'Brain fog', guilt, and gratitude: experiences of symptoms and life changes in older survivors 6 months after hospitalisation for COVID-19.

PURPOSE: Several of those who have been infected with COVID-19 suffer from the post-COVID-19 condition months after the acute infection. Little is known about how older survivors have experienced the consequences and how these have affected their lives. The aim of this study was to explore how older survivors experienced post-COVID-19 condition and life changes approximately 6 months after hospitalisation for COVID-19. METHODS: The study had an explorative and descriptive design. Semi-structured interviews were performed with 17 participants from two local hospitals, 11 men and 6 women, aged 60 years and older (age range 60-96), approximately 6 months after hospitalisation for COVID-19. A thematic descriptive analysis inspired by Braun and Clarke was used. RESULTS: Two main themes and seven subthemes were revealed. The main themes were: From few to various persistent symptoms and Existential thoughts and reflections. Most of the participants experienced various physical and/or cognitive symptoms, such as reduced physical fitness, heavy breathing, fatigue, and 'brain fog'. On the other hand, they also experienced guilt and gratitude for having survived. The recognition of having achieved other life perspectives was also present. CONCLUSION: Six months after undergone COVID-19 the participants still experienced various distressing symptoms, which were in line with larger studies. The novel findings of this study were connected to the existential area, where the patients' thoughts and reflections of guilt, gratitude, and new life perspectives were revealed. These findings are important for health professionals to consider when treating patients after COVID-19.

Effect of an additional health-professional-led exercise programme on clinical health outcomes after hip fracture.

PURPOSE: To examine the effect of an additional 2-week health professional-led functional exercise programme compared to usual care for patients after hip fracture during a short-term nursing home stay directly after hospital discharge. METHOD: One hundred and forty participants, 65 years or older with hip fracture, admitted to a short-term nursing home stay were randomised to an intervention group or control group. Participants in the intervention group (n = 78) received the experimental programme consisted of functional exercises, performed by health care professionals up to four times a day, 7 days a week, in addition to usual care during a 2-week short-term nursing home stay. Participants in the control group (n = 62) received usual care alone. Primary outcome was Short Physical Performance Battery (SPPB). Secondary outcomes were Timed Up & Go, New Mobility Score, The University of California, Los Angeles Activity Scale, Fall Efficacy Scale International, The EuroQol five dimension five-level questionnaire, and Numeric Rating Scale for pain. Outcome measures were assessed after 2 weeks in a short-term nursing home stay and 3 months after hip fracture surgery. The activity monitor ActivPal registered activity during the 2-week short-term nursing home stay. RESULTS: No statistically significant differences between groups was found in any outcomes after 2 weeks or 3 months (p > 0.05). There were statistically significant within-group improvements in primary outcome SPPB and in most secondary outcomes at all time points in both groups (p > 0.05). CONCLUSIONS: A 2-week health professional-led functional exercise programme in addition to usual care demonstrated no difference in clinical outcomes compared to usual care alone up to 3 months after hip fracture. The patients with hip fracture are fragile and vulnerable in this early phase, and usual physiotherapy may be sufficient to improve their physical function. TRIAL REGISTRATION: ClinicalTrials.gov NCT02780076.

Effect of exercise interventions in the early phase to improve physical function after hip fracture - A systematic review and meta-analysis.

BACKGROUND: The efficacy of exercise interventions in the early recovery phase, i.e. started within the first three months after hip fracture, has been poorly studied compared to prolonged exercise interventions. OBJECTIVE: To examine the effect of exercise interventions to improve physical function in the early phase after hip fracture. DATA SOURCES: Seven databases including MEDLINE via Ovid, The Cochrane Library, Embase, Cinahl, Pedro, AMED and Web of Science were comprehensively searched till December 2019. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) of exercise interventions initiated within the first three months after hip fracture to improve physical function, were eligible for inclusion. Primary outcome was physical function assessed using walking ability, walking speed, balance, muscle strength, mobility, and endurance. DATA EXTRACTION AND DATA SYNTHESIS: We conducted subgroup analyses specifically to investigate outcomes of these individual measurements. A meta-analysis was conducted to examine the overall effect of early exercise interventions. A meta-regression was conducted to examine the impact of study characteristic on exercise interventions. We used the PEDro score to determine quality of the included studies. RESULTS: Nine studies (669 patients) were included. Despite high statistical heterogeneity, there was high to moderate quality evidence that exercise provided benefit in improving physical function (standardised mean difference (SMD) 1.07; 95% CI: 0.44 to 1.70; p<0.001). There was no statistically significant difference in outcome, when measured by the individual physical function outcome (p>0.05). Meta-regression demonstrated no statistically significant association between study characteristics and exercise interventions (p>0.05). CONCLUSION: Exercise in the early phase of hip fracture rehabilitation can improve physical function. It remains unclear what type of exercise is superior in the early phase after hip fracture. LIMITATIONS: This conclusion should be interpreted with caution given the high statistical heterogeneity reported and non-significant subgroup analyses of specific physical function measures, which were underpowered. Protocol Registration (PROSPERO): CRD42018091135.

Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five-Year Followup of a Randomized Controlled Trial.

OBJECTIVE: To examine whether the 1-year effects from a previous walking skill training program on walking and stair climbing still persist 5 years following total hip arthroplasty (THA), to examine recovery of physical functioning from before to 5 years after surgery, and to identify predictors of physical activity 5 years after THA from preoperative measures. METHODS: We performed a 5-year followup of a randomized controlled trial and a longitudinal study. Sixty participants with a mean age of 70 years (range 50-87 years; 95% confidence interval 68, 72 years) were assessed. Outcome measures were the 6-minute walk test, the stair climbing test (SCT), active hip range of motion (ROM), self-efficacy, Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and University of California, Los Angeles (UCLA) activity scale. Data were analyzed by Student's t-tests, generalized linear model, and multivariate regression analyses. RESULTS: The training and control groups were approximately equal on outcome measures of physical functioning, pain, and self-efficacy at 5 years (P > 0.05). In the total group, the recovery course was unchanged from 1 to 5 years (P > 0.05), except for 9% improvement in ROM (P < 0.001) and an increase in time on SCT of 18% (P = 0.004). Preoperative HOOS pain (P = 0.022) and HOOS sport (P = 0.019) predicted UCLA activity scale 5 years after THA. CONCLUSION: At 5 years after THA, the control group had caught up with the training group on physical functioning, and the participants led an active lifestyle. Those with worse preoperative scores on pain and physical functioning in sport were at risk of being less physically active in the long term following THA.