TP101. TP101 REHABILITATION IN THE TIME OF COVID-19最新文献

{"title":"A Simple Sit-to-Stand Test to Detect Exercise-Induced Oxygen Desaturation in Patients Being Discharged from Hospital with COVID-19","authors":"L. Houchen-Wolloff, E. Daynes, C. Gerlis, E. Chaplin, N. Gardiner, S. Singh","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4122","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4122","url":null,"abstract":"Introduction: Patients with COVID-19 with normal oxygen levels at rest may desaturate on exertion which could predict adverse outcomes (1). A 3% drop in oxygen saturation (SpO2) has been suggested as cause for concern in COVID-19 (2). Field walking tests are often used in respiratory disease to assess desaturation. However these tests can be impractical to perform as an inpatient due to space, equipment and technical skill requirements. The aim of this project was to use a simple sit-to-stand test to evaluate exercise-induced oxygen desaturation to inform home oxygen prescription. Methods: Patients were invited to perform a 1 minute sit-to stand test (1minSTS). Tests were performed at the bedside, around the time of hospital discharge, by the inpatient therapy team at a large teaching hospital (Leicester, UK). All but 2 patients were normoxive at rest (87 and 89%). SpO2 was recorded before, during and after each test. A standard height chair and stopwatch were required. Results: 64 patients performed the STS test. 7 COPD (1 existing oxygen prescription). 72% male, 42% white British, 28% Indian, 13% Asian, 17% other. Mean (Standard Deviation: SD) age 59.2 (14.7) years, BMI 29.1 (5.7), length of stay 13.8 (13.7 days). Median (Inter Quartile Range) Medical Research Council Dyspnoea Scale 2 (1-4), Clinical Frailty Scale 2 (2-3). During admission, 7 patients were ventilated. Pre and post/during STS test SpO2 are shown in table 1 for 57 subjects with complete data. There was a change of -3.1% (p=0.000).32% of patients desaturated by >3% and 30% were discharged with oxygen.Conclusion: This quick and simple to perform sit-to-stand test identified statistically (and possibly clinically) relevant oxygen desaturation following exercise, in 30% of patients being discharged from hospital with COVID-19. This is important to inform oxygen prescription and when considering patients returning to or starting exercise/physical activity.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114300657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced Exercise Tolerance in Long-COVID Patients","authors":"R. Varughese, G. Y. Lam, A. Brotto, E. Bok, E. Wong, D. Befus, R. Damant, G. Ferrara, M. Smith, M. Stickland","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4116","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4116","url":null,"abstract":"Introduction: Because many patients report long-term symptoms including dyspnea and fatigue after an acute COVID-19 infection, we recently developed a comprehensive follow-up clinic to understand and manage these patients. We conducted cardiopulmonary exercise tests (CPET) to characterize the respiratory responses to exercise as a potential cause of dyspnea in long-COVID patients. Methods: Seven long-COVID patients (mean age 53±4 years, 100% female) and seven age, sex and height-matched healthy controls (mean age 55±10 years) completed a pulmonary function test and an incremental CPET to exhaustion. These seven long-COVID patients were assessed due to persistent dyspnea after recovery from the acute infection;three long-COVID patients required hospitalization during the acute infection. The CPET was performed on average 158±59 days since COVID-19 diagnosis. Arterial saturation (SpO2) and breath-by-breath respiratory data, including ventilatory equivalents for carbon dioxide (VE/VCO2), were collected continuously, while inspiratory capacity (IC), inspiratory reserve volume (IRV), and dyspnea (modified Borg scale) were evaluated throughout exercise. Statistical analyses were performed using unpaired t-tests with a significance level of 0.05. Results: Prior to testing, COVID-19 patients reported resting dyspnea (mean modified Medical Research Council Dyspnea scale 2.1±0.7) and elevated post-COVID functional scale (mean 2.1±1.2), revealing persistent symptoms. Spirometric assessment at rest was within expected normal limits, though a reduction in FEV1 was seen in the COVID-19 patients (88.9±16.6% predicted) compared to matched controls (111.1±13.2% predicted;p = 0.02). Lung volumes and diffusion capacity were similar between both groups. Most notably, COVID-19 patients (19.6±7.4 mL/kg/min) had a reduced VO2peak when compared to controls (29.1±8.3 mL/kg/min, p<0.01). As well, VE/VCO2 at rest and anaerobic threshold were elevated in COVID-19 patients as compared to controls. SpO2 at peak exercise was not different between COVID-19 patients and controls (95±4% vs. 94±3%, p=0.57). At peak exercise, there were no between-group differences in tidal volume, breathing frequency, IC, IRV observed. Patient-reported dyspnea and leg fatigue at peak exercise were also similar between groups. Conclusion: Initial results suggest that long-COVID patients demonstrate reduced exercise tolerance and elevated VE/VCO2;however, SpO2, operating lung volumes and dyspnea responses to exercise are similar to healthy controls, suggesting that there may be a non-pulmonary cause for the observed exercise intolerance. Further investigation is required to understand this limitation and its relationship to symptoms in long-COVID patients.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130311484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Happens to Survivors of COVID-19 After Hospital Discharge? - 30-Day Functional Outcomes Among Older and Younger Adults","authors":"E. Qin, L. Gold, A. Bunnell, J. Andrews","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4117","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4117","url":null,"abstract":"Introduction: As of December 19th 2020, Coronavirus Disease 2019 (COVID-19) has resulted in approximately 17.6 million cases and 315,000 deaths in the United States. The hospitalization rate for COVID-19 in the US continues to rise and is currently around 295.8 hospitalizations per 100,000 population. Despite the increasing number of individuals who are contracting and recovering from this disease, little is known about their functional recovery. Understanding functional outcomes in these patients is critical to address their rehabilitation needs. The purpose of this study is to characterize the 30-day patient-reported functional outcomes of older and younger adults following acute hospitalization for COVID-19. Methods: A single-center prospective cohort study was performed from April to October 2020 of adult survivors of hospitalization for COVID-19 (n=28). A standardized telephone questionnaire was administered 30-days after hospital discharge to participants addressing their ability to perform basic activities of daily living (ADLs), instrumental ADLs, mobility, fatigue symptoms (Patient-Reported Outcomes Measurement Information Systems-PROMIS) and general disability (Health Assessment Questionnaire Disability Index - HAQ-DI). Results: Participants' were 23-95 years old. Twenty-one (75%) were less than 65 years old. Fifteen (54%) were female and 19 (68%) were white. Mean hospital length of stay was 11.3 days and 10 (36%) participants required ICU admission. Among adults aged <65 years, 76% developed new functional impairments and 14% developed new dependence (requiring help to perform a task) post-COVID compared to pre-hospitalization baseline. In comparison, 71% of adults aged >65 years developed new impairments and 29% new dependence. The most common new impairments in both age groups were transferring for basic ADLs and preparing meals and grocery shopping for instrumental ADLs. Seventy-one percent of older and 76% of younger adults experienced a decline in at least one mobility task (getting up from a chair, walking up 10 stairs, or walking mile). Seventy-six percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 5 points) in their PROMIS fatigue scores. Sixty-two percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 0.22 points) in their HAQ-DI scores. Conclusions: Among adults hospitalized with COVID-19, the majority experienced a decline in ≥1 functional task 30 days after discharge compared to pre-hospitalization. Younger adults had similar to worse impairment in physical functional outcomes than older adults. These results indicate all adults, regardless of age, are at risk for prolonged, clinically significant functional impairment following hospitalization for COVID-19.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124329837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Face to Face Pulmonary Rehabilitation on the Recovery of Patients Who Have Been Diagnosed with Severe COVID-19 Requiring Non-Invasive and Invasive Ventilation","authors":"A. Lucey, V. Lewis, S. Jones, S. Fairbairn","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4115","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4115","url":null,"abstract":"Rationale: During March to July 2020, in the COVID-19 pandemic, Aneurin Bevan University Health board reported 2,761 patients diagnosed with COVID-19 1. Many of those with severe COVID-19 showed persisting fatigue, shortness of breath, muscle mass loss and deconditioning. This resulted in decreased exercise tolerance, in addition to ongoing complex psychological and health concerns. There is significant evidence to support PR as a means of improving mental and physical health in many respiratory conditions. 2 A bespoke face to face COVID-19 pulmonary rehabilitation (PR) programme was therefore setup to maximise patient recovery.Aim: 1. To assess the impact of PR on the Modified Fatigue Impact Scale (MFIS) of patients diagnosed with severe COVID-19. 2. To assess the impact of PR on six minute walk test, sit to stand test and Borg dyspnoea score 3. To identify patients most likely to benefit from PR in the future.Method: Patients were identified as 'severe COVID-19' and referred for PR following a consultant case review of patients requiring non-invasive and invasive ventilation in either the respiratory high care unit (RHCU) or intensive care unit (ICU). Patients were then assessed by a multidisciplinary team to ensure consent and appropriateness for the PR programme.Patients completed MFIS and were assessed on a variety of other physical and psychological measures, including: six minute walk test, sit to stand test and Borg dyspnoea score. During weekly PR sessions the patients engaged with a tailored programme of cardio and strengthening exercises as well as Pilates to improve movement and flexibility. Patients repeated the assessments after six weeks.Results: A total of 31 patients attended the programme. 97% of patients attended 80-100% of sessions. The median change in total MFIS was -16%. There were also improvements seen in the six minute walk test with a median increase of 23% and sit to stand with a median increase of 36%. Median change in BORG score -0.5(-50%).Graph 1: Conclusion: Face to face pulmonary rehab is an effective treatment for patients who have been diagnosed with severe COVID-19 following resolution of their acute illness. PR has resulted in improved physical abilities and psychological wellbeing. Improvements were seen in MFIS in all three MFIS severity categories and PR should be offered to all patients recovering from severe COVID-19.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128847083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Rehabilitation and Its Role in Long-Term COVID-19 Recovery","authors":"M. Baig, M. Joo, K. Nada, R. Deer, J. Seashore","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4118","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4118","url":null,"abstract":"Coronavirus - 2019 (COVID-19)-a respiratory syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2)-is responsible for the world's latest pandemic unlike any seen since the 1980s HIV/AIDs pandemic. While significant effort has been made towards acute management, long-term management has received less attention. To address this, our study identified patients diagnosed with COVID-19 and recorded the time to enrollment into a formal pulmonary rehabilitation program at an academic center;the differences in time allowed us to assess whether earlier enrollment led to differences in physiologic and psychologic outcomes. First, we hypothesize that enrollment into a pulmonary rehabilitation program is essential to a patient's long term treatment and management of post-infectious, chronic COVID-19 symptoms. Second, we aim to demonstrate that early participation leads to improvements in dyspnea, anxiety and depression as supported by the UCSD SOBQ, GAD-7 and PHQ-9 scores respectively. Through chart review, we collected data from 24 patients enrolled in a post-COVID recovery program centered around pulmonary rehabilitation at an academic medical center in Texas. We administered: (1) pulmonary function test (PFT);(2) University of California - San Diego (UCSD) Dyspnea Questionnaire;and (3) six-minute walk (6MW) tests when a patient entered and completed the program. We used this data to assess for subjective and objective changes in respiratory function postrehabilitation. To analyze the indirect benefits of pulmonary rehabilitation on mental health effects of COVID-19, we used the Generalized Anxiety Disorder 7 (GAD7) and Patient Health Questionnaire (PHQ9) questionnaires to evaluate a patients' anxiety and depression respectively at the same time points. Our results showed that it took patients an average 67.8 days to initiate rehabilitation after initial diagnosis. 13 of 24 patients began rehab earlier than the average and had an average decrease in UCSD SOBQ score of 35.6 and 6MW increase of 64.5 m compared to the group averages of 17.8 and 74.7 m respectively. The average initial GAD7 and PHQ9 scores were 6.7 and 8.7, with an average decrease of 1.5 and 2.2 respectively. Through our study, we highlight the benefit of early initiation of pulmonary rehabilitation in the post-COVID 19 recovery period. Through both subjective and objective measurements of patient respiratory function and mental health, our study supports inclusion and standardization of early pulmonary rehabilitation as a component of COVID-19 recovery.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131936831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Need for Pulmonary Rehabilitation Six Months After Hospital Discharge to Home Following COVID-19 Infection","authors":"H. Shahzad, J. Reardon, S. Congrete, R. Zuwallack, A. Kaur","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4125","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4125","url":null,"abstract":"Rationale: Individuals recovering from COVID-19 may have prolonged symptoms and functional limitations well after the acute illness has subsided. Pulmonary rehabilitation, with its interdisciplinary, holistic approach to individuals with complex and systematic manifestations from chronic respiratory disease may be a platform to provide comprehensive healthcare to these patients. Methods: We did a structured telephone interview and review of medical records from a random sample of patients discharged home from our hospital approximately five months after a COVID-19 hospitalization this spring. This was a hypothesis-generating study. Data categories included: 1) Demographics;2) Acute disease severity markers;3) Dyspnea (Modified MRC);4) A structured review of systems (ROS);and 5) Generic heath status (Medical Outcomes Study Short Form -12, Version 1). The SF-12 has 8 domains and physical and mental composite scores (PCS and MCS, respectively). Results: In our sample of 26 patients, 65% were male, age (mean ± SD) was 60 ± 16 years, hospital length of stay was 5.6 ± 3.5 days, interval from discharge to telephone contact was 154 ± 34 days, 85% had pneumonia, and 42% required &gt; 4 L/min supplemental oxygen. The most common positive ROS categories were: (% for each) dyspnea (50), cognitive impairment (38), fatigue (27), and sleepiness (24). The MRC (range, 0-4 with higher scores indicating more dyspnea) was 0.87 ± 1.00, corresponding to breathlessness hurrying or walking up a slight hill;27% were MRC2 or higher. SF-12 Composite and its 8 domain scores for the sample are given in Table 1. Comparative reference values for these variables from a large sample are provided. Conclusions: Patients discharged from the hospital following COVID-19 infection approximately five months earlier had, on average, mild-to-moderate MRC dyspnea and mild-to-moderate impairments in general health status. It is uncertain whether these abnormalities are residual effects of the remote COVID -19 infection or represent unrelated medical or mental problems. Limitations of our study include its small size and potential selection bias from evaluating those discharged directly to home from the hospital. Based on these observations, pulmonary rehabilitation would not be uniformly indicated months after hospital discharge for COVID-19. However, in view of the considerable variability in dyspnea and health status, the intervention would be reasonable in selected patients with more substantial limitations.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132067773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom Clusters in Adult Patients with Post-Acute COVID-19","authors":"R. Shah, Y. Vayner, S. Lessen, D. Tomer, M. Gong, S. Congdon, A. Hope","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4123","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4123","url":null,"abstract":"Background: As more reports emerge that many COVID-19 survivors suffer protracted and lingering symptoms, how to define and better characterize these patients with post-acute COVID-19 is a research challenge. To understand the overall symptom burden in patients with post-acute COVID-19, we explored whether identifiable symptom clusters exist in a cohort of patients with post-acute COVID-19 and then examined whether these clusters are associated with quality of life impairments. Methods: In a prospective observational study of COVID-19 patients at a Covid-19 Recovery (CORE) clinic between June and December 2020 (eligible patients had either a positive COVID-19 PCR or IgG antibody test), we administered a modified revised Edmonton Symptom Assessment survey which assessed whether patients had 13 symptoms over the week prior to presentation to the clinic on a scale of 0 (no symptoms) to 10 (most severe symptoms). We performed exploratory factor analysis to search for clustering of symptoms into factors and examined the relationship between these clusters and quality of life measures. Results: Across 127 adult patients treated at CORE (mean (standard deviation (SD) age 51.8 (14.0);73.2% were women. We found four symptom factors: emotional factor (including depression and anxiety), activity limiting factor (fatigue, sleepiness and shortness of breath), gastrointestinal symptom factor (nausea, appetite and taste changes) and pain factor (pain, neuropathy). The Cronbach's α for the individual factors ranged from 0.64-0.84. The emotional factor was associated with an increased odds of reporting worse emotional (Odds Ratio (95% Confidence Interval (95% CI) 1.9 (1.2-3.3) and worse cognitive health status (OR 4.9 (2.5-9.5);the activity limiting factor was associated with increase odds of worse physical health status (OR 4.5 (2.1-9.7);the gastrointestinal symptom factor was associated with increase odds of worse cognitive health status (OR 2.1 (1.1-4.2). Conclusions: We found four symptom factors in adult patients with post-acute COVID-19. There was strong internal correlation between the factors and the factors were associated with quality of life measures. Routine assessment of post-acute COVID-19 patient's emotional, gastrointestinal, pain and activity limiting symptoms is important as they may be associated with impaired health related quality of life.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124553595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper Limb Function in Survivors of COVID-19 Requiring Mechanical Ventilation","authors":"S. Lovage, R. Doughty, B. Mehta, A. Hudson, L. Finney, S. Singh, W. Man","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4121","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4121","url":null,"abstract":"Rationale Upper limb dysfunction is well recognised in survivors of intensive care (Gustafson et al Crit Care Med 2018;46:1769-1774). A mainstay of respiratory support through the COVID-19 pandemic has been use of repeated patient prone positioning to improve ventilation. Potential complications reported with prone positioning of sedated patients include brachial plexopathy, shoulder subluxation and peripheral nerve injury. We hypothesised that there would be a high prevalence of upper limb dysfunction, disability and pain in survivors of COVID-19 requiring mechanical ventilation, particularly in those who were prone positioned. Methods Eligible patients were laboratory-confirmed swab positive for SARS-CoV-2, mechanically ventilated for a minimum of 72 hours on the Royal Brompton Hospital Adult Intensive Care Units. We measured handgrip strength (HGS), normalised for age and sex, the Disability of Arm Shoulder Hand (DASH) questionnaire (Beaton et al J Hand Ther 2001;14:128-146) and Upper limb Pain Numerical Rating Scale (from 0-10). Health related quality of life was measured using the EuroQol-5 dimensions 5-level (EQ5D5L Utility Index (UI) and Visual Analogue Score (VAS)). Patients were stratified according to whether they received prone positioning or not. Results Twenty-seven consecutive patients were assessed at mean 45 days after hospital discharge. Baseline demographics, admission characteristics, and follow-up upper limb assessment data are shown in Table 1. There was evidence of upper limb weakness (mean (SD) right HGS: 44.77(19.31) %predicted;left HGS 47.69 (18.41) %predicted), with 63% showing upper limb dysfunction (DASH ≥ 16) and 33% showing severe upper limb dysfunction (DASH ≥40). Median (IQR) pain scores were 4 (0.75-6.25) with 53% reporting severe pain (≥ 5). DASH correlated significantly with EQ5D5L UI and VAS (r=-0.69 and r=-0.73 respectively;both p<0.001). No significant differences in upper limb parameters were seen between patients who did or did not receive prone positioning.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128293497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Intensity Pulmonary Rehabilitation Through Videoconference for Post-Acute COVID-19 Patients","authors":"Y. D. Souza, Joseane Macedo, R. Nascimento, Melissa A. Alves, S. Medeiros, L. Leal, J. Soares","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4124","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4124","url":null,"abstract":"RATIONALE: In mid-March 2020, all rehabilitation centers in Rio de Janeiro closed as a strategy to contain the progress of COVID-19. Patients who went through the acute phase of disease noticed the need for rehabilitation follow-up, at that time was impossible to perform presently. The objective of this study was to verify whether a pulmonary rehabilitation program through videoconference could improve patients' exercise capacity after the acute phase of COVID-19. METHOD: We prospectively evaluated 196 subjects during the post-acute phase of COVID-19, without requiring ICU admission and they were divided into two groups. The Control Group (CG) with 92 subjects receiving no non-drug intervention for six weeks, and the Intervention Group (IG) with 104 subjects that performed a low-intensity Pulmonary Rehabilitation Program (PRP) during 6 weeks, held at home, with a weekly session by videoconference. As all the protocol was performed trough videoconference, the exercise capacity was assessed through 30 seconds sit-to-stand test (STS), the fatigue sensation after the exercise using 10-points Borg Scale, and the Physical Activity in Daily Life (PADL) assessed using a cell phone application that measures moves you in steps/day. RESULTS: The IG after the six weeks of PRP, achieved a significant increase in the STS and PADL, and an important decrease in the sensation of fatigue after exercise (p <0.05). The control group does not present a significant improvement in AFVD and STS and does not show improvement in the fatigue sensation. CONCLUSION: Our findings reinforce the importance of evaluating and offering a low-intensity program for patients after the acute phase of COVID-19, that in this population presented improvement in exercise capacity, AFVD, and feeling of fatigue after 6 weeks, compared to subjects who did not perform a PRP and they did not achieve this improvement after that time.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122636185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the Multidisciplinary Team in the Management of the Patient After SARS-COV 2 Severe Infection","authors":"M. A. Popescu-Hagen, A. Ichim, A. Croitoru, V. Biciușcă, G. Ciolan, B. Mahler","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4120","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4120","url":null,"abstract":"SARS-COV2 infection is a challenge for the clinician, not only in the acute phase, in which the impairment of the patient's respiratory function can occur and evolve surprisingly quickly, but also in the post-acute phase, when the patient, especially the one who needed support long-term ventilator, requires complex recovery of respiratory, motor, neurological and cardiac functions. We present the case of a 60-year-old patient, diagnosed with a severe form of SARS COV2 infection for which he needed ventilatory support for 20 days, as well as antiviral treatment, systemic corticosteroid, anticoagulant and antibiotic. After 20 days from the first positive RT-PCR test, the patient is considered cured in terms of SARS COV2 infection, but severe respiratory failure requires transfer to the Pulmonology Department of the Marius Nasta Institute for further treatment. Upon admission to the ward, the patient has hypotrophy and hypotonia in the limb muscles, resting dyspnea, bilaterally diminished vesicular murmur, bilateral subcrepitant rales, SaO2 = 72% in aa and rest, 90% with oxygen supplement 8/min. Starting with the 10th day of hospitalization respiratory physiotherapy is initiated. The rehabilitation of the patient is also supported through exercises for the upper limbs with dumbbells, walking with frame support and breathing exercises with incentive spirometers. After 30 days of systemic corticosteroid therapy, anticoagulant treatment and respiratory physiotherapy, the patient was able to make the daily activities, the spirometry reveals a moderate restrictive syndrom;after 60 days the respiratory function was normal. Conclusion: The management of patients after severe SARS-COV 2 infection in order to improve and maintain the quality of life requires a long time care and multidisciplinary team consisting in pulmonologist, respiratory therapist, nurse, cardiology specialist.","PeriodicalId":147454,"journal":{"name":"TP101. TP101 REHABILITATION IN THE TIME OF COVID-19","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124355578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}