The effectiveness of POST-DISCHARGE telerehabilitation practices in COVID-19 patients: Tele-COVID study-randomized controlled trial

Esra Pehlivan, İsmail Palalı, Sibel Gayretli Atan, Demet Turan, Halit Çınarka, Erdoğan Çetinkaya, Esra Pehlivan, İsmail Palalı, Sibel Gayretli Atan, Demet Turan, Halit Çınarka, Erdoğan Çetinkaya

Abstract

Aims: We aimed to investigate the effectiveness of a telerehabilitation exercise program performed without requiring any special equipment on the physical condition of COVID-19 subjects.

Settings and design: This was a randomized controlled study.

Methods: This study included subjects with a history of hospitalization with a diagnosis of COVID-19 and discharged within 4 weeks. The subjects were divided into two groups randomly, namely telerehabilitation group (TeleGr, n = 17) or control group (CGr, n = 17). The TeleGr received breathing and range of motion exercises, active cycle of breathing technique, and an aerobic training 3 days a week for 6 weeks, while CGr received an exercise brochure with the same content. Subjects were evaluated using the modified Medical Research Council (mMRC) dyspnea score for dyspnea, 30 s sit-to-stand test (30STS) and short physical performance battery (SPPB) to determine their physical status, Saint George Respiratory Questionnaire (SGRQ) to assess quality of their life, and Beck Depression Inventory. All evaluations were carried out at home using videoconferencing.

Results: A significant improvement was observed in TelerGr in terms of mMRC (P= 0.035), 30STS (P= 0.005), 5 sit-to-stand time which is one of the subtests of SPPB (P = 0.039) and SGRQ scores. Significant improvement was observed only in the pain score in the CGr (P = 0.039). There was a statistically significant difference between the groups in SGRQ activity (P = 0.035) and total (P = 0.042) scores. In addition, more symptomatic improvement was found in TeleGr.

Conclusion: Telerehabilitation exercise program with less technical equipment is a good alternative treatment method for COVID-19 subjects, which improves the quality of life and symptomatic status of subjects.

Clinical trial registration number: nct04402983.

Trial registration: ClinicalTrials.gov NCT04402983.

Keywords: Depression; exercise; pandemic; physiotherapy; quality of life; rehabilitation.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2022 Annals of Thoracic Medicine.

Figures

Figure 1
Figure 1
Study flowchart

References

    1. Organization WH. Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease is Suspected. Interim Guidance. 2020. [Last accessed on 2020 Apr 05]. Available from: .
    1. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Mil Med Res. 2020;7:4.
    1. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol. 2020;5:831–40.
    1. Hsieh MJ, Lee WC, Cho HY, Wu MF, Hu HC, Kao KC, et al. Recovery of pulmonary functions, exercise capacity, and quality of life after pulmonary rehabilitation in survivors of ARDS due to severe influenza A (H1N1) pneumonitis. Influenza Other Respir Viruses. 2018;12:643–8.
    1. Vitacca M, Carone M, Clini EM, Paneroni M, Lazzeri M, Lanza A, et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: The Italian position paper. Respiration. 2020;99:493–9.
    1. Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46:637–53.
    1. Gandotra S, Lovato J, Case D, Bakhru RN, Gibbs K, Berry M, et al. Physical function trajectories in survivors of acute respiratory failure. Ann Am Thorac Soc. 2019;16:471–7.
    1. Skinner EH, Haines KJ, Howe B, Hodgson CL, Denehy L, McArthur CJ, et al. Health-related quality of life in australasian survivors of H1N1 influenza undergoing mechanical ventilation.A multicenter cohort study. Ann Am Thorac Soc. 2015;12:895–903.
    1. Zanaboni P, Hoaas H, Aarøen Lien L, Hjalmarsen A, Wootton R. Long-term exercise maintenance in COPD via telerehabilitation: A two-year pilot study. J Telemed Telecare. 2017;23:74–82.
    1. Hansen H, Bieler T, Beyer N, Godtfredsen N, Kallemose T, Frølich A. COPD online-rehabilitation versus conventional COPD rehabilitation – Rationale and design for a multicenter randomized controlled trial study protocol (CORe trial) BMC Pulm Med. 2017;17:140.
    1. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93:580–6.
    1. Hayes MH. Experimental developement of the graphics rating method. Physiol Bull. 1921;18:98–9.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.
    1. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556–61.
    1. Polatlı M, Yorgancıoğlu A, Aydemir Ø, Yılmaz Demirci N, Kırkıl G, Atış Naycı S, et al. Validity and reliability of Turkish version of St.George's respiratory questionnaire. Tuberk Toraks. 2013;61:81–7.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
    1. Kupferberg DH, Kaplan RM, Slymen DJ, Ries AL. Minimal clinically important difference for the UCSD Shortness of Breath Questionnaire. J Cardiopulm Rehabil. 2005;25:370–7.
    1. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: Recommendations to guide clinical practice. J Physiother. 2020;66:73–82.
    1. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Post-discharge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021;93:1013–1022.
    1. Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petraroli A, et al. Rehabilitation of patients post-COVID-19 infection: A literature review. J Int Med Res. 2020;48:1–10.
    1. Remy C, Valet M, Stoquart G, El Sankari S, Van Pesch V, De Haan A, et al. Telecommunication and rehabilitation for patients with multiple sclerosis: Access and willingness to use.A cross-sectional study. Eur J Phys Rehabil Med. 2020;56:403–11.
    1. Dlott CC, Moore A, Nelson C, Stone D, Xu Y, Morris JC, et al. Preoperative risk factor optimization lowers hospital length of stay and postoperative emergency department visits in primary total hip and knee arthroplasty patients. J Arthroplasty. 2020;35:1508–15.e2.
    1. Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol. 2020;27:367–77.
    1. Simonÿ C, Riber C, Bodtger U, Birkelund R. Striving for confidence and satisfaction in everyday life with chronic obstructive pulmonary disease: Rationale and content of the tele-rehabilitation programme>CPD-Life>>. Int J Environ Res Public Health. 2019;16:3320.
    1. van Egmond MA, van der Schaaf M, Vredeveld T, Vollenbroek-Hutten MM, van Berge Henegouwen MI, Klinkenbijl JH, et al. Effectiveness of physiotherapy with telerehabilitation in surgical patients: A systematic review and meta-analysis. Physiotherapy. 2018;104:277–98.
    1. Bonnevie T, Gravier FE, Elkins M, Dupuis J, Prieur G, Combret Y, et al. People undertaking pulmonary rehabilitation are willing and able to provide accurate data via a remote pulse oximetry system: A multicentre observational study. J Physiother. 2019;65:28–36.
    1. Nield M, Hoo GW. Real-time telehealth for COPD self-management using Skype™. COPD. 2012;9:611–9.
    1. Paneroni M, Colombo F, Papalia A, Colitta A, Borghi G, Saleri M, et al. Is telerehabilitation a safe and viable option for patients with COPD.A Feasibility Study? COPD. 2015;12:217–25.
    1. Bruton A, Lee A, Yardley L, Raftery J, Arden-Close E, Kirby S, et al. Physiotherapy breathing retraining for asthma: A randomised controlled trial. Lancet Respir Med. 2018;6:19–28.
    1. Bernocchi P, Vitacca M, La Rovere MT, Volterrani M, Galli T, Baratti D, et al. Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: A randomised controlled trial. Age Ageing. 2018;47:82–8.
    1. Ahmed NU, Begum S, Ali T, Suhana M. Home based pulmonary rehabilitation on oxygenation status, dyspnea and fatigue in stable patients with COPD. Mymensingh Med J. 2020;29:424–30.
    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.
    1. Ceravolo MG, de Sire A, Andrenelli E, Negrini F, Negrini S. Systematic rapid “living” review on rehabilitation needs due to COVID-19: Update to March 31st, 2020. Eur J Phys Rehabil Med. 2020;56:347–53.
    1. Cikajlo I, Rudolf M, Goljar N, Burger H, Matjačić Z. Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disabil Rehabil. 2012;34:13–8.
    1. Dias Correia F, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I, et al. Digital versus conventional rehabilitation after total hip arthroplasty: A single-center, parallel-group pilot study. JMIR Rehabil Assist Technol. 2019;6:e14523.
    1. Malik AN, Masood T. Effects of virtual reality training on mobility and physical function in stroke. J Pak Med Assoc. 2017;67:1618–20.
    1. Mohan D, Benson VS, Allinder M, Galwey N, Bolton CE, Cockcroft JR, et al. Short physical performance battery: What does each sub-test measure in patients with chronic obstructive pulmonary disease? Chronic Obstr Pulm Dis. 2020;7:13–25.
    1. Bernhardt V, Mitchell GS, Lee WY, Babb TG. Short-term modulation of the ventilatory response to exercise is preserved in obstructive sleep apnea. Respir Physiol Neurobiol. 2017;236:42–50.
    1. Patel MS, Mohan D, Andersson YM, Baz M, Samantha Kon SC, Canavan JL, et al. Phenotypic characteristics associated with reduced short physical performance battery score in COPD. Chest. 2014;145:1016–24.
    1. Burkow TM, Vognild LK, Johnsen E, Risberg MJ, Bratvold A, Breivik E, et al. Comprehensive pulmonary rehabilitation in home-based online groups: A mixed method pilot study in COPD. BMC Res Notes. 2015;8:766.
    1. Purssell E, Gould D, Chudleigh J. Impact of isolation on hospitalised patients who are infectious: Systematic review with meta-analysis. BMJ Open. 2020;10:e030371.
    1. Schuch FB, Bulzing RA, Meyer J, Vancampfort D, Firth J, Stubbs B, et al. Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional survey in Brazil. Psychiatry Res. 2020;292:113339.
    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.

Source: PubMed

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