Randomized controlled trial of home-based vs. hospital-based pulmonary rehabilitation in post COVID-19 patients.

BACKGROUND: Between 30% and 60% of people who have been infected with COVID-19 still had symptoms 3 months after the start of the disease. Prescribing a pulmonary rehabilitation program in rehabilitation facilities for post COVID-19 patients could help alleviate the symptoms. However, rehabilitation facilities known to provide good quality care to COVID-19 patients and all other patients, could become saturated by the rise in cases. Home-based rehabilitation is a potential solution that could be sustainable in the long term to avoid this saturation and/or a very long waiting list for patients. AIM: The aim of this study was to investigate whether home-based rehabilitation would have similar effects compared to inpatient rehabilitation on physical and respiratory variables in post COVID-19 patients. DESIGN: This is a randomized controlled trial. SETTING: Pulmonary rehabilitation facility. POPULATION: Seventeen post COVID-19 patients were randomized into two groups: inpatient pulmonary rehabilitation (IPR) or home-based pulmonary rehabilitation (HPR). METHODS: The comparison of the two rehabilitation methods relied on questionnaires, physical tests and the evaluation of several respiratory parameters. A 2-way Analysis of Variance (ANOVA) with repeated measures was performed to assess the effects of time (pre- vs. post-rehabilitation), group (IPR vs. HPR) and their interaction for all parameters. RESULTS: The main result of this study is that distance covered in the 6MWT (6MWD) shows significant improvements, between pre- and postrehabilitation program in both groups (+95 m in IPR group vs.+72 m in HPR group, P<0.001) with no significant interaction between time and group (P=0.420). CONCLUSIONS: These results suggest that home-based pulmonary rehabilitation would be as efficient as IPR to decrease physical sequelae in post COVID-19 patients. CLINICAL REHABILITATION IMPACT: It is possible to suggest both methods (home-based rehabilitation or inpatient pulmonary rehabilitation) according to the specificities of each patient and depending on hospital saturation. The choice of one or the other method should not be made to the detriment of the patient.

Longitudinal trajectories of mental health and loneliness for Australian adolescents with-or-without neurodevelopmental disorders: the impact of COVID-19 school lockdowns.

BACKGROUND: The impact of COVID-19 (SARS-CoV-2) pandemic school lockdowns on the mental health problems and feelings of loneliness of adolescents with neurodevelopmental disorders (NDDs) is hypothesized to be greater than that of their non-NDD peers. This two and a half year longitudinal study compared changes in the mental health and loneliness of Western Australian adolescents pre-COVID-19 (November 2018 and April 2019), immediately prior to COVID-19 school lockdowns (March 2020), and post schools reopening (July/August 2020). METHODS: An age-and-gender matched sample of 476 adolescents with-or-without NDDs completed online assessments for mental health and loneliness. RESULTS: Adolescents with NDDs reported elevated levels of adverse mental health across all four waves of data collection. These young people experienced little change in mental health problems and feelings of loneliness over time, and any increase during school lockdowns returned to, or fell below pre-COVID-19 levels once schools reopened. In comparison, adolescents without NDDs experienced significant increases from a low baseline in depression symptoms, externalizing symptoms, feelings of isolation, and having a positive attitude to being alone, and evidenced a significant decline in positive mental wellbeing. Quality of friendships were unaffected by COVID-19 school lockdowns for all adolescents regardless of NDD status. Of the adolescents with NDDs, those with Attention-Deficit/Hyperactivity Disorder reported a significant increase in positive mental wellbeing following school lockdowns. CONCLUSIONS: Adolescents with NDDs emerged relatively unscathed from COVID-19 school lockdowns and the short term impacts associated with these were not maintained over time. These findings should be considered in the context of this study's geographical location and the unpredictability of school lockdowns. Learning to live with school lockdowns into the future may be a critical element for further investigation in the context of interventions.