Functional Improvements Observed in Long-Covid Patients Following Participation in Pulmonary Rehabilitation

ABSTRACT

PURPOSE/HYPOTHESIS: Some patients with COVID-19 have physical impairments that last well beyond the acute infection, termed long-COVID. An increasing number of patients experiencing ongoing symptoms are being referred to outpatient Pulmonary Rehabilitation (PR) with a growing understanding of their key limitations and the benefits of PR. Patients with long- COVID often present with significant inspiratory muscle weakness and functional limitations even months after infection and benefit from PR and IMT. The purpose of this study was to examine the impact of PR on inspiratory muscle performance (IMP) and several functional performance measures (FPM), as well as COPD Assessment Tool (CAT), quality of life (QOL) and depression (D) screening. NUMBER OF SUBJECTS: Eight patients (3 male and 5 female, age 51 +/- 15, BMI 32 +/- 6) diagnosed with long- COVID-19. MATERIALS AND METHODS: Twenty-two patients with long-COVID entered PR but only 8 patients successfully completed the program. The PR program included aerobic exercise, strength training, IMT, and education. Of the 22 patients who started PR, 64% dropped out due to a variety of reasons. IMP was examined via the PrO2 from residual volume providing the maximal inspiratory pressure (MIP) at 1 to 2 seconds of inspiration and the sustained maximal inspiratory pressure (SMIP) from MIP to total lung capacity. The 6-minute walk test (6MWT), timed-up-and-go (TUG), BERG balance test (BERG), 5x-sit-to-stand (5xSS), Patient Health Questionnaire (PHQ9), Ferrans & Powers QOL, and CAT were measured using standardized methods. Wilcoxon Signed Rank Tests were computed before and after PR with statistical significance set at P< 05. RESULT(S) No significant difference in any outcome measure was found when comparing completers to non-completers of PR. Significant (P< 05) improvements in the SMIP (198.1 +/- 61.5-286.8 +/- 130.7 PTU), 6MWT (313 +/- 103-451 +/- 101 m), TUG (7.7 +/- 2.3-6.2 +/- 1.1 s), 5xSS (13.0 +/- 3.2-10.5 +/- 1.5 s) and QOL (21.2 +/- 3.6-24.8 +/- 2.4) were observed, while non-significant changes were observed in PHQ9 (7.3 +/- 5.6-6.5 +/- 5.1), BERG (52.7 +/- 6.7-55.8 +/- 0.4), MIP (69.9 +/- 17.2-84.8 +/- 27.7 cmH2O), and CAT (22.2 +/- 7.7-19.8 +/- 7.9) following PR. At baseline, SMIP but not MIP was significantly (P< 05) lower than predicted values (41 +/- 11% and 76 +/- 20%) but following PR the difference from predicted was no longer significant. CONCLUSION(S) Only 36% of patients with long-COVID who were referred to and initiated PR successfully completed the program. Following PR, patients demonstrated significant improvements in inspiratory muscle endurance, functional performance, and self-reported QOL, with non-significant improvements in balance and self-reported symptoms, confidence with activity, and depression. CLINICAL RELEVANCE IMP and FPM are significantly impaired in patients with long-COVID. PR has been shown to significantly improve many respiratory, functional performance, and psychosocial outcome measures and should be considered as part of the plan of care for these patients. Furthermore, methods to improve adherence to PR in patients with long-COVID are needed.