Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors
DOI:
https://doi.org/10.17267/2238-2704rpf.2024.e5416Keywords:
COVID-19, Dyspnea, Pulmonary Rehabilitation, Quality of Life, TelerehabilitationAbstract
INTRODUCTION: Telerehabilitation advanced significantly with the emergence of COVID-19 and the recommendation of limiting physiotherapist-patient contact time whenever practicable. The effectiveness of telerehabilitation on those who had a longer stay in hospital and on oxygen support following discharge is still under question. OBJECTIVES: To evaluate the effects after six weeks of pulmonary telerehabilitation on exercise tolerance, fatigue level, perceived exertion, symptoms of depression and quality of life in patients surviving COVID-19. MATERIALS AND METHODS: A quasi-experimental study was conducted on 25 post-COVID-19 patients following discharge in a home environment setting. The participants were advised to prepare equipment such as oxygen concentrator, B-type oxygen cylinder (backup), lengthy oxygen tubes, finger pulse oximeter, mini static pedal exerciser, incentive spirometry, weight cuffs or water bottles and sandbags. After six weeks of telerehabilitation, the patients underwent assessments including initial oxygen saturation (SPO2), heart rate, peak oxygen demand during exercise to maintain baseline SPO2, peak heart rate, maximum drop in SPO2, recovery time to baseline SPO2 measured with a pulse oximeter and stopwatch, peak perceived exertion using the Borg Dyspnea Scale, peak fatigue score using the visual analog scale (VASF), quality of life assessed with the SF-36 questionnaire, and mental health status evaluated with the Hamilton Depression Scale (HAMD). One-way repeated measure ANOVA and paired t-test were used. RESULTS: Significant improvements following the intervention on the initial SPO2 (F (2.12, 23.13) = 21.0, p<0.05) and heart rate (F (1.839, 20.23) = 43.73, p<0.05), peak maximum oxygen demand during exercise to maintain baseline SPO2 (F (1.487, 16.36) = 8.96, p<0.05), peak maximum perceived exertion (F (5, 55) = 112.51, p<0.05), peak maximum fatigue score (F (1.755, 19.30) = 67.44, p<0.05), peak heart rate (F (1.798, 19.78) = 50.99, p<0.05), peak drop in SPO2 (F (2.467, 27.14) = 41.46, p<0.05) and peak recovery time to achieve baseline SPO2 (F (5, 55) = 78.89, p<0.05). Six-week post-analysis on the depressive symptoms (mean difference =11.25, p< 0.05) and quality of life also showed significant improvement (mean difference =29.92, p< 0.05). CONCLUSION: Six weeks of comprehensive pulmonary telerehabilitation with simple equipment improved tolerance to exercise, fatigue, perceived exertion, symptoms of depression and quality of life for post-COVID-19 patients.
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(1) Jácome C, Marques A, Oliveira A, Rodrigues LV, Sanches I. Pulmonary telerehabilitation: An international call for action. Pulmonology. 2020;26(6):335-7. https://doi.org/10.1016/j.pulmoe.2020.05.018
(2) El‐Maradny YA, Rubio‐Casillas A, Uversky VN, Redwan EM. Intrinsic factors behind long‐COVID: I. Prevalence of the extracellular vesicles. J Cell Biochem. 2023;124(5):656-73. https://doi.org/10.1002/jcb.30415
(3) Scurati R, Papini N, Giussani P, Alberti G, Tringali C. The challenge of long COVID-19 management: from disease molecular hallmarks to the proposal of exercise as therapy. Int J Mol Sci. 2022;23(20):12311. https://doi.org/10.3390/ijms232012311
(4) Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Palacios-Ceña M, Rodríguez-Jiménez J, de-la-Llave-Rincón AI, et al. Fatigue and dyspnoea as main persistent post-COVID-19 symptoms in previously hospitalized patients: related functional limitations and disability. Respiration. 2022;101(2):132-41. https://doi.org/10.1159/000518854
(5) Jimeno-Almazán A, Pallarés JG, Buendía-Romero Á, Martínez-Cava A, Franco-López F, Martínez BJSA, et al. Post-COVID-19 syndrome and the potential benefits of exercise. Int J Environ Res Public Health. 2021;18(10):5329. https://doi.org/10.3390/ijerph18105329
(6) Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64. https://doi.org/10.1164/rccm.201309-1634st
(7) Zhao HM, Xie YX, Wang C. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J. 2020;133(13):1595-602. https://doi.org/10.1097/cm9.0000000000000848
(8) 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(9):769-74. https://doi.org/10.1097/phm.0000000000001505
(9) Salawu A, Green A, Crooks MG, Brixey N, Ross DH, Sivan M. A proposal for multidisciplinary tele-rehabilitation in the assessment and rehabilitation of COVID-19 survivors. Int J Environ Res Public Health. 2020;17(13):4890. https://doi.org/10.3390%2Fijerph17134890
(10) Gonzalez-Gerez JJ, Bernal-Utrera C, Anarte-Lazo E, Garcia-Vidal JA, Botella-Rico JM, Rodriguez-Blanco C. Therapeutic pulmonary telerehabilitation protocol for patients affected by COVID-19, confined to their homes: Study protocol for a randomized controlled trial. Trials. 2020;21(1):588. https://doi.org/10.1186/s13063-020-04494-w
(11) Singh SJ, Bolton C, Nolan C, Harvey-Dunstan T, Connolly B, Man W, et al. British Thoracic Society survey of rehabilitation to support recovery of the post-COVID-19 population. BMJ Open 2020;10:e040213. https://doi.org/10.1136/bmjopen-2020-040213
(12) She J, Nakamura H, Makino K, Ohyama Y, Hashimoto H. Selection of suitable maximum-heart-rate formulas for use with Karvonen formula to calculate exercise intensity. Int J Autom Comput. 2015;12(1):62-9. https://doi.org/10.1007/s11633-014-0824-3
(13) British Thoracic Society. Guidance for pulmonary rehabilitation – Reopening services for the ‘business as usual’ participants [Internet]. 2020. Available from: https://docslib.org/doc/4617286/bts-guidance-for-pulmonary-rehabilitation-reopening-services-for-the-business-as-usual-participants
(14) Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE. Thorax. 2013;68(suppl 2):ii1-ii30. https://doi.org/10.1136/thoraxjnl-2013-203808
(15) Ghodge S, Tilaye P, Deshpande S, Nerkar S, Kothary K, Manwadkar S. Effect of Pulmonary Telerehabilitation on Functional Capacity in COVID Survivors; An Initial Evidence. Int J Heal Sci Res [Internet]. 2020;10(10):123-9. Available from: https://www.ijhsr.org/IJHSR_Vol.10_Issue.10_Oct2020/IJHSR_Abstract.018.html
(16) Priya N, Isaac BTJ, Thangakunam B, Christopher DJ. Effect of home-based pulmonary rehabilitation on health-related quality of life, lung function, exercise tolerance, and dyspnea in chronic obstructive pulmonary disorder patients in a tertiary care center in South India. Lung India. 2021;38(3):211-5. https://doi.org/10.4103/lungindia.lungindia_895_20
(17) Lee KA, Hicks G, Nino-Murcia G. Validity and reliability of a scale to assess fatigue. Psychiatry Res. 1991;36(3):291-8. https://doi.org/10.1016/0165-1781(91)90027-m
(18) Rotterdam F-J, Hensley M, Hazelton M. Measuring Change in Health Status Over Time (Responsiveness): A Meta-analysis of the SF-36 in Cardiac and Pulmonary Rehabilitation. Arch Rehabil Res Clin Transl. 2021;3(2):100127. https://doi.org/10.1016/j.arrct.2021.100127
(19) Duan H, Li P, Wang Z, Chen H, Wang T, Wu W, et al. Effect of 12-week pulmonary rehabilitation on cognitive function in patients with stable chronic obstructive pulmonary disease: Study protocol for a single-center randomised controlled trial. BMJ Open. 2020;10(10):e037307. https://doi.org/10.1136%2Fbmjopen-2020-037307
(20) Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. J Psychosom Res. 2002;52(2):69-77. https://doi.org/10.1016/s0022-3999(01)00296-3
(21) Shah S, Majmudar K, Stein A, Gupta N, Suppes S, Karamanis M, et al. Novel Use of Home Pulse Oximetry Monitoring in COVID-19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization. Acad Emerg Med. 2020;27(8):681-92. https://doi.org/10.1111/acem.14053
(22) 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. https://doi.org/10.1016/j.ctcp.2020.101166
(23) Debeaumont D, Boujibar F, Ferrand-Devouge E, Artaud-Macari E, Tamion F, Gravier F-E, et al. Cardiopulmonary Exercise Testing to Assess Persistent Symptoms at 6 Months in People With COVID-19 Who Survived Hospitalization: A Pilot Study. Phys Ther. 2021;101(6):pzab099. https://doi.org/10.1093/ptj/pzab099
(24) Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FVC, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020;6(4):00542-2020. https://doi.org/10.1183/23120541.00542-2020
(25) Yang LL, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Dis Transl Med. 2020;6(2):79-86. https://doi.org/10.1016/j.cdtm.2020.05.002
(26) He ZF, Zhong NS, Guan WJ. The benefits of pulmonary rehabilitation in patients with COVID-19. ERJ Open Res. 2021;7(2):00212-2021. http://dx.doi.org/10.1183/23120541.00212-2021
(27) Capin JJ, Jolley SE, Morrow M, Connors M, Hare K, MaWhinney S, et al. Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study. BMJ Open. 2022;12(7):e061285. https://doi.org/10.1136/bmjopen-2022-061285
(28) 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(2):00108-2021. http://dx.doi.org/10.1183/23120541.00108-2021
(29) Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID‐19 infection: A cross‐sectional evaluation. J Med Virol. 2021;93(2):1013-22. https://doi.org/10.1002/jmv.26368
(30) Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603-5. https://doi.org/10.1001/jama.2020.12603
(31) Wang C, Pan R, Wan X, Tan Y, Xu L, Ho RC, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020;17(5):1729. https://doi.org/10.3390%2Fijerph17051729
(32) Hameed F, Palatulan E, Jaywant A, Said R, Lau C, Sood V, et al. Outcomes of a COVID-19 recovery program for patients hospitalized with SARS-CoV-2 infection in New York City: A prospective cohort study. PM R. 2021;13(6):609-17. https://doi.org/10.1002/pmrj.12578
(33) 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. https://doi.org/10.2147/copd.s263031
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Copyright (c) 2024 Ramanathan Palaniappan Ramanathan, Sivaguru Muthusamy, Ambusam Subramaniam, Anusuya Krishnan, Krishna Kumar Jagannathan, Abirami Rajagopal
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
