Applying the WHO ICF framework to long COVID patients with persistent respiratory symptoms.

Objectives: The aim of this study was to evaluate long COVID patients with persistent respiratory symptoms through the application of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework. Patients and methods: This national, prospective, multicenter, cross-sectional study was conducted with 213 patients (118 females, 95 males; median age 56 years; range, 20 to 85 years) with long COVID between February 2022 and November 2022. The ICF data were primarily collected through patient interviews and from the acute medical management records, physical examination findings, rehabilitation outcomes, and laboratory test results. Each parameter was linked to the Component Body Functions (CBF), the Component Body Structures (CBS), the Component Activities and Participation (CAP), the Component Environmental Factors (CEF), and Personal Factors according to the ICF linking rules. Analysis was made of the frequency of the problems encountered at each level of ICF category and by what percentage of the patient sample. Results: In the ICF, 21 categories for CBF, 1 category for CBS, and 18 categories of CAP were reported as a significant problem in a Turkish population of long COVID patients with persistent respiratory symptoms. Furthermore, eight categories for CEF were described as a facilitator, and four as a barrier. Conclusion: These results can be of guidance and provide insight into the identification of health and health-related conditions of long COVID patients with persistent respiratory symptoms beyond the pathophysiological aspects, organ involvement, and damage of COVID-19. The ICF can be used in patients with long COVID to describe the types and magnitude of impairments, restrictions, special needs, and complications.

COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.

Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

The effects of COVID-19 on Physical Medicine and Rehabilitation in Turkey in the first month of pandemic.

OBJECTIVES: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. PATIENTS AND METHODS: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. RESULTS: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2±128.5 per week before the pandemic, it significantly decreased to 23.4±33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7±39.3 per week to 2.5±10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. CONCLUSION: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?

PURPOSE: This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels. PATIENTS AND METHODS: Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared. RESULTS: The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively). CONCLUSION: In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.

Pregabalin treatment of three cases with brachioradial pruritus.

Brachioradial pruritus (BRP) is a rare type of chronic pruritus that usually localized at the dorsolateral part of the forearms. Itching, burning, or pain are common symptoms at the involved areas. The etiological factors are still unknown but sun exposure and/or cervical spine lesions seem to be trigerring or precipiting factors. Neuropathogenic mechanism plays role in etiopathogenesis of BRP, therefore, antiepileptic drugs such as gabapentin, oxcarbazepine. and pregabalin are suggested medications for BRP. Herein, we report three cases with BRP successfully treated with pregabaline.