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1.
BMJ Open Respir Res ; 9(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1736079

ABSTRACT

INTRODUCTION: COVID-19 sequelae are numerous and multisystemic, and how to evaluate those symptomatic patients is a timely issue. Klok et al proposed the Post-COVID-19 Functional Status (PCFS) Scale as an easy tool to evaluate limitations related to persistent symptoms. Our aim was to analyse PCFS Scale ability to detect functional limitations and its correlation with quality of life in a cohort of patients, 2-9 months after hospitalisation for COVID-19 hypoxemic pneumonia. METHODS: PCFS Scale was evaluated in 121 patients together with quality of life and dyspnoea questionnaires, pulmonary function tests and CT scans. RESULTS: We observed a high correlation with multiple questionnaires (Short Form-36, Hospital Anxiety and Depression Scale, modified Medical Research Council, end Borg Six-Minute Walk Test), making the PCFS Scale a quick and global tool to evaluate functional limitations related to various persistent symptoms following COVID-19 pneumonia. DISCUSSION: The PCFS Scale seems to be a suitable instrument to screen for patients who will require careful follow-up after COVID-19 hypoxemic pneumonia even in the absence of pulmonary sequelae.


Subject(s)
COVID-19 , Pneumonia , COVID-19/complications , Functional Status , Humans , Pneumonia/diagnosis , Quality of Life , SARS-CoV-2
2.
BMC Infect Dis ; 21(1): 1271, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1633329

ABSTRACT

BACKGROUND: The long-term functional outcome of discharged patients with coronavirus disease 2019 (COVID-19) remains unresolved. We aimed to describe a 6-month follow-up of functional status of COVID-19 survivors. METHODS: We reviewed the data of COVID-19 patients who had been consecutively admitted to the Tumor Center of Union Hospital (Wuhan, China) between 15 February and 14 March 2020. We quantified a 6-month functional outcome reflecting symptoms and disability in COVID-19 survivors using a post-COVID-19 functional status scale ranging from 0 to 4 (PCFS). We examined the risk factors for the incomplete functional status defined as a PCFS > 0 at a 6-month follow-up after discharge. RESULTS: We included a total of 95 COVID-19 survivors with a median age of 62 (IQR 53-69) who had a complete functional status (PCFS grade 0) at baseline in this retrospective observational study. At 6-month follow-up, 67 (70.5%) patients had a complete functional outcome (grade 0), 9 (9.5%) had a negligible limited function (grade 1), 12 (12.6%) had a mild limited function (grade 2), 7 (7.4%) had moderate limited function (grade 3). Univariable logistic regression analysis showed a significant association between the onset symptoms of muscle or joint pain and an increased risk of incomplete function (unadjusted OR 4.06, 95% CI 1.33-12.37). This association remained after adjustment for age and admission delay (adjusted OR 3.39, 95% CI 1.06-10.81, p = 0.039). CONCLUSIONS: A small proportion of discharged COVID-19 patients may have an incomplete functional outcome at a 6-month follow-up; intervention strategies are required.


Subject(s)
COVID-19 , Patient Discharge , Follow-Up Studies , Functional Status , Humans , SARS-CoV-2
3.
Exp Gerontol ; 159: 111701, 2022 03.
Article in English | MEDLINE | ID: covidwho-1626277

ABSTRACT

OBJECTIVE: The elderly population is increasing worldwide, and the decline in physical function resulting from this is a critical issue that, especially, leads to a disorder of balance. To investigate the effect of home-based specific and comprehensive balance training on balance and functional status in older adults. METHODS: Forty elderly men were randomized to conditions specific (n = 13) and comprehensive (n = 14) balance training or control (n = 13). The exercises were performed individually at each subject's home three times a week for ten weeks. The BESTest total and subsection scores, Activities-specific Balance Confidence (ABC) score, gait speed, timed-up-and-go (TUG), and functional gait assessment were evaluated at baseline, immediately after training and at 4-week follow-up. RESULTS: After the intervention, both intervention groups showed more significant improvements than the control group in all variables except section II of BESTest. At follow-up, significantly more gains than control were observed in all variables except section II of BESTest in the specific group and sections II and III in the comprehensive group. CONCLUSIONS: Our findings provide evidence that these home-based balance training regimens can enhance balance and functional status in aged individuals. Therefore, at present, because of the coronavirus disease 19 stay-at-home restrictions, it seems that these interventions are applicable strategies for the elderly when access to facilities or opportunities for physical activity outside the home is restricted for all ages, especially the elderly.


Subject(s)
COVID-19 , Functional Status , Aged , Exercise Therapy , Humans , Male , Postural Balance , SARS-CoV-2
4.
Stroke ; 52(12): 3908-3917, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526560

ABSTRACT

BACKGROUND AND PURPOSE: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection. METHODS: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses. RESULTS: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3-18] versus 6 [2-14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10-4.71]; P<0.001). CONCLUSIONS: Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups.


Subject(s)
COVID-19/physiopathology , Functional Status , Ischemic Stroke/physiopathology , Age Factors , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , COVID-19/complications , Case-Control Studies , Female , Humans , Ischemic Stroke/complications , Ischemic Stroke/mortality , Ischemic Stroke/therapy , Logistic Models , Male , Middle Aged , Mortality , Multivariate Analysis , Prognosis , Prospective Studies , SARS-CoV-2 , Severity of Illness Index , Thrombectomy , Thrombolytic Therapy
5.
Am J Phys Med Rehabil ; 100(12): 1109-1114, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1526236

ABSTRACT

OBJECTIVE: The aim of the study was to describe the characteristics and functional outcomes of patients undergoing acute inpatient rehabilitation after hospitalization for COVID-19. DESIGN: Using a retrospective chart review, patients were identified who were admitted to inpatient rehabilitation after COVID-19. Patient information collected included sociodemographic characteristics, comorbidities, length of stay, discharge disposition, self-care, mobility, and cognitive functioning. These patients were compared with patients (controls) without COVID-19 with similar impairment codes treated at the same facility before the COVID-19 pandemic. RESULTS: There were 43 patients who were admitted to the inpatient rehabilitation hospital after COVID-19 infection and 247 controls. Patients who had COVID-19 were significantly more likely to be African American and to have been admitted to a long-term acute care hospital. They also had a longer length of rehabilitation stay. The groups did not differ by age, sex, or insurance. Functionally, although presenting with significantly worse mobility, self-care, and motor scores, the patients previously infected with COVID-19 had similar functional outcomes at time of discharge to the control group. CONCLUSIONS: Although patients with a history of COVID-19 had worse function at time of admission to acute rehabilitation, inpatient rehabilitation significantly improved their function to comparable levels as patients who did not have COVID-19. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify how characteristics of patients with COVID-19 admitted to acute rehabilitation differ from those with similar admission codes but without COVID-19; (2) Describe changes in functional measures at admission and discharge of COVID-19 patients compared with patients without COVID-19; and (3) Recognize how inpatient rehabilitation may help reduce inequities in outcomes after severe COVID-19 infection. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Subject(s)
COVID-19/rehabilitation , Functional Status , Hospitals, Rehabilitation/statistics & numerical data , Length of Stay/statistics & numerical data , Patient Discharge/statistics & numerical data , Aged , Case-Control Studies , Disability Evaluation , Female , Hospitalization , Humans , Male , Middle Aged , Recovery of Function , Retrospective Studies , SARS-CoV-2 , Time Factors , Treatment Outcome
6.
Am J Phys Med Rehabil ; 100(12): 1115-1123, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1522398

ABSTRACT

OBJECTIVE: The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. DESIGN: For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. RESULTS: The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. CONCLUSIONS: The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.


Subject(s)
COVID-19/rehabilitation , Facilities and Services Utilization/statistics & numerical data , Health Services Needs and Demand/statistics & numerical data , Inpatients/statistics & numerical data , Subacute Care/statistics & numerical data , Acute Disease , Critical Care/statistics & numerical data , Databases, Factual , Female , Functional Status , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , New Jersey , New York , Patient Discharge/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Subacute Care/methods , Treatment Outcome
7.
Exp Gerontol ; 157: 111620, 2022 01.
Article in English | MEDLINE | ID: covidwho-1505907

ABSTRACT

Clinical course of COVID-19 may be associated with functional dependency of geriatric patients. Data from the records of patients admitted to the COVID-19 Geriatric Unit were gathered during three months, including background, clinical aspects, time to resolution of infection and functional status. Functionally dependent patients had higher rates of diabetes (p = 0.03) and stroke (p = 0.004), as well as longer time to resolution of infection (p < 0.001), but less respiratory COVID-19 symptoms (p = 0.007), compared to independent patients. Time to resolution of infection was longer in women (p = 0.01) and positively associated with WBC level (p < 0.01) and age (p < 0.001). An adjusted analysis which controlled these variables confirmed the significant effect of functional status on the time to resolution of infection (p = 0.015). Functionally dependent geriatric patients with mild to moderate infection had less respiratory COVID-19 symptoms but showed longer time to resolution of infection compared to independent. Assessment of functional status in the elderly population may contribute to decision making for care of geriatric inpatients with COVID-19.


Subject(s)
COVID-19 , Aged , Female , Functional Status , Geriatric Assessment , Hospitals , Humans , SARS-CoV-2
8.
Nutrients ; 13(11)2021 Nov 06.
Article in English | MEDLINE | ID: covidwho-1502478

ABSTRACT

Post-acute consequences of COVID-19, also termed long COVID, include signs and symptoms persisting for more than 12 weeks with prolonged multisystem involvement; most often, however, malnutrition is ignored. METHOD: The objective was to analyze persistent symptoms, nutritional status, the evolution of muscle strength and performance status (PS) at 6 months post-discharge in a cohort of COVID-19 survivors. RESULTS: Of 549 consecutive patients hospitalized for COVID-19 between 1 March and 29 April 2020, 23.7% died and 288 patients were at home at D30 post-discharge. At this date, 136 of them (47.2%) presented persistent malnutrition, a significant decrease in muscle strength or a PS ≥ 2. These patients received dietary counseling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were admitted to post-care facilities. At 6 months post-discharge, 91.0% of the 136 patients (n = 119) were evaluated and 36.0% had persistent malnutrition, 14.3% complained of a significant decrease in muscle strength and 14.9% had a performance status > 2. Obesity was more frequent in patients with impairment than in those without (52.8% vs. 31.0%; p = 0.0071), with these patients being admitted more frequently to ICUs (50.9% vs. 31.3%; p = 0.010). Among those with persistent symptoms, 10% had psychiatric co-morbidities (mood disorders, anxiety, or post-traumatic stress syndrome), 7.6% had prolonged pneumological symptoms and 4.2% had neurological symptoms. CONCLUSIONS: Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients.


Subject(s)
COVID-19/complications , Malnutrition/etiology , Muscle Strength , Muscle Weakness/etiology , Muscle, Skeletal/physiopathology , Nutritional Status , Adult , Aged , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Female , Functional Status , Hospitalization , Humans , Length of Stay , Male , Malnutrition/diagnosis , Malnutrition/physiopathology , Malnutrition/therapy , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/physiopathology , Muscle Weakness/therapy , Obesity/complications , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Time Factors
9.
Stroke ; 52(12): 3978-3986, 2021 12.
Article in English | MEDLINE | ID: covidwho-1501852

ABSTRACT

BACKGROUND AND PURPOSE: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. METHODS: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. RESULTS: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke. CONCLUSIONS: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.


Subject(s)
COVID-19/epidemiology , Hospital Mortality , Hospitalization , Ischemic Stroke/epidemiology , Pulmonary Embolism/epidemiology , Age Factors , Aged , Aged, 80 and over , COVID-19/physiopathology , Cohort Studies , Female , Functional Status , Humans , Incidence , Intensive Care Units , Ischemic Stroke/physiopathology , Male , Middle Aged , Netherlands/epidemiology , Prognosis , Risk Factors , SARS-CoV-2
11.
Pulmonology ; 27(6): 481-483, 2021.
Article in English | MEDLINE | ID: covidwho-1461776
13.
Turk J Med Sci ; 51(5): 2304-2310, 2021 10 21.
Article in English | MEDLINE | ID: covidwho-1359315

ABSTRACT

Background/aim: The post-COVID-19 Functional Status (PCFS) has recently been developed for functional outcomes of COVID-19 upon discharge and in long term. The purpose of this study was to investigate the reliability and validity properties of the Turkish version of the PCFS in Turkish post-COVID-19 patients with hospitalized and nonhospitalized during infection. Materials and methods: One hundred participants with post-COVID-19 were included in this cross-sectional study. Test-retest reliability of the Turkish version of PCFS assessed by intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated for internal consistency. For construct validity, correlation coefficients between the Turkish version of PCFS developed by translation-back translation method and modified Medical Research Council (mMRC) dyspnea scale (MMRC), London Chest Activities of Daily Living (LCADL) scale, Barthel Index (BI) were analyzed. Results: For test-retest reliability analysis, ICC ranged between 0.734 and 0.880. The total ICC score was 0.821, indicating excellent reliability. The Cronbach's alpha value of the PCFS test and retest scores were recorded as 0.821 indicating that the scale is quite reliable. The PCFS score was moderately correlated with the mMRC score (r = 0.534, p < 0.001) and weakly correlated with the LCADL self care (r = 0.311, p = 0.002), domestic (r = 0.277, p = 0.005), physical activity (r = 0.342, p < 0.001), leisure subscores (r = 0.434, p < 0.001) and total score (r = 0.399, p < 0.001). Conclusion: The Turkish version of the PCFS scale is reliable scale that reflects activity limitation and functional status after COVID-19. The Turkish version of the PCFS will be a guide for rehabilitation professionals to understand functional limitation after COVID-19 and to direct interventions accordingly to functional status of the patients at discharge and in long term.


Subject(s)
COVID-19/physiopathology , Functional Status , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Reproducibility of Results , Turkey , Young Adult
14.
J Nutr Health Aging ; 25(8): 964-970, 2021.
Article in English | MEDLINE | ID: covidwho-1343048

ABSTRACT

OBJECTIVES: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. DESIGN: Cohort study with a mean follow-up of 12.8 days. SETTING: Public university hospital (Madrid, Spain). PARTICIPANTS: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. MEASUREMENTS: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)]. CONCLUSIONS: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Hospital Mortality , Hospitalization/statistics & numerical data , Activities of Daily Living , Aged , Aged, 80 and over , COVID-19/diagnosis , Cohort Studies , Female , Functional Status , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2 , Spain/epidemiology
15.
J Stroke Cerebrovasc Dis ; 30(9): 105991, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1320171

ABSTRACT

OBJECTIVES: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. MATERIALS AND METHODS: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. RESULTS: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). CONCLUSIONS: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.


Subject(s)
Cognition , Exercise Therapy , Motor Activity , Quality of Life , Stroke Rehabilitation , Stroke/therapy , Telerehabilitation , Upper Extremity/innervation , Video Games , Aged , Disability Evaluation , Female , Functional Status , Humans , Male , Middle Aged , Recovery of Function , Stroke/diagnosis , Stroke/physiopathology , Stroke/psychology , Time Factors , Treatment Outcome , Turkey
16.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878

ABSTRACT

BACKGROUND: Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS: We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS: In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03747055.


Subject(s)
Depression/therapy , Mental Health , Natural Disasters , Problem Solving , Psychotherapy, Brief , Psychotherapy, Group , Relief Work , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Functional Status , Humans , Male , Middle Aged , Nepal , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Time Factors , Treatment Outcome , Young Adult
17.
BMC Med ; 19(1): 163, 2021 07 14.
Article in English | MEDLINE | ID: covidwho-1309910

ABSTRACT

BACKGROUND: Few studies had described the health consequences of patients with coronavirus disease 2019 (COVID-19) especially in those with severe infections after discharge from hospital. Moreover, no research had reported the health consequences in health care workers (HCWs) with COVID-19 after discharge. We aimed to investigate the health consequences in HCWs with severe COVID-19 after discharge from hospital in Hubei Province, China. METHODS: We conducted an ambidirectional cohort study in "Rehabilitation Care Project for Medical Staff Infected with COVID-19" in China. The participants were asked to complete three physical examinations (including the tests of functional fitness, antibodies to SARS-CoV-2 and immunological indicators) at 153.4 (143.3, 164.8), 244.3 (232.4, 259.1), and 329.4 (319.4, 339.3) days after discharge, respectively. Mann-Whitney U test, Kruskal-Wallis test, t test, one-way ANOVA, χ2, and Fisher's exact test were used to assess the variance between two or more groups where appropriate. RESULTS: Of 333 HCWs with severe COVID-19, the HCWs' median age was 36.0 (31.0, 43.0) years, 257 (77%) were female, and 191 (57%) were nurses. Our research found that 70.4% (114/162), 48.9% (67/137), and 29.6% (37/125) of the HCWs with severe COVID-19 were considered to have not recovered their functional fitness in the first, second, and third functional fitness tests, respectively. The HCWs showed improvement in muscle strength, flexibility, and agility/dynamic balance after discharge in follow-up visits. The seropositivity of IgM (17.0% vs. 6.6%) and median titres of IgM (3.0 vs. 1.4) and IgG (60.3 vs. 45.3) in the third physical examination was higher than that in the first physical examination. In the third physical examination, there still were 42.1% and 45.9% of the HCWs had elevated levels of IL-6 and TNF-α, and 11.9% and 6.3% of the HCWs had decreased relative numbers of CD3+ T cells and CD4+ T cells. CONCLUSION: The HCWs with severe COVID-19 showed improvement in functional fitness within 1 year after discharge, active intervention should be applied to help their recovery if necessary. It is of vital significance to continue monitoring the functional fitness, antibodies to SARS-CoV-2 and immunological indicators after 1 year of discharge from hospital in HCWs with severe COVID-19.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing , COVID-19 , Exercise Test , Health Personnel/statistics & numerical data , SARS-CoV-2/immunology , Adult , COVID-19/epidemiology , COVID-19/immunology , COVID-19/physiopathology , COVID-19/rehabilitation , COVID-19 Serological Testing/methods , COVID-19 Serological Testing/statistics & numerical data , China/epidemiology , Exercise Test/methods , Exercise Test/statistics & numerical data , Female , Follow-Up Studies , Functional Status , Humans , Interleukin-6/blood , Male , Patient Discharge/statistics & numerical data , Severity of Illness Index , Tumor Necrosis Factor-alpha/blood
18.
RMD Open ; 7(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1172774

ABSTRACT

AIM: To assess the impact of the COVID-19 pandemic on patients with rheumatic and musculoskeletal diseases (RMDs). METHODS: REUMAVID is a cross-sectional study using an online survey developed by an international multidisciplinary patient-led collaboration across seven European countries targeting unselected patients with RMDs. Healthcare access, daily activities, disease activity and function, well-being (WHO Five Well-Being Index (WHO-5)), health status, anxiety/depression (Hospital Anxiety and Depression Scale (HADS)) and access to information were evaluated. Data were collected in April-July 2020 (first phase). RESULTS: Data from the first phase included 1800 patients with 15 different RMDs (37.2% axial spondyloarthritis, 29.2% rheumatoid arthritis, 17.2% osteoarthritis and others). Mean age was 53, 80% female and 49% had undertaken university studies. During the beginning of the pandemic, 58.4% had their rheumatology appointment cancelled and 45.6% reported not having received any information relating to the possible impact of SARS-CoV-2 infection in their RMDs, with the main source being patient organisations (27.6%).Regarding habits, 24.6% increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable to continue exercising. Self-reported disease activity was high (5.3±2.7) and 75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being (WHO-5) and 46.6% that their health had changed for the worse during lockdown. According to HADS, 57.3% were at risk of anxiety and 45.9% of depression. CONCLUSION: Throughout the first wave of the COVID-19 pandemic, patients with RMDs have experienced disruption in access to healthcare services, poor lifestyle habits and negative effects on their overall health, well-being and mental health. Furthermore, information on COVID-19 has not reached patients appropriately.


Subject(s)
Anxiety , COVID-19 , Depression , Exercise , Mental Health/statistics & numerical data , Musculoskeletal Diseases , Patient Acceptance of Health Care/statistics & numerical data , Rheumatic Diseases , Anxiety/diagnosis , Anxiety/epidemiology , COVID-19/epidemiology , COVID-19/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Europe/epidemiology , Female , Functional Status , Humans , Life Style , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/psychology , Patient Acuity , Patient Reported Outcome Measures , Rheumatic Diseases/diagnosis , Rheumatic Diseases/epidemiology , Rheumatic Diseases/psychology , SARS-CoV-2
19.
Cerebrovasc Dis ; 50(4): 412-419, 2021.
Article in English | MEDLINE | ID: covidwho-1158151

ABSTRACT

INTRODUCTION: Acute ischemic stroke (AIS) and thrombotic events (TEs) were reported in patients with COVID-19. Clinical outcome of AIS in the course of COVID-19 remains unknown. We compared early clinical outcome and mortality of COVID-positive (+) patients admitted for AIS with COVID-negative (-) ones. We hypothesized that COVID+ patients would have poorer clinical outcomes and present a higher rate of TEs and mortality compared with COVID- ones. METHODS: In this multicentric observational retrospective study, we enrolled patients over 18 years old admitted for AIS in 3 stroke units of the Parisian region during lockdown from March 17, 2020, to May 2, 2020. COVID-19 status as well as demographic, clinical, biological, and imaging data was collected retrospectively from medical records. Poor outcome was defined as modified Rankin score (mRS) 3-6 (3-6) at discharge. We also compared TE frequency and mortality rate through a composite criterion in both groups. RESULTS: Two hundred and sixteen patients were enrolled; mean age was 68 years old, and 63% were male. Forty patients were CO-VID+ (18.5%) and 176 were COVID-. Obesity was statistically more frequent in the COVID+ group (36 vs. 13% p < 0.01). The percentage of patients with mRS (3-6) at discharge was higher in the COVID+ group compared with the COVID- group (60 vs. 41%, p = 0.034). The main predictor of presenting a mRS (3-6) at discharge was high NIHSS score at admission (OR, CI 95%: 1.325, 1.22-1.43). Mortality rate was higher in the COVID+ group (12 vs. 3.4%, p = 0.033) as well as TE frequency (15 vs. 2.8%, p < 0.01). CONCLUSION: In this study, patients with AIS infected by SARS-CoV-2 showed a poorer early outcome than COVID- ones. However, when compared to other factors, COVID-19 was not a significant predictor of poor outcome. Vascular morbidity and mortality rates were significantly higher in the COVID+ group compared with the COVID- group.


Subject(s)
COVID-19/physiopathology , Ischemic Stroke/physiopathology , Aged , Aged, 80 and over , COVID-19/epidemiology , Case-Control Studies , Diabetes Mellitus/epidemiology , Female , France/epidemiology , Functional Status , Hospital Mortality , Humans , Ischemic Stroke/epidemiology , Male , Middle Aged , Obesity/epidemiology , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2
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