Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors

Abstract

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.