Financial Burden and Shortage of Respiratory Rehabilitation for SARS-CoV-2 Survivors: The Next Step of the Pandemic?

We read with great enthusiasm the recent article by Daynes et al [...]

Đánh giá hiệu quả phục hồi chức năng hô hấp trên bệnh nhân Covid-19

TÓM TẮT Đặt vấn đề: Bệnh nhân Covid-19 cần kết hợp nhiều phương pháp điều trị trong có phục hồi chức năng hô hấp. Nghiên cứu này giúp đánh giá hiệu quả của Chương trình Phục hồi chức năng (PHCN) hô hấp ở bệnh nhân Covid-19 nặng và nguy kịch. Đối tượng và phương pháp: Nghiên cứu tiến cứu trên mẫu thuận tiện gồm 65 bệnh nhân được chẩn đoán Viêm phổi do Covid-19 mức độ nặng, nguy kịch được điều trị cải thiện tại Trung tâm Hồi sức Tích cực Bệnh viện Trung Ương Huế tại TP Hồ Chí Minh. Đánh giá lại khả năng hồi phục của bệnh nhân sau 1 tuần dựa trên chỉ số SpO2, thang điểm khó thở Borg và thang điểm độc lập sinh hoạt Barthel. So sánh hiệu quả hồi phục chức năng hô hấp chọn kiểm định tổng hạng Wilcoxon. Kết quả: Tuổi nhỏ nhất là 19 tuổi, lớn nhất là 93 tuổi, nhóm bệnh có độ tuổi 50 - 59 chiếm tỷ lệ nhiều nhất, chiếm 29.2 %. Tỷ lệ mắc bệnh ở nữ lớn hơn nam (tương ứng 56,9% và 43,1%). Thời gian đang nằm viện ngắn nhất là 6 ngày, dài nhất là 47 ngày. Các bệnh nhân được tiến hành tập PHCN hô hấp ngay từ đầu khi mới vào viện và suốt quá trình bệnh nằm viện. Tăng huyết áp là yếu tố bệnh nền hay gặp nhất chiếm 61,8%. Các biện pháp hỗ trợ thông khí hay liệu pháp oxy thì sử dụng mask cannula là chủ yếu chiếm 96,5%. SpO2 tăng 98% (95,5 - 99%) lên 99% (97 - 100%) có ý nghĩa thống kê với p < 0.05. Thang điểm khó thở Borg giảm từ 2 (1 - 4) xuống 1 (0,5 - 2) có ý nghĩa thống kê với p < 0,05. Thang điểm độc lập chức năng sinh hoạt Barthel tăng từ 80 (67,5 - 100) lên 100 (80 - 100), có ý nghĩa thống kê với p < 0,05. Kết luận: Chương trình phục hồi chức năng hô hấp góp phần thúc đẩy sự hồi phục của bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF PULMONARY REHABILITATION IN COVID-19 PATIENTS Background: Covid-19 patients need a combination of treatment methods, including respiratory rehabilitation. This study aims to evaluate the effectiveness of the Respiratory Rehabilitation Program in Covid-19 patients. Methods: A cross - sectional descriptivestudy was carried out in 65 patients with severe and critical Covid-19 pneumonia who were receiving improved treatments at the Intensive Care Center of Hue Central Hospital in Ho Chi Minh City. The patient’s ability to recover after one week was re - evaluated based on SpO2 index, Borg dyspnea scale and Barthel’s independent life scale. The effectiveness of respiratory rehabilitation was compared using the Wilcoxon sum test. Results: The age ranged from 19 to 93 years. The age group from 50 to 59 years old was made up the largest proportion, accounting for 29.2%. The prevalence was higher in women than men (56.9% vs. 43.1%, respectively). The shortest hospital stay was six days, and the longest was 47 days. The patients experienced respiratory rehabilitation exercises from the beginning when they were admitted to the hospital and throughout their stay. Hypertension was the most common underlying disease factor, accounting for 61.8%. Ventilation support measured or oxygen therapy using mask cannula is the main factor accounting for 96.5%. SpO2 statistically increased from 98% (95.5 - 99%) to 99% (97 - 100%) (p < 0.05). The Borg dyspnea scale statistically decreased from 2 (1 - 4) to 1 (0.5 - 2) (p < 0.05). Barthel’s independent functional - life scale statistically increased from 80 (67,5 - 100) to 100 (80 - 100) (p < 0.05). Conclusion: Respiratory rehabilitation program contributes to the recovery of Covid-19 patients Keywords: Respiratory, rehabilitation, Covid-19.

Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a protocol for a systematic review and meta-analysis

IntroductionRespiratory rehabilitation is the use of exercise, education, and behavioural interventions to alleviate symptoms and improve quality of life. Recent studies highlight that respiratory rehabilitation is effective and safe for patients with COVID-19. We aim to evaluate the effectiveness and feasibility of respiratory telerehabilitation on patients infected with COVID-19 by conducting a systematic review and meta-analysis.Methods and analysisPubMed, Web of Science, Science Direct, Physiotherapy Evidence Database, Google Scholar and Cochrane Library databases will be searched from inception to the end of November 2021. Randomised controlled trials investigating the effectiveness of telerehabilitation in the management of COVID-19 will be included. The primary outcomes will be functional capacity, cardiopulmonary exercise tests and quality of life. Secondary outcomes will include anxiety/depression level, sleep quality, mortality rate, completion rate, reason for withdrawal, adverse events, service satisfaction, cost-effectiveness and other potential factors. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. Review Manager V.5.4 (Cochrane Collaboration) software will be used for statistical analysis. Heterogeneity will be analysed using I² statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables.Ethics and disseminationEthical approval is not required because this systematic review and meta-analysis is based on previously published data. Final result will be published in peer-reviewed journal and presented at relevant conferences and events.PROSPERO registration numberCRD42021287975.

INSPIRATORY MUSCLES TRAINING: AN EFFECTIVE WAY TO IMPROVE POST-OPERATIVE OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING

Cardiovascular diseases (CVD) are the leading cause of death worldwide. It is a multifactorial disease and has many risk factors including hypertension, diabetes mellitus, physical inactivity and smoking. Coronary artery disease (CAD) is one of the consequences of CVD.1 If we talk about CAD, it is a really common heart disease in our country, also known as ischemic heart disease and develops when coronary arteries or its sub-branches which are the blood supply of the heart become narrowed or blocked due to accumulation of plaque leading to an impaired supply of oxygen rich blood to the heart and thus cause retrosternal chest pain typically known as angina that is accompanied by dyspnea.2 Coronary artery bypass grafting (CABG) is generally the ideal treatment option for the individuals suffering from CAD. In this procedure, an auto-graft of vessel is taken and the commonly used vessels are left internal thoracic artery and great saphenous vein. The graft is sutured in such a way that the blocked coronary artery is bypassed and the blood supply to the heart is restored.3 Although medical sciences have advanced a lot, yet the prevalence of post-operative complications, specifically the respiratory ones pose an immediate threat to the survival and are the aiding factors to mortality and morbidity.4 Physical therapy after any surgery plays a pivotal role in improving the post-operative outcomes and helps the patient fight the effects of surgery. It makes a patient return to his or her normal life and helps in the early discharge of patients from hospitals thus preventing the chances of hospital acquired infections and reducing the financial load on masses.5 Respiratory rehabilitation, which is the specialty of physical therapy, have tremendous positive effects on the pulmonary compliance and function by preventing the post-operative pulmonary atelectasis.6 Moving further towards the components of respiratory rehabilitation, a group of breathing maneuvers conjointly known as inspiratory muscles training (IMT), if applied pre-operatively to the patients who are scheduled to undergo the coronary artery by-pass grafting displayed healthy post-operative outcomes.7 To conclude, it is the dire need of today to raise awareness among the health care professionals especially cardiologists and cardio-thoracic surgeons; and the general public regarding the pre-operative respiratory physical therapy for the patients planned to go through CABG. So, in the light of supported evidence, it is proved that respiratory physical therapy, particularly pre-operative IMT has positive outcomes in post-operative state. Moreover, the authors would also like to shed light on the facts about the healthcare policies and physical therapy services in Pakistan. Contrary to public sector hospitals, the rehabilitation departments in private sector hospitals are properly managed, substantially equipped and well established, leading to enhanced quality of physical therapy practices that result in better prognosis of the patients. The health department of our country should also emphasize on the public sector hospitals to make necessary arrangements for logistics of sufficient equipment and the hiring of physical therapists that are qualified and specialized in the field of cardiopulmonary physical therapy.

Respiratory rehabilitation for patients with COVID-19 infection and chronic respiratory failure: a real-life retrospective study by a Lombard network

The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1st 2020 to March 1st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low. At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.

Haloaerosoltherapy: Mechanisms of Curative Effect and Place in the Respiratory Rehabilitation

Introduction. Management of patients with chronic pathology requires development of long-term programs with organic combinations of medicamental and non-medicamental influences. Haloaerosoltherapy is a group inhalation of rock salt aerosol with concentration of more than 2-3mg/m3 and certain dispersion (with presence of large-, medium- and small-grained aerosol) aboveground. Material and method. On the basis of literature data review and results of own researches a comprehensive description of haloaerosoltherapy, its mechanisms, available technologies, indications and effectiveness at pulmonary pathology was given. Results and discussion. Basis of haloaerosol curative influence is hyperosmolar stimulus that improves drainage function of bronchi and provides sanitizing effect, which causes further changes at local and systemic levels. This justifies haloaerosoltherapy usage as method of rehabilitation treatment. Comparison of haloaerosoltherapy and other methods of halotherapy (use of halite), in particular, "salt rooms (caves)" was made. It has been proven that "salt rooms" can be used only as spa procedure. Conclusions. Application of term "halotherapy" to all methods that use halite or underground treatment is incorrect. This determines necessity for stop using this term. It is necessary to differentiate clearly applied methods of treatment using terms that reflect the essence of therapeutic effect. Haloaerosoltherapy should be considered a method of respiratory rehabilitation with a proven mechanism of action and effectiveness. Haloaerosol is obtained using specific devices - halogenegenerators. The effectiveness of haloaerosoltherapy immediately after the course of treatment and in remote period is testified. Keywords: Respiratory rehabilitation, halotherapy, haloaerosoltherapy, speleotherapy,

Exercise Intolerance and Oxygen Desaturation in Patients with Parkinson’s Disease: Triggers for Respiratory Rehabilitation?

The role that oxygen desaturation plays in exercise tolerance and its rehabilitative implications in patients with Parkinson’s disease (PD) are unclear. We aimed to test exercise tolerance and oxygen saturation levels both during exercise and at night in PD patients to better define their rehabilitative needs. In clinically stable PD patients, undergoing inpatient rehabilitation, and in “ON” phase, we prospectively assessed clinical data, sleepiness, comorbidities, PD severity (Hoehn&Yahr, HY), motor function (ADLs, UPDRSII and UPDRSIII, Barthel Index, Functional Independence Measure), balance, spirometry, respiratory muscles (MIP/MEP), peak cough expiratory flow (PCEF), continuous night oxygen monitoring, and meters at 6MWD. Of 55 patients analyzed (28 with moderate–severe PD, HY ≥ 2.5), 37% and 23% showed moderate–severe impairment on UPDRSII and UPDRSIII, respectively; 96% had reduced exercise tolerance and severe respiratory muscles impairment (MIP/MEP < 45%pred.); 21.8% showed desaturations during exercise; and 12.7% showed nocturnal desaturations. At multiple regression, low exercise tolerance and low mean nocturnal and exercise-induced saturation correlated with several respiratory and motor function and disability indices (all p < 0.03). Exercise tolerance, exercise-induced desaturations, and nocturnal desaturations were extremely frequent in PD patients and were worse in more severe PD patients. This suggests considering a combined role for motor and respiratory rehabilitation in these patients.

The Aftermath of the COVID-19 Crisis in Saudi Arabia: Respiratory Rehabilitation Recommendations by Physical Therapists

Since late 2019, the number of COVID-19 patients has gradually increased in certain regions as consecutive waves of infections hit countries. Whenever this wave hits the corresponding areas, the entire healthcare system must respond quickly to curb the diseases, morbidities, and mortalities in intensive care settings. The healthcare team involved in COVID-19 patients’ care must work tirelessly without having breaks. Our understanding of COVID-19 is limited as new challenges emerge with new COVID-19 variants appearing in different world regions. Though medical therapies are finding solutions to deal with the disease, there are few recommendations for respiratory rehabilitation therapies. A group of respiratory rehabilitation care professionals in Saudi Arabia and international experts have agreed with the World Health bodies such as the World Health Organization (WHO) on the treatment and rehabilitation of patients with COVID-19. Professionals participating in COVID-19 patient treatment, rehabilitation, and recovery formulated respiratory rehabilitation guidelines based on the DELPHI Method, combining scientific research and personal practical experience. As a result, it is envisaged that the number of individuals in the region suffering from respiratory ailments due to post-COVID-19 will decrease. This narrative review and clinical expertise guidelines may give physiotherapists acceptable and standard clinical guideline protocols for treating COVID-19 patients.