Randomized controlled trial of home-based vs. hospital-based pulmonary rehabilitation in post COVID-19 patients

Jean-Marc Vallier, Charles Simon, Antoine Bronstein, Maxence Dumont, Asmaa Jobic, Nicolas Paleiron, Laurent Mely, Jean-Marc Vallier, Charles Simon, Antoine Bronstein, Maxence Dumont, Asmaa Jobic, Nicolas Paleiron, Laurent Mely

Abstract

Background: Between 30% and 60% of people who have been infected with COVID-19 still had symptoms 3 months after the start of the disease. Prescribing a pulmonary rehabilitation program in rehabilitation facilities for post COVID-19 patients could help alleviate the symptoms. However, rehabilitation facilities known to provide good quality care to COVID-19 patients and all other patients, could become saturated by the rise in cases. Home-based rehabilitation is a potential solution that could be sustainable in the long term to avoid this saturation and/or a very long waiting list for patients.

Aim: The aim of this study was to investigate whether home-based rehabilitation would have similar effects compared to inpatient rehabilitation on physical and respiratory variables in post COVID-19 patients.

Design: This is a randomized controlled trial.

Setting: Pulmonary rehabilitation facility.

Population: Seventeen post COVID-19 patients were randomized into two groups: inpatient pulmonary rehabilitation (IPR) or home-based pulmonary rehabilitation (HPR).

Methods: The comparison of the two rehabilitation methods relied on questionnaires, physical tests and the evaluation of several respiratory parameters. A 2-way Analysis of Variance (ANOVA) with repeated measures was performed to assess the effects of time (pre- vs. post-rehabilitation), group (IPR vs. HPR) and their interaction for all parameters.

Results: The main result of this study is that distance covered in the 6MWT (6MWD) shows significant improvements, between pre- and postrehabilitation program in both groups (+95 m in IPR group vs.+72 m in HPR group, P<0.001) with no significant interaction between time and group (P=0.420).

Conclusions: These results suggest that home-based pulmonary rehabilitation would be as efficient as IPR to decrease physical sequelae in post COVID-19 patients.

Clinical rehabilitation impact: It is possible to suggest both methods (home-based rehabilitation or inpatient pulmonary rehabilitation) according to the specificities of each patient and depending on hospital saturation. The choice of one or the other method should not be made to the detriment of the patient.

Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

References

    1. Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol 2020;49:717–26. 10.1093/ije/dyaa033
    1. Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health 2020;25:278–80. 10.1111/tmi.13383
    1. Daher A, Balfanz P, Cornelissen C, Müller A, Bergs I, Marx N, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae. Respir Med 2020;174:106197. 10.1016/j.rmed.2020.106197
    1. Van den Borst B, Peters JB, Brink M, Schoon Y, Bleeker-Rovers CP, Schers H, et al. Comprehensive health assessment three months after recovery from acute Corona Disease 2019 (COVID-19). Clin Infect Dis 2021;73:1089–98. 10.1093/cid/ciaa1750
    1. Negrini F, de Sire A, Andrenelli E, Lazzarini SG, Patrini M, Ceravolo MG; International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Rehabilitation and COVID-19: update of the rapid living systematic review by Cochrane Rehabilitation Field as of December 31st, 2021. Eur J Phys Rehabil Med 2022;58:328–31. 10.23736/S1973-9087.22.07497-4
    1. de Sire A, Andrenelli E, Negrini F, Lazzarini SG, Cordani C, Ceravolo MG, International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER Action . Rehabilitation and COVID-19: update of the rapid living systematic review by Cochrane Rehabilitation Field as of February 28th, 2022. Eur J Phys Rehabil Med 2022;58:498–501. 10.23736/S1973-9087.22.07593-1
    1. Thomas M, Price OJ, Hull JH. Pulmonary function and COVID-19. Curr Opin Physiol 2021;21:29–35. 10.1016/j.cophys.2021.03.005
    1. Spagnolo P, Balestro E, Aliberti S, Cocconcelli E, Biondini D, Casa GD, et al. Pulmonary fibrosis secondary to COVID-19: a call to arms? Lancet Respir Med 2020;8:750–2. 10.1016/S2213-2600(20)30222-8
    1. Curci C, Pisano F, Bonacci E, Camozzi DM, Ceravolo C, Bergonzi R, et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med 2020;56:633–41. 10.23736/S1973-9087.20.06339-X
    1. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract 2020;39:101166. 10.1016/j.ctcp.2020.101166
    1. Nopp S, Moik F, Klok FA, Gattinger D, Petrovic M, Vonbank K, et al. Outpatient Pulmonary Rehabilitation in Patients with Long COVID Improves Exercise Capacity, Functional Status, Dyspnea, Fatigue, and Quality of Life. Respiration 2022;101:593–601. 10.1159/000522118
    1. Thornton J. Covid-19: the challenge of patient rehabilitation after intensive care. BMJ 2020;369:m1787. 10.1136/bmj.m1787
    1. Andrenelli E, Negrini F, de Sire A, Arienti C, Patrini M, Negrini S, et al. ; International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020. Eur J Phys Rehabil Med 2020;56:508–14.
    1. Cristinziano M, Assenza C, Antenore C, Pellicciari L, Foti C, Morelli D. Telerehabilitation during COVID-19 lockdown and gross motor function in cerebral palsy: an observational study. Eur J Phys Rehabil Med 2022;58:592–7.
    1. LA Rosa G , Frizziero A, Roi GS. Musculoskeletal telerehabilitation experience during the 70 days of COVID-19 lockdown in Italy. Eur J Phys Rehabil Med 2022;58:151–3. 10.23736/S1973-9087.21.07169-0
    1. Selzler AM, Wald J, Sedeno M, Jourdain T, Janaudis-Ferreira T, Goldstein R, et al. Telehealth pulmonary rehabilitation: A review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation. Chron Respir Dis 2018;15:41–7. 10.1177/1479972317724570
    1. Bhatt SP, Baugh D, Hitchcock J, Kim YI, Cutter G, Aban I, et al. Video telehealth pulmonary rehabilitation for chronic obstructive pulmonary disease is associated with clinical improvement similar to center-based pulmonary rehabilitation. Ann Am Thorac Soc 2022;19:331–3. 10.1513/AnnalsATS.202104-419RL
    1. Bickton FM, Chisati E, Rylance J, Morton B. An Improvised Pulmonary Telerehabilitation Program for Postacute COVID-19 Patients Would Be Feasible and Acceptable in a Low-Resource Setting. Am J Phys Med Rehabil 2021;100:209–12. 10.1097/PHM.0000000000001666
    1. Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J Gastrointest Surg 2020;24:1692–7. 10.1007/s11605-020-04623-5
    1. Tsutsui M, Gerayeli F, Sin DD. Pulmonary Rehabilitation in a Post-COVID-19 World: Telerehabilitation as a New Standard in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2021;16:379–91. 10.2147/COPD.S263031
    1. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347–65. 10.1164/rccm.201204-0596PP
    1. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995;39:315–25. 10.1016/0022-3999(94)00125-O
    1. Ninot G, Soyez F, Fiocco S, Nassih K, Morin AJ, Prefaut C. [The VQ11, a short health-related quality of life questionnaire for routine practice in COPD patients]. Rev Mal Respir 2010;27:472–81. [French].
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories . ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–7. 10.1164/ajrccm.166.1.at1102
    1. Vaidya T, Chambellan A, de Bisschop C. Sit-to-stand tests for COPD: A literature review. Respir Med 2017;128:70–7. 10.1016/j.rmed.2017.05.003
    1. Brooks ER, Benson AC, Bruce LM. Novel technologies found to be valid and reliable for the measurement of vertical jump height with jump-and-reach testing. J Strength Cond Res 2018;32:2838–45. 10.1519/JSC.0000000000002790
    1. Laviolette L, Bourbeau J, Bernard S, Lacasse Y, Pepin V, Breton MJ, et al. Assessing the impact of pulmonary rehabilitation on functional status in COPD. Thorax 2008;63:115–21.
    1. Ozalevli S, Ozden A, Itil O, Akkoclu A. Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med 2007;101:286–93. 10.1016/j.rmed.2006.05.007
    1. Crook S, Büsching G, Schultz K, Lehbert N, Jelusic D, Keusch S, et al. A multicentre validation of the 1-min sit-to-stand test in patients with COPD. Eur Respir J 2017;49:1601871. 10.1183/13993003.01871-2016
    1. Markovic G, Dizdar D, Jukic I, Cardinale M. Reliability and factorial validity of squat and countermovement jump tests. J Strength Cond Res 2004;18:551–5.
    1. O’Donnell DE, McGuire M, Samis L, Webb KA. The impact of exercise reconditioning on breathlessness in severe chronic airflow limitation. Am J Respir Crit Care Med 1995;152:2005–13. 10.1164/ajrccm.152.6.8520769
    1. Gloeckl R, Leitl D, Jarosch I, Schneeberger T, Nell C, Stenzel N, et al. Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study. ERJ Open Res 2021;7:00108–02021. 10.1183/23120541.00108-2021
    1. Incorvaia C, Russo A, Foresi A, Berra D, Elia R, Passalacqua G, et al. Effects of pulmonary rehabilitation on lung function in chronic obstructive pulmonary disease: the FIRST study. Eur J Phys Rehabil Med 2014;50:419–26.
    1. Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical medicine and rehabilitation and pulmonary rehabilitation for COVID-19. Am J Phys Med Rehabil 2020;99:769–74. 10.1097/PHM.0000000000001505
    1. Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007;86:30–6. 10.1097/PHM.0b013e31802b8eca
    1. Marquis N, Larivée P, Saey D, Dubois MF, Tousignant M. In-Home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Pre-experimental Study on Effectiveness, Satisfaction, and Adherence. Telemed J E Health 2015;21:870–9. 10.1089/tmj.2014.0198

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit