A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): a randomised controlled trial

Abstract

Objectives: To investigate superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL) and dyspnoea.

Design: Parallel-group randomised controlled trial with 1:1 block randomisation.

Setting: Three major hospitals from Jiangsu and Hubei provinces, China.

Participants: 120 formerly hospitalised COVID-19 survivors with remaining dyspnoea complaints were randomised with 61 allocated to control and 59 to TERECO.

Intervention: Unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry.

Outcomes: Primary outcome was 6 min walking distance (6MWD) in metres. Secondary outcomes were squat time in seconds; pulmonary function assessed by spirometry; HRQOL measured with Short Form Health Survey-12 (SF-12) and mMRC-dyspnoea. Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up).

Results: Adjusted between-group difference in change in 6MWD was 65.45 m (95% CI 43.8 to 87.1; p<0.001) at post-treatment and 68.62 m (95% CI 46.39 to 90.85; p<0.001) at follow-up. Treatment effects for LMS were 20.12 s (95% CI 12.34 to 27.9; p<0.001) post-treatment and 22.23 s (95% CI 14.24 to 30.21; p<0.001) at follow-up. No group differences were found for lung function except post-treatment maximum voluntary ventilation. Increase in SF-12 physical component was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24 to 6.35; p=0.004) at post-treatment and 2.69 (95% CI 0.06 to 5.32; p=0.045) at follow-up.

Conclusions: This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and physical HRQOL.

Trial registration number: ChiCTR2000031834.

Keywords: COVID-19; pulmonary rehabilitation.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work. JL reports a research grant from Jiangsu CF PharmTech. JR reports research grants from Xi’an Bureau of Technology, China; from the Fundamental Research Funds for the Central Universities, China and from Sichuan Bureau of Science and Technology, China during the conduct of the study. No other relationships or activities exist that could appear to have influenced the submitted work.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Flow of patients through the study. ITT, intention to treat; PP, per protocol.

Figure 2

Marginal trajectories for outcomes estimated from models used for main analysis (intention to treat) and presented with visual comparison bars (84% CIs). Note that models for continuous outcomes impose equality constraints on baseline means, while some variation is reintroduced by adjustment for centre. Post-treatment is at 6 weeks after baseline and follow-up is at approximately 28 weeks after baseline (average). mMRC, modified Medical Research Council; SF-12, Short Form Health Survey-12; TERECO, telerehabilitation intervention for COVID-19 survivors.