Role of the Inspiratory Muscles on Functional Performance from Critical Care to Hospital Discharge and beyond in Patients with COVID-19.

OBJECTIVE: The role of inspiratory muscle performance in functional performance in patients with COVID-19 is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. METHODS: Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. RESULTS: The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] versus 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (ß = 0.308; odds ratio = 1.36) at HD. CONCLUSIONS: A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. IMPACT: This study shows that inspiratory muscle training may be an important adjunct after COVID-19.

Higher levels of physical activity is associated with better walking ability and fall-related fitness of older adults during COVID-19 in China

This study analyzed the relationship of physical activity levels with walking ability and fall-related fitness in older adults in the Henan Provence, China. Physical activity levels of 288 older adults were assessed using the short form of the International Physical Activity Questionnaire. The participants were divided into low (LPAG, n = 81), moderate (MPAG, n = 106), and high physical activity groups (HPAG, n = 101). The 10-m walking test (10MWT), 3-m backward walking (3MBW), and Berg Balance Scale (BBS) were used to evaluate walking ability. Thirty seconds Sit to Stand Test (30SST), Time up and Go Test (TUGT), and figure-of-8 walk test (8WT) were evaluated for fall-related fitness. One-way ANOVA was used to detect between group differences, whilst Pearson's correlation was used to evaluate the relationship between total physical activity level and the measured variables. Logistic regression analyses were used to compute the odds ratios (ORs) of LPAG and MPAG relative to HPAG. There were significant differences between the groups for walking ability, 10MWT (p < 0.01), 3MBW, and BBS (p < 0.01), and also for variables of fall-related fitness, TUGT (p < 0.01), and 8WT (p < 0.01). Total physical activity levels had significant correlations with all variables except 30SST. In the walking ability, OR for 10MWT was 2.42 and 2.53 times for the LPAG compared to that for HPAG by model 1 and model 2. OR for BBS was 3.24 and 3.54 times for the LPAG and 9.31 and 9.65 times for the MPAG compared to for the HPAG by model 1 and model 2. In the fall-related fitness, OR for 8WT was 14.09 and 16.76 times for the LPAG compared to that for HPAG. High levels of physical activity are positively correlated with good walking ability and fall-related fitness. Increasing physical activity levels can reduce the risks associated with impaired walking ability and fall-related fitness.Copyright ©2023 The Author(s). Published by MRE Press.

One-minute-sit-to-stand-test elicits less desaturation than 6MWT in advanced respiratory disease

Introduction: During the COVID-19 pandemic pulmonary rehabilitation moved to a telehealth platform and the 1-min sit-to-stand test (1minSTS) was often used instead of the 6-min walk test (6MWT) to evaluate functional exercise capacity. We sought to determine;(i) the extent to which the six-minute walk distance (6MWD) could be estimated from the number of repetitions achieved during the 1minSTS and, (ii) agreement in cardiorespiratory responses elicited collected during the tests. Method(s): Data were extracted from medical records on all people who attended the advanced lung disease service at Fiona Stanley Hospital between September 2021 and January 2022. Pulse rate and oxygen saturation (SpO 2) were measured continuously during both tests using a pulse oximeter. Symptoms were quantified using the Borg scale (0 to 10). Result(s): Data were available on 80 participants (43 males;age 64 +/- 10 years;FEV 1 1.65 +/- 0.77 L). Compared with the 6MWT, the 1minSTS resulted in a higher nadir (mean difference [MD] 4%, 95% CI 3 to 5), higher peak pulse rate (MD 8 bpm, 95% CI 5 to 11), similar intensity of dyspnoea (MD -0.3, 95% CI -0.6 to 0.1) and greater leg fatigue (MD 1.1, 95% CI 0.6 to 1.6). Of those who demonstrated severe desaturation (SpO 2 nadir <85%) on the 6MWT (n = 18), 5 and 10 were classified as moderate (SpO 2 nadir 85% to 89%) or mild desaturators (SpO 2 nadir >= 90%), respectively on the 1minSTS. The equation that represented the relationship between 6MWD and 1minSTS was: 6MWD (m) = 247 + (7 x number of transitions achieved during the 1minSTS;r 2 = 0.44). Conclusion(s): The 6MWT elicited greater desaturation, a lower peak pulse rate and greater leg fatigue than the 1minSTS. A smaller proportion of people will be classified as 'severe desaturators' using the 1minSTS test. The capacity to estimate the 6MWD using results of the 1minSTS is limited.

Comparison between in-person and remote assessment of four field tests for people with chronic lung diseases

Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.

Validity and test-retest reliability of field tests carried out by teleassessment of children and adolescents with cystic fibrosis

Background: The COVID-19 pandemic led to the rapid adoption of alternative evaluation methods for measuring functional capacity in people with cystic fibrosis, who are at high risk for severe COVID-19 outcomes. Teleassessment may be an alternative to conducting in-person field tests in this population. Objectives : To investigate the validity, reliability, and safety of field tests conducted by teleassessment in children and adolescents with cystic fibrosis. Method(s): Participants underwent three functional tests: 3-min step test (3-min ST), 1-min sit-to-stand test (1-min StS), and a timed up-and-go (TUG) test performed in their homes with in-person and remote assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation center. The order of the tests was randomized and the same in both assessments. For validity, main outcomes were compared between in-person and remote supervision by Wilcoxon test for 3-min ST and TUG, expressed as median (IQR), and pair t -test for 1-min StS, expressed as mean (SD). For test-retest reliability (test 1 vs. test 2) of the remote tests, intraclass correlation coefficient (ICC 2,1) and Bland-Altman analysis were used. Result(s): Thirty-two participants (15 boys, 11 +/- 3 years, FEV 1 73 +/- 17% of predicted) were included. No significant difference was observed between in-person and remote supervision (3-min ST: 88 [83.5-90] vs. 88 [82.5-90] steps;1-min StS: 33(7) vs. 32(8) repetitions;TUG: 6.5 [5.6-8.0] vs. 6.6 [5.7-7.9] s). Test-retest of remote supervision demonstrated very good to excellent reliability for all field tests (ICC (95%CI) 3-min ST: 0.88 [0.65-0.95], 1-min StS: 0.86 [0.67-0.94], and TUG: 0.76 [0.41-0.89]). Mean difference (lower-upper limits of agreement) were 3-min-ST: -3.6 (-13.9-6.7) steps, 1-min StS: -1.9 (-8.6-4.7) repetitions, and TUG: 0.8 (-1.4-2.9) s. No adverse events were reported. Conclusion(s): In children and adolescent with cystic fibrosis, 3-min ST, 1-min StS, and TUG are valid, reliable and safe when carried out by teleassessment.

Feasibility, Reliability, and Safety of Remote Five Times Sit to Stand Test in Patients with Gastrointestinal Cancer.

Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between July and November 2022 were included. Participants completed the 5STS test both face-to-face and remotely, with the order randomised. Outcomes included measures of feasibility, reliability, and safety. Results: Of fifty-five patients identified, seventeen (30.9%) were not interested, one (1.8%) had no internet coverage, and thirty-seven (67.3%) consented and completed both 5STS tests. The mean (SD) time taken to complete the face-to-face and remote 5STS tests was 9.1 (2.4) and 9.5 (2.3) seconds, respectively. Remote collection by telehealth was feasible, with only two participants (5.4%) having connectivity issues at the start of the remote assessment, but not interfering with the tests. The remote 5STS test showed excellent reliability (ICC = 0.957), with limits of agreement within acceptable ranges and no significant systematic errors observed. No adverse events were observed within either test environment. Conclusions: Remote 5STS for the assessment of functional lower extremity strength in gastrointestinal cancer patients is feasible, reliable, and safe, and can be used in clinical and research settings.

Inadequate Physical Activity Is Associated with Worse Physical Function in a Sample of COVID-19 Survivors with Post-Acute Symptoms.

Background-Patients affected by Long COVID often report shorter times spent doing physical activity (PA) after COVID-19. The aim of the present study was to evaluate potential associations between PA levels and parameters of physical function in a cohort of COVID-19 survivors with post-acute symptoms, with a particular focus on individuals aged 65 and older. Materials and methods-PA levels before and after COVID-19 were assessed in a sample of patients that had recovered from COVID-19 and were admitted to a post-acute outpatient service at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy). Participation in PA was operationalized as the engagement in leisure-time PA for at least 150 min per week in the last 3 months. Self-rated health and measures of physical performance and muscle strength were assessed. Results-Mean age of 1846 participants was 55.2 ± 14.4 years and 47% were women. Before COVID-19, inactivity was detected in 47% of the whole study population; only 28% maintained pre-COVID-19 PA engagement. Inactivity was more frequent in women. The stopping of physical activity was associated with increased BMI and CRP levels, lower vitamin D levels and a higher prevalence of post-COVID-19 fatigue, dyspnea, arthralgia, and myalgia. Active participants had higher handgrip strength and performed better on both the six-minute walking test (6MWT) and at the one-minute sit-to-stand test (1MSTST). In particular, at the 6MWT, participants 65 and older that were still active after COVID-19 walked 32 m more than sedentary peers. Moreover, the distance covered was 28 m more than those who were active only before COVID-19 (p = 0.05). Formerly active subjects performed similarly at the 6MWT to inactive participants. PA was associated with better self-rated health. Conclusions-Our findings reveal that inactivity is frequent in the post-acute COVID-19 phase. Stopping physical activity after COVID-19 results in measures of performance that are comparable to those who were never active. Relevant differences in the distance covered at the 6MWT were found between older active subjects and their sedentary peers.

Post-COVID Assessment of Pulmonary Function and Muscles Strength Test in Healthy Subjects

Introduction: Pulmonary function can be affected in Long COVID Syndrome as long-term health consequences caused by SARS CoV2 infection. Objects: The aim of the study was to evaluate the consequences of SARS-CoV-2 infection on pulmonary function, exercise tolerance and muscle strength in healthy middle age outpatients. Method(s): a retrospective cohort study was carried out at the long-COVID outpatient clinics after 3 month from the last negative PCR test. Pulmonary function tests, diffusion of carbon monoxide (Dlco), 6 Minute Walk Test (6MWT), Handgrip Test (HT), and One Minute Sit to Stand Test (1'STS) were perfomed and only in symptomatic patients chest HRCT was carried out. Subjects included were divided according to age, BMI positive HRCT for pneumonia and comorbidities. Result(s): 89 males and 4 female (age: 49,49 +/- 9,1yrs) were included. Subjects older than 50 yrs or with a positive HRCT had a significantly (p<0,05) lower FVC, DLco, and 6MWT distance compared to younger subjects or subjects with negative or no HRCT. Subjects with a greater BMI (>30) had similar lung function compared to the group with a BMI<=30, but a significantly lower distance at the 6MWT (509m vs 570m, p.<0,05), a lower nadir saturation and a lower number of repetition at the 1'STS. In the all group, the DLco, %pr positively correlates with number of repetition at the 1'STS, the distance at the 6MWT and the strength at the HG. Conclusion(s): These results showed that BMI has an impact on exercise tolerance impairment, age and CT pulmonary involvement due to SARS-CoV-2 infection lead to a spirometric restrictive pattern, while DLco correlates with an impaired exercise tolerance, regardless of the exercise modalities.

Identifiying patients who require respiratory follow up after hospital admission with COVID-19

Introduction: A significant number of patients admitted to hospital with COVID-19 have ongoing functional and radiological deficits which require follow up. Limited data exist to identify these patients, resulting in inefficient healthcare resource utilisation. Aims and objectives: To investigate which clinical characteristics of patients hospitalised with COVID-19 can be used to predict recovery and need for follow up. Method(s): Prospective observational study of 1317 adults with COVID-19 admitted to St Thomas' Hospital, London, UK, between December 2020 and March 2021. All patients were telephoned 5 weeks post-discharge and invited for in-person review if they had ongoing symptoms, or at their request. Clinical characteristics were recorded including duration of inpatient treatment with corticosteroids. Respiratory recovery was defined as no change in MRC dyspnoea score compared to pre-morbid state, no chest radiograph abnormality, and no desaturation during 1- minute sit-to-stand test. Receiver-operator curve analysis was performed to calculate sensitivity, specicifity, positive (PPV) and negative predictive values (NPV). Result(s): 363/519 (70.0%) patients reviewed in-person had recovered at 6 weeks post-hospital discharge. Avoidance of critical care admission predicted recovery (p <0.001), but age and co-morbidity did not. Three days or fewer of steroid treatment was found to be the optimum threshold to predict recovery, with AUC 0.80, NPV 92.0%, and sensitivity 94.5%. Conclusion(s): Patients receiving inpatient treatment for 3 days or fewer have a high probability of respiratory recovery from COVID-19. We propose that this cohort do not require respiratory follow up to be routinely offered.

Validation of the one minute sit to stand test(1MSTS)for identification of exertional oxygen desaturation in chronic respiratory disease

Background: Despite limited validation data (Kalin et al Systematic Reviews 2021 Mar 16;10(1):77), the 1MSTS was widely used as a rapid exercise test to assess exertional oxygen desaturation during the COVID-19 pandemic. Aim(s): To assess the diagnostic accuracy of the 1MSTS to detect significant exertional oxygen desaturation in people with chronic respiratory disease. Method(s): 99 patients referred for pulmonary rehabilitation assessment were assessed for ambulatory oxygen requirements using a shuttle walk test according to British Thoracic Society Guidelines for Home Oxygen Use. Exertional oxygen desaturation was defined as a drop in oxygen saturations (SpO ) of >=4% with nadir <90%. 1MSTS was conducted in each participant by an assessor blinded to ambulatory oxygen assessment results. Result(s): Mean(SD) age 68.9(11.4) years, 59%COPD, 13%ILD. 21% demonstrated significant exertional oxygen desaturation. Using a drop of SpO >=4% to nadir <90% threshold, the 1MSTS only identified 6 out of 21 patients with exertional oxygen desaturation (sensitivity 29%). Simplifying the threshold to a drop in SpO of >=4% alone during 1MSTS improved sensitivity to 81% with specificity of 87%. Conclusion(s): Using a threshold of drop in SpO of >=4%, the 1MSTS test had reasonable sensitivity and specificity identifying significant exertional oxygen desaturation in patients with chronic respiratory disease.

Physical and respiratory function of people following hospital discharge for COVID-19

Background: People following hospital discharge for COVID-19 may experience persisting negative effects of the disease. Investigation of the short and long-term effects are necessary to refer people to appropriate rehabilitation services for functional recovery. Aim(s): To evaluate physical and respiratory function of people with COVID-19 shortly after hospital discharge. Method(s): Assessments were undertaken at three time points: (i) within three weeks following hospital discharge (A1);(ii) at three months (A2);and (iii) six months following discharge (A3). Measures were collected of: fatigue (Fatigue Severity Scale;FSS), lower-limb function (1 minute sit-to-stand test;1-STS), pulmonary function (spirometry), dyspnea (MRC Scale) and physical activity in daily life (PADL) (accelerometry). Result(s): Forty people were included (18[45%] men;55[51-60] years;length of hospital stay: 8+/-6 days;FSS: 54.5[44.2-59];1-STS: 21+/-7;FVC %pred: 87+/-15;FEV1 %pred: 88+/-15;FEV1/FVC (%): 83+/-6;4,284+/-2,460 steps/day;MRC: 3+/-1). There was a: reduction in fatigue from A1 to A2 (mean difference [95% CI] -1.8 [-2,5;-1.2])] and from A1 to A3 (-2.2 [-2.9;-1.4]);an improvement in lower-limb function from A1 to A2 (5.1 [2.2;7,9]) and from A1 to A3 (5.6 [3.18;8]);an improvement in FVC %pred from A1 to A3 (5.9 [1.5;10.2]);and a reduction on dyspnea from A1 to A2 (-1.2 [-0.6;-0.3]) and from A1 to A3 [-1.2 (-0.6;-1,8)]. No change in PADL was found. Conclusion(s): People with COVID-19 post-hospital discharge present fatigue, functional impairment, dyspnea, poor PADL and normal lung function. Improvements in dyspnea, fatigue and lower-limb function were observed at three and six-months follow-up.

Fatigue and functional capacity post COVID-19

Background: We explored if fatigue influenced the long-term functional capacity of patients post COVID-19. Method(s): People after COVID -19, grouped by treatment setting (home - H, hospital ward - HW or intensive care unit - ICU), were studied 12 months after discharge. Fatigue-Functional Chronic Illness Assessment Questionnaire Fatigue Subscale, FACIT-F and functional capacity-6min walk test, 6MWD and 1min sit-to-stand test, 1minSTS were assessed. Groups were compared with one-way ANOVA or Kruskal-Wallis H test. Spearman's rho and multiple regression analyses were performed between fatigue-functional tests. Result(s): 148 subjects (H, n=44;HW, n=60;ICU, n=44) participated. Fatigue was clinically relevant at 12 months although not significantly different among groups [H: 41(35-49);HW: 42(33-50);ICU;42(32-48) points;p=.979). Functional capacity was significantly higher in those treated at home (6MWD: H,626 114m, HW: 527 146m, ICU: 528 129m, p<.001;1minSTS: H,29 11reps, HW: 23 8reps, ICU: 24 8reps, p<.002). Fatigue was significantly correlated with functional tests within each group (FACIT-F-6MWD,.317<rho<=.550, p<.01;FACIT-F-1minSTS, .364<rho<=.485, p<.01). Each point of FACIT-F could change 6MWD by 5-6m and 1minSTS by. 3-.5reps, explaining between 12-33% of change in 6MWD and 17-22% of change in 1minSTS (Table 1). Conclusion(s): Fatigue seems to influence functional capacity of patients post COVID-19. Early management of this symptom seems important for their long-term management.

Comparison of the 1-minute sit-to-stand test with the 6- minutes walk test for the evaluation of the functional status of post-COVID-19 patients

The assessment of functional capacity in severe post-COVID-19 patients, after hospitalization, is essential for estimating functional consequences, disability and exertional desaturation. To date, the 6-minutes walk test (6WMT) and the 1-minute sit-to-stand test (1STST) have been the most commonly used tests. The aim of this study is to investigate the relationship and discuss the utility of the 1STST compared to the 6MWT for follow-up evaluation of the functional status of severe post-COVID-19 patients. A cross-sectional study was performed in a post-COVID-19 public care clinic. A total of 55 patients (mean age: 57.85, SD 12.65) were evaluated. Functional performance was evaluated by 1STST and 6MWT. Both tests were performed 6 months after hospital discharge, on the same day, 1 hour apart. During the tests, the severity of dyspnea (by Modified Borg Scale), heart rate and pulse oxygen saturation (by pulse oximeter) were measured. A significant positive correlation was observed between 1STST and 6MWT (r = 0.30, p =. 026, 95% CI = [0.04, 0.53]). The correlation coefficient between the two tests was 0.30, indicating a moderate effect size. Also, the differences on the severity of dyspnea, heart rate and pulsed oxygen saturation between the two tests were not statistically significant (p =. 061;p =. 169;p =. 965). The 6MWT requires technical execution conditions that are not always easy to meet. Considering the statistically significant relationship between the 1STST and 6MWT, the 1STST may be used for a quick and alternative measurement of the functional assessment in post-COVID-19 patients.

Is pulmonary tele rehabilitation effective and safe for people with respiratory conditions?

Background: COVID-19 caused the temporary suspnsion of outpatient-based pulmonary rehabilitation (PR). Pulmonary telerehabilitation (PTR) became a way of providing exercise training and education for people with respiratory conditions. Aim(s): To determine if PTR was safe and effective for people with respiratory conditions. Method(s): Retrospective observational study. Participants who were referred to PR, had a range of respiratory conditions, had access to Wi-Fi and a home device for videoconferencing. Outcomes were: five time sit-to-stand test (5STS), one minute sit-to-stand test (1MinSTS);St George's Respiratory Questionnaire (SGRQ);COPD assessment test (CAT);Hospital Anxiety and Depression Scale (HADS);Modified Medical Research Council dyspnoea scale (mMRC), adverse events. PTR used a zoom platform, ran for 40 minutes, twice per week for eight weeks, with a maximum of 10 participants in each class. An experienced physiotherapist led the exercise and education sessions with support from physiotherapy students. Result(s): Seventy-five participants (66 females) commenced PTR [mean (SD): Age 67 (11) years, FEV1 63 (20) % pred] and 52 (70%) completed. Statistically significant improvement (mean change (SD) [95% CI]) for 5STS: -4 (7) [-6 to -1] seconds;1MinSTS: 5 (8) [2 to 9] repetitions;SGRQ total: -7 (12) [-11 to -3] points;mMRC: -0.3 (0.7) [-0.6 to -0.7] score;CAT: -2.4 (6) [-4 to -0.5] score with no adverse events were reported. Conclusion(s): Outpatient-based PR remains the gold standard, however PTR could be provided during COVID lockdowns or incorporated into PR programs as a flexible option for people who find it difficult to attend outpatientbased programs.

Pulmonary telerehabilitation in the COVID era - pilot program

COVID-19 has changed healthcare systems and imposed several restrictions on the delivery of pulmonary rehabilitation. To overcome this, telerehabilitation has emerged as a promising strategy. However, little is known about its effectiveness and safety. Aim(s): To present the preliminary results of the efficacy and safety of a pulmonary telerehabilitation program in a Portuguese hospital. Method(s): A pulmonary telerehabilitation program was made available by the hospital center in 2021. An initial face-toface assessment was performed in a multidisciplinary consultation. The program consisted of 3 weekly sessions and lasted 8 weeks, conducted by a rehabilitation nurse via videoconference. Patients received a kit consisting of a tensiometer, oximeter, cycle ergometer, elastic bands, and a Borg Scale. Result(s): From March 2021 to January 2022, 8 patients participated in the program. Improvements were observed in all variables evaluated: muscle strength of the lower limbs (range from19 Kg to 23 Kg) and upper limbs (range from 17 Kg to 19 Kg), 6 Minute Walk Test (range from 376.5 m to 403.5 m), Sit-to-Stand Test 1 Minute (range from 19 stands to 25 stands), Modified Medical Research Council (range from 2 to 3), COPD Assessment Test (range from 18 to 14), London Chest Activity of Daily Living (range from 25 to 19), Hospital Anxiety and Depression Scale (range from 16 to 12). There were no reports of adverse events. Conclusion(s): The threats and challenges posed by the COVID-19 pandemic present the opportunity to reorganize and improve the supply of rehabilitation care. Preliminary results from our program demonstrate that pulmonary telerehabilitation is an effective and safe alternative to traditional face-to-face intervention.

Exercise capacity in one minute sit to stand test and cardiopulmonary exercise test after 90 days of severe Covid 19

Exercise capacity is impaired after severe Covid 19. Exercise tests have different characteristics and are necessary to better understanding the recovery phase. Aim(s): To evaluate the physiological variables in 1 Minute Sit to Stand (1STST) and Cardiopulmonary Exercise Test (CPET) in severe Covid 19 recovery at 90 days after the onset of symptoms. Method(s): We assessed 25 post-severe Covid 19 individuals after 90 days the onset of symptoms. We performed bioelectrial impedance to verify skeletal muscle mass (SMM), hand grip (HG) to determine muscle strength, 1STST and CPET to verify exercise capacity. Result(s): In 1STST, 28% of the sample presented performance below the reference for Brazilian population (Furlanetto, K. et al. Arch Phys Med Rehabil 2022;103(1): 20-28). The impairment was found in 5 first repetitions, as in the number of repetitions performed in 1 minute. The physiological responses of the 1STST proved to be a submaximal test (RER = 0.97). In CPET, we found a maximum effort (RER = 1.22) and peripheral muscle limitation. Performance was reduced in 68% of the individuals. In both tests, good and significant correlations were observed with SMM and HG. Conclusion(s): After 90 days of Covid-19, we still found significant correlations of peripheral muscle disfunction and exercise performance in both tests. Interventions focusing on peripheral muscle rehabilitation might be highly relevant in critical Covid-19.

Effects Of An Early Rehabilitation Program In COVID-19 Patients Weaned From Non-Invasive Mechanical Ventilation: The Experience Of A Respiratory Subintensive Unit

Background: The purpose of the study was to verify the variation of some physiopathological-respiratory parameters, physical performance indicators and the ability to carry out activities of daily living in a group of patients suffering from respiratory failure secondary to SARS-CoV2 pneumonia newly weaned from non-invasive ventilation. Method(s): This study was conducted on 20 patients with SARS-CoV2 pneumonia admitted in a COVID-19 subintensive respiratory unit of Cotugno Hospital in Naples, who have just been weaned from non-invasive mechanical ventilation. The experimental group underwent an early rehabilitation lasting 7 days in addition to a specific medical therapy. Result(s): The intragroup comparison showed in the rehabilitation group an improvement in PaO2/FiO2 ratio, respiratory function physical performance measured by "handgrip test" and by "sit to stand test" (number of repetitions, dyspnoea measured by Borg modified scale, muscular fatigue measured by Borg) and in Barthel Index score. The control group showed an improvement only in PaO2/FiO2 ratio and Bathel Index Score. Conclusion(s): An early rehabilitation program initiated immediately after weaning from NIV is effective in improving gas exchanges, physical performance and daily life activities in a group of patients with respiratory failure secondary to SARS-CoV2 pneumonia.

Is sleep impaired in post-COVID syndrome vs. healthy controls? Preliminary data

Background: People with post-COVID syndrome (PCS) suffer from persisting symptoms, e.g. self-reported sleep disorders (31%). However, sleep has not yet been objectively measured by polysomnography (PSG) in PCS. Objective(s): To examine differences in sleep characteristics between PCS and healthy controls (HC). Method(s): People with PCS and HC were included in this prospective trial. All subjects performed baseline characteristics, 1-minute sit-to-stand test (STST), subjective impairments of sleep and a single night sleep assessment in a sleep lab via PSG and Whoop strap (digital health coach). Post-COVID functional scale (PCFS) and Ordinal Scale for Clinical Improvement (OSCI) were assessed only in PCS. Result(s): To date, 20 PCS patients (49+/-11y, FVC 87+/-12%pred., DLCO: 81+/-19%pred., PCFS: 2.8+/-0.9, OSCI: 2.7+/-1.3pts) and 3 HC (44+/-9y, FVC 92+/-3%pred., DLCO 105+/-25%pred.) completed the trial. Only PCS patients reported an impaired sleep ("Is your sleep impaired since COVID?" [yes: 89%]) mainly due to insomnia in the middle of the night (61%). Total sleep time and the distribution of sleep stages (light, deep, REM) were comparable between PCS and HC. The REM latency trended to be longer in PCS vs. HC (114+/-51 vs. 52+/-17 min.). Apnea-hypopnea index (AHI) trended to be higher in PCS (8.9+/-8.5 vs. 0.9+/-1.2 events/h), 55.6% of PCS reported an AHI>5/h. The individual quality of recovery after the study night was classified to be "adequate" (PCS: 56+/-21%, HC: 52+/-15%). Conclusion(s): In PCS, sleep seems to be subjectively and objectively impaired compared to HC. A significant number of PCS patients (44%) was diagnosed with obstructive sleep apnea. Hence, measuring sleep might be an important diagnostic tool in the management of PCS.

The utility of 1-minute sit-to-stand test to detect exerciseinduced oxygen desaturation in outpatient assessment of post COVID-19 patients

Introduction: The 6-min walk test (6MWT) is the gold standard for assessing exercise-induced impairment of gas exchange, but it is technically challenging in a busy outpatient clinic. The aim of this study was to compare the 1-min sit-to-stand test (1STST) with the 6MWT in assessment of exercise-induced oxygen desaturation in post COVID-19 patients in an outpatient setting. Method(s): A total of 447 outpatient post COVID-19 patients were recruited from post COVID-19 clinic. Both 6MWT and 1STST (a set) were performed on the same day including pulse oxygen saturation (SpO2) recording at baseline, nadir, and recovery stage. Result(s): A total of 447 sets were performed at a mean of 160 days post discharge. Majority were in category severe (n=251, 56%), critical (n=118, 26%) and moderate (n=6, 15%). At assessment, most patients were symptomatic (mMRC > 2) n= 258, 58%. There was no significant difference between nadir SpO2 for 6MWT and 1STST (p<0.075) with Bland-Altman plots showing good agreement, p<0.593 (figure 1). There was good correlation between SpO2 and 6MWT or 1STST at baseline;R=0.592 p<0.001, nadir;R=0.456 p<0.001, and recovery;R= 0.514 p<001. 1STST had 76.8% sensitivity and 42.4% specificity to detect > 4% oxygen desaturation compared with 6MWT (table 1). There was also correlation between 6MWT distance and 1STST repetition;R=0.144 p<0.002. Conclusion(s): Both 6MWT and 1STS have good agreement on nadir SpO2 and are sensitive to detect > 4% oxygen desaturation. Therefore, 1STST is an useful screening test to detect exercise-induced oxygen desaturation during outpatient assessment.