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1.
Chin Med J (Engl) ; 133(9): 1039-1043, 2020 May 05.
Article in English | MEDLINE | ID: covidwho-1722619

ABSTRACT

BACKGROUND: A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence. METHODS: The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed. RESULTS: In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P < 0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P > 0.05). CONCLUSIONS: In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/genetics , Pneumonia, Viral/genetics , RNA, Viral/genetics , Adult , Aged , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/rehabilitation , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/rehabilitation , Real-Time Polymerase Chain Reaction , Retrospective Studies , SARS-CoV-2
2.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1386577

ABSTRACT

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Subject(s)
Aftercare/methods , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Aftercare/standards , Ambulatory Care/methods , Ambulatory Care/standards , COVID-19 , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care/methods , Critical Care/standards , Diagnostic Techniques, Respiratory System/standards , Disease Management , Emergency Medical Services/methods , Emergency Medical Services/standards , Health Priorities , Hospitalization , Humans , Inpatients , Outpatients , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Respiratory Therapy/standards , Symptom Assessment/methods , Symptom Assessment/standards , Thromboembolism/prevention & control , Thrombophilia/drug therapy , Thrombophilia/etiology
4.
Age Ageing ; 49(5): 696-700, 2020 08 24.
Article in English | MEDLINE | ID: covidwho-1087659

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.


Subject(s)
Aging , Chronic Disease , Coronavirus Infections , Delivery of Health Care , Health Services Accessibility/standards , Pandemics , Pneumonia, Viral , Rehabilitation , Aged , Aging/physiology , Aging/psychology , Betacoronavirus , COVID-19 , Chronic Disease/epidemiology , Chronic Disease/rehabilitation , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Coronavirus Infections/rehabilitation , Delivery of Health Care/methods , Delivery of Health Care/trends , Forecasting , Health Services Needs and Demand , Humans , Organizational Innovation , Physical Functional Performance , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/rehabilitation , Recovery of Function , Rehabilitation/methods , Rehabilitation/organization & administration , Rehabilitation/trends , SARS-CoV-2
6.
Eur J Phys Rehabil Med ; 56(5): 652-657, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024859

ABSTRACT

INTRODUCTION: This paper is the first update of the second edition of the rapid living systematic review on the latest scientific literature informing rehabilitation of patients with COVID-19 and/or describing consequences of the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. The aim of this study was to report data of a systematic search performed on papers published in July 2020. EVIDENCE ACQUISITION: The methodology described in the second edition of the rapid living systematic review was applied to search eligible papers included in the databases between July 1, 2020 and July 31, 2020. EVIDENCE SYNTHESIS: Eight-hundred-ninety-two papers were identified through database searching (after removal of duplicates); of these, only 23 studies were included. According to OCEBM 2011 Levels of Evidence Table, they were level 3 in 30.5% cases and level 4 in 69.5%. No RCT was found. Nineteen papers studied COVID-19 patients, assessed in the acute (10 studies), post-acute (8 studies) and chronic phase (one study). Four studies reported data on the impact of COVID-19 on subjects with pre-existing health conditions. CONCLUSIONS: The current literature production still focuses more on describing all the possible aspects and complications of the pathology than on interventions or new organization models to deal with it. Albeit evidence on handling COVID-19 from a rehabilitative point of view is improving each month, further studies are still mandatory to report the role of rehabilitation in this scenario.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Severe Acute Respiratory Syndrome/rehabilitation , Adult , Aged , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Databases, Factual , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , Rehabilitation Centers/statistics & numerical data , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/epidemiology , Treatment Outcome
7.
Eur J Phys Rehabil Med ; 56(5): 642-651, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024858

ABSTRACT

INTRODUCTION: This paper improves the methodology of the first edition of the rapid living systematic review started in April 2020, with the aim to gather and present the current evidence informing rehabilitation of patients with COVID-19 and/or describing the consequences due to the disease and its treatment. EVIDENCE ACQUISITION: The Cochrane methodology for a rapid living systematic review was applied. Primary research papers, published from 1 January to 30 June 2020, reporting patients' data, with no limits of study design were included. Studies were categorized for study design, research question, COVID-19 phase, limitations of functioning (disability) of rehabilitation interest and type of rehabilitation service involved. Methodological quality assessment was based on the Cochrane Risk of Bias tools, and the level of evidence table (OCEBM 2011) for all the other studies. EVIDENCE SYNTHESIS: Thirty-six, out of 3703 papers, were included. One paper was of level 2 (RCT), 7 were of level 3 (2 cohort studies, 2 cross-sectional studies and 3 case-control studies), and 28 papers of level 4 (descriptive studies); 61% of papers reported epidemiological data on clinical presentations, 5 investigated natural history/determining factors, 1 searched prevalence, 2 studies reported on intervention efficacy (though not on harms), and 5 studies looked at health service organization. CONCLUSIONS: Main issues emerging from the review: it is advised to test for COVID-19 people with neurological disorders presenting with symptom changes; dysphagia is a frequent complication after oro-tracheal intubation in COVID-19 patients admitted to the ICU; after discharge, COVID-19 survivors may report persistent restrictive ventilatory deficits regardless of disease severity; there is only sparse and low quality evidence concerning the efficacy of any rehabilitation intervention to promote functional recovery; a substantial increase in resource (staff and equipment) is needed for rehabilitation.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Rehabilitation Centers/statistics & numerical data , Respiratory Therapy/methods , COVID-19 , Case-Control Studies , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Early Ambulation/methods , Female , Humans , Intensive Care Units/statistics & numerical data , Italy , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , Randomized Controlled Trials as Topic , Recovery of Function , Risk Assessment , Treatment Outcome
9.
Eur J Phys Rehabil Med ; 56(5): 633-641, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1024855

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial role in reducing disability in order to reintroduce patients in the community. AIM: The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit. DESIGN: Cross-sectional observational study. SETTING: Inpatients Rehabilitation Unit. POPULATION: Post-acute COVID-19 patients. METHODS: Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2. RESULTS: We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters. CONCLUSIONS: Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients. CLINICAL REHABILITATION IMPACT: This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.


Subject(s)
Coronavirus Infections/rehabilitation , Critical Illness/rehabilitation , Early Ambulation/methods , Pneumonia, Viral/rehabilitation , Rehabilitation Centers/statistics & numerical data , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Databases, Factual , Exercise Therapy/methods , Female , Follow-Up Studies , Humans , Intensive Care Units/statistics & numerical data , Italy , Male , Middle Aged , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Recovery of Function , Respiratory Therapy/methods , Treatment Outcome
10.
Nutrients ; 12(11)2020 Oct 22.
Article in English | MEDLINE | ID: covidwho-983188

ABSTRACT

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Malnutrition/therapy , Nutrition Policy , Nutrition Therapy/standards , Pneumonia, Viral/rehabilitation , Adult , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Dietary Supplements , Female , Humans , Male , Malnutrition/virology , Pandemics , Patient Discharge , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Risk Assessment , SARS-CoV-2
11.
Medicine (Baltimore) ; 99(47): e23225, 2020 Nov 20.
Article in English | MEDLINE | ID: covidwho-939606

ABSTRACT

BACKGROUND: The outbreak of a novel coronavirus (2019-nCoV)-infected pneumonia is currently ongoing all over the world. The treatment scheme is generally isolation treatment and symptomatic support treatment. While the majority of patients recover from this disease through methods above, COVID-19 Infection severely affect the physical and mental health of rehabilitation patients, as well as their living quality. Thus, meditative movement is needed to improve outcome of COVID-19 patients in recovery period. METHODS: We will conduct systematic searches to identify all relevant studies without any language limitation from the following electronic databases from inception to October 2020: Medline, Ovid, PubMed, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Chinese Biomedical Database, Chinese Biomedical Literature Service System and Wan fang Database. At the same time, we will search the following Clinical trial registries to identify records of on-going or completed but not yet published trials, including WHO International Clinical Trials Registry Platform (ICTRP), Trials Register of Promoting Health Interventions (TRoPHI) and Chinese Clinical Trial Registry (ChiCTR). No limits will be placed on language. The article will study the effect of meditative movement on the quality of life of convalescent patients. The main outcome will be the effect of meditative movement on the quality of life of patients in recovery period. The secondary results will select accompanying symptoms (including myalgia, cough, sputum, runny nose, pharyngalgia, anhelation, chest distress, nausea, vomiting, anorexia, diarrhea), disappearance rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), the quality of life improved, CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Data collection and management 3 authors will independently carry out data from eligible studies in a pretested and standardized Microsoft Excel sheet, with reciprocal validation of data extraction results. Data analysis and quantitative data synthesis will be performed using RevMan software (V.5.3). RESULTS: The findings of the study will provide new and relatively high-quality evidence in meditative movement treatment for COVID-19. CONCLUSION: The conclusion of systematic review will provide evidence to judge whether meditative movement is an effective intervention for patient with COVID-19 in recovery period. PROSPERO REGISTRATION NUMBER: CRD42020210256.


Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Exercise Movement Techniques/methods , Meditation/methods , Pneumonia, Viral/rehabilitation , Quality of Life , COVID-19 , Coronavirus Infections/psychology , Female , Humans , Male , Meta-Analysis as Topic , Pandemics , Pneumonia, Viral/psychology , Research Design , SARS-CoV-2 , Systematic Reviews as Topic , Treatment Outcome
13.
Am J Phys Med Rehabil ; 99(12): 1092-1095, 2020 12.
Article in English | MEDLINE | ID: covidwho-936527

ABSTRACT

The recent novel severe acute respiratory syndrome coronavirus 2 infection resulted in a coronavirus disease 2019 pandemic that significantly strained healthcare systems globally. The early wave of patients in Singapore with severe pneumonia requiring intensive care units are gradually being referred for post-critical illness management with our inpatient medical rehabilitation unit. There is growing information regarding the actual rehabilitation process for patients severely affected by coronavirus disease 2019. This case report shares experiences and challenges faced during rehabilitation of severe coronavirus disease 2019 pneumonia and post-intensive care syndrome. It also describes the post-discharge rehabilitation program in a setting of strict nationwide safe distancing and stay-home policies.


Subject(s)
Aftercare , Coronavirus Infections/rehabilitation , Patient Discharge , Pneumonia, Viral/rehabilitation , Betacoronavirus , COVID-19 , Critical Illness , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
14.
Rev Paul Pediatr ; 39: e2020238, 2020.
Article in English, Portuguese | MEDLINE | ID: covidwho-934373

ABSTRACT

OBJECTIVE: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. CASES DESCRIPTION: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. COMMENTS: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.


Subject(s)
Coronavirus Infections/rehabilitation , Patient-Centered Care/methods , Physical Therapy Modalities/nursing , Pneumonia, Viral/rehabilitation , Brazil , COVID-19 , Child , Coronavirus Infections/nursing , Female , Humans , Infant , Male , Pandemics , Pneumonia, Viral/nursing , Range of Motion, Articular
15.
Medicine (Baltimore) ; 99(45): e23044, 2020 Nov 06.
Article in English | MEDLINE | ID: covidwho-930133

ABSTRACT

BACKGROUND: A new type of coronavirus (COVID-19), is spreading all over the world. Under the background of the comprehensive medical treatment and strict prevention and control in China, the number of discharged patients increased substantially. By the end of July, more than 80,000 patients had been cured and discharged from hospital in China. In order to effectively promote the full recovery of the patient's physical and mental functions and quality of life, gradually shift the emphasis of clinical work to convalescence therapy is very important, thus Chinese experts draw up Expert Consensus on Rehabilitation of Chinese Medicine for COVID-19. This systematic review and meta-analysis will assess studies of the effects of traditional Chinese exercise (TCE) for COVID-19 patients. METHODS AND ANALYSIS: We will search 6 English and 4 Chinese databases by 01, December 2020. After a series of screening, Randomized Clinic Trials (RCTs) will be included related to TCE for COVID-19. Two assessors will use the Cochrane bias risk assessment tool to assess the RCTs. Finally, the evidence grade of the results will be evaluated. RESULTS: This study will provide a reliable evidence for the selection of TCE therapies for COVID-19. CONCLUSION: The results of this study will provide references for the selection of TCE treatment for COVID-19, and provide decision making references for clinical research. PROSPERO REGISTRATION NUMBER: CRD42020179095.


Subject(s)
Coronavirus Infections/rehabilitation , Exercise Therapy , Pneumonia, Viral/rehabilitation , Betacoronavirus , COVID-19 , Humans , Meta-Analysis as Topic , Pandemics , Qigong , Randomized Controlled Trials as Topic , Research Design , SARS-CoV-2 , Systematic Reviews as Topic , Tai Ji
19.
PLoS One ; 15(10): e0239570, 2020.
Article in English | MEDLINE | ID: covidwho-868653

ABSTRACT

Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.


Subject(s)
Cognitive Dysfunction/epidemiology , Coronavirus Infections/epidemiology , Dyspnea/epidemiology , Malnutrition/epidemiology , Pneumonia, Viral/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Aftercare/statistics & numerical data , Aged , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation
20.
Am J Phys Med Rehabil ; 99(10): 873-875, 2020 10.
Article in English | MEDLINE | ID: covidwho-860315

ABSTRACT

A 65-yr-old man visited a primary care hospital with a continued fever of 38°C for 3 days. As his fever did not improve until 8 days after, he was admitted into another acute care hospital, where his respiratory condition rapidly worsened. Therefore, the patient was transferred to our hospital. On the day of transfer (day 1), he was started on mechanical ventilation. COVID-19 was diagnosed using a polymerase chain reaction assay 6 days after admission (day 6). The rehabilitation therapy was begun on day 6. The initial rehabilitation programs focused on positioning and postural drainage. The patient was extubated on day 19, and he began standing and stepping on the same day. Gait exercises began on day 22, and endurance training was initiated on day 28. The patient was discharged from our hospital on day 34 as he met the physical function milestones. One month after discharge, the Medical Research Council sum score and Barthel Index had each improved; therefore, muscle strength and daily activities had returned to normal. It was assumed that mobilization should be performed as soon as possible after the end of sedation during the acute phase of severe COVID-19 infection in patients receiving mechanical ventilation.


Subject(s)
Coronavirus Infections/rehabilitation , Drainage, Postural/methods , Exercise Therapy/methods , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Humans , Japan , Male , Pandemics , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2 , Treatment Outcome
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