LTX) may be the only life-saving option. Inspiratory muscle training (IMT) has been extensively studied in a variety of non-LTX population with results indicating improvements in exercise capacity, diaphragmatic thickness, reduced dyspnea with ADL's and improved quality of life. Several previous studies found that IMT is a feasible and safe modality in ICU patients. A recent study showed significant improvements in the dyspnea index and quality of life following 2 weeks of IMT in Covid-19 patients after weaning from MV. To the best of our knowledge, no studies have investigated the use of IMT immediately after lung transplantation due to Covid-19 in addition to physical therapy intervention. This report describes the effects of IMT on inspiratory muscle strength, perceived dyspnea and physical performance over the course of 22 weeks in two patients post lung transplantation. CASE DESCRIPTION: Two males (45 ± 9 yr, BMI 33.6 ± 0.1 kg/m2) admitted to the hospital with ARDS secondary to Covid-19 underwent double lung transplantation and performed IMT (2 sessions/day;30 breathes, 50% maximal inspiratory pressure, (MIP);5 days/week) in addition to physical therapy immediately following surgery. Inspiratory muscle strength (MIP), perceived dyspnea (Modified Borg Dyspnea Scale, MBS) and physical performance (4- meter walking speed and 5 times sit to stand) were assessed at baseline and weekly for a total of 22 weeks. Length of hospital stay (LOS) was 58 ± 22 days and both patients participated in a 12 week Pulmonary Rehab Program upon hospital discharge. OUTCOMES: There were no adverse events associated with the intervention. IMT resulted in an increase MIP from -25.7 ± 13 cmH2O to -79.8 ± 7 cmH2O (22% to 66% of predicted normal). MBS improved 4 and 2, to 3 and 0 respectively. Baseline physical performance: 4-meter walking speed and 5-time sit to stand test were 0.40 ± 0.3 m/sec and 60 seconds, and improved to 1.28 ± 0.1 m/s and 7 ± 3 seconds, respectively, after IMT. Activity Measure for Post-Acute Care mobility score (AM-PAC) 7 improved from 7.5 ± 0.7 at evaluation to 18 ± 6.4 upon discharge. DISCUSSION: The present case report describes the integration of IMT to physical therapy intervention in two patients immediately following double lung transplantation due to Covid-19. Improvements in inspiratory muscle strength, perceived dyspnea and functional performance following IMT were present in both cases after a 22 week intervention. These results indicate that IMT program should be encouraged in the rehabilitation of patients post Covid-19. Further research is needed to investigate the benefits of IMT for patients requiring lung transplantation and/or post-Covid-19.

Four weeks of Mollii intervention on lower limb strength, gait speed, lower back pain, quality of life and fatigue in a female person with Multiple Sclerosis

Objective: Whole body electrical garment - Mollii suit delivers sensory input to improve sensorimotor organisation, balance muscle tone, facilitate muscle contraction and reduce pain experience. The aim of this study was to evaluate 4 weeks of Mollii intervention on lower limb strength, gait speed, lower back pain, quality of life and fatigue in a female person with Multiple Sclerosis (pwMS). Methods: Mollii was programmed by physiotherapist and subsequently worn at home for 60 minutes for 4 weeks every second day, by a female participant with primary progressive MS. Participant was walking with 2 elbow crutches. Stimulation parameters: pulse width 25-175 microseconds, constant current at 20 Hertz. Usability and perceived effects were monitored by a weekly phone call. Five time sit to stand (5xSTS) was used for functional lower limb strength, Timed Up and Go test (TUG) to evaluate gait speed, Visual analogue scale 0-10 (VAS) for the perceived back pain, Multiple Sclerosis Impact scale (MSIS29v2) for the quality-of-life and Modified Fatigue Impact scale (MFIS) for patient reported fatigue. Data was collected at baseline (T1) and 4 weeks (T2) later. Results: No adverse effects were reported. Compliance was 100% (14 sessions in 4 weeks). T1: 5xSTS was 20.73 seconds and T2: 12.76, change of 7.97sec., T1: TUG 29.09 sec. T2: 19.97, change of 9.12sec. VAS for pain T1: 6 points, T2: 0, change of 6 points: T1: MSIS29v2 total 86 points), T2: MSIS29v2 total 57 change of 29 points, T1: MFIS total 68 points, T2: 36 points, change of 32 points. Conclusion: This case study provides preliminary evidence of the effect of Mollii treatment for pwMS. High compliance and home usability are additional benefits in the Covid times. Larger studies that include muscle tone assessment will be particularly interesting as Mollii intervention might be an alternative approach to baclofen or surgical interventions.

Virtual Versus in-Person Frailty Assessments in Older Adults with Hematologic Malignancies

Introduction: Time and resource barriers limit widespread implementation of frailty assessment in oncology practice, and the COVID-19 pandemic has reduced the number of in-person visits. To overcome these barriers, virtual geriatric assessments (GAs) have been developed, but lack important objective performance measures such as gait speed and cognitive tests-measures that are important predictors for poor outcomes in older patients with blood cancers (Liu et al., Blood, 2019;Hshieh et al., JAMA Oncol., 2018). We adapted an in-person frailty assessment to a virtual format that maintained both patient-reported and objective measures. Methods: Our cohort assessed in-person (February 2015 to March 2020;resumed June 2021 to July 2021) included all transplant-ineligible patients aged 75 years and older who presented to DFCI for initial consultation for their hematologic malignancy. On the same day as their initial consult, a research assistant administered to consented patients a screening geriatric assessment that assessed for 42 aging-related health deficits using patient-reported and objective performance measures spanning the domains of function, cognition, comorbidity, and mobility. From this assessment, frailty was measured using both the phenotypic (Fried et al., J Gerontol A Biol Sci Med Sci, 2001) and deficit-accumulation approaches (Rockwood et al., J Gerontol A Biol Sci Med Sci, 2007). The frailty phenotype uses five criteria to define a syndrome (slow gait speed, weakness [grip strength], self-reported exhaustion, low physical activity, and weight loss). The deficit-accumulation method calculates the proportion of deficits present in an individual out of the total number of possible deficits measured. To virtually adapt our assessment (Figure 1), patient-reported items were readily converted to questions administered over video- or teleconference. Of the objective measures, grip strength was replaced with self-reported grip strength. The Clock-in-the-Box test was changed to a simple clock draw that the patient completes and displays to the video camera for scoring. 4-meter gait speed is collected by teaching a caregiver to administer with a stopwatch and a 4-meter strip of ribbon. If video is unavailable, self-reported gait speed is measured instead. We expanded eligibility of virtual assessments to patients aged 70 and older. Geriatricians (C.D., T.H., and J.D.) and oncologists (G.A. and J.D.) reviewed the virtual GA for content validity. We measured the proportion of patients who consented and completed the virtual assessment. We assessed for differences in the distributions of age and frailty between virtual and in-person frailty assessments in patients 75 and older using Fisher exact (age) and Chi-square (frailty) tests. Results: Since starting our virtual frailty assessments in November 2020 through July 2021, 118 patients were enrolled and 89 (75%) completed assessments. Median age was 77.6 years (SD = 4.21), 55 (62%) were male, 38 (43%) had lymphoma, 32 (36%) had leukemia/myelodysplastic syndrome/myeloproliferative disorders, and 19 (21%) had multiple myeloma. Of the 89 who completed virtual assessments, 67 (75%) completed the assessment over video with the remaining 22 (25%) over telephone. For the objective measures, 68 (76%) participants were able to complete the clock draw and 47 (53%) were able to complete the gait speed tests. The distribution of age (p = 0.78) and frailty categories (p = 0.49) in our virtual assessments was similar to that of our in-person assessments (Table 1). Conclusion: We developed and successfully delivered a virtual frailty assessment for older adults with blood cancers and found no evidence that frail patients or patients of the highest age categories were unable to complete them. These data suggest that virtual frailty assessment will allow decentralization of assessments even beyond the pandemic, potentially reaching more older adults with blood cancers. The ability to scale to more patients and measure frailty where it matters most-in their own homes-could help over ome barriers to frailty assessments in busy oncology clinics. Virtual frailty assessments also allow for serial measurement while on treatment to better understand and track the trajectory of frailty in this population. [Formula presented] Disclosures: Kim: Alosa Health: Other: Personal Fee;NIH: Other: Grants;Alosa Health: Other: Personal Fee.