The Impact of Early Pulmonary Rehabilitation on Dyspnea, Quality of Life, and Symptoms in Moderate to Severe COVID-19 Pneumonia Patients
DOI:
https://doi.org/10.48048/tis.2024.7476Keywords:
Pulmonary rehabilitation, COVID-19, Pneumonia, SAR-CoV-2, Respiratory physiotherapyAbstract
Introduction: COVID-19 pneumonia leads to dyspnea, persistent symptoms and poor quality of life. Inpatient pulmonary rehabilitation (PR) has limited evidence of effectiveness. Therefore, we aimed to determine the effect of a comprehensive inpatient PR program on dyspnea symptoms and quality of life in patients with COVID-19 pneumonia. Methods: A group pretest-posttest design was conducted in patients with COVID-19 pneumonia. Comprehensive PR was administered during hospitalization. Baseline dyspnea index (BDI), Transitional dyspnea score (TDI), Modified Medical Research Council score (mMRC), and St. George’s Respiratory Questionnaire (SGRQ) were assessed at baseline, 4th week and 12th week after discharge. Results: In total, 28 patients were included (9 with oxygen supplementation, 19 without oxygen supplementation). The mean BDI at baseline was 7.82 ± 2.13. TDI scores at the 4th and 12th weeks were 5.14 ± 1.90 and 6.61 ± 1.59, respectively, with a significant difference observed between the 4th and 12th weeks (p < 0.001). Median mMRC scores at baseline, 4th week, and 12th week were 2(1.25 - 3), 1 (1 - 2) and 1 (0 - 1), respectively, showing a significant improvement between baseline vs 4th week, baseline vs 12th week, and 4th week vs 12th week (p < 0.001). The total SGRQ score exhibited a median (IQR) of 11.34 (7.88 - 8.58) at the 4th week and 6.93 (4.43 - 13.03) at the 12th week, demonstrating a statistically significant improvement (p < 0.001). No adverse events were reported during inpatient PR. Conclusion: Inpatient PR provides a safe and feasible profile, reduces dyspnea symptoms, and improves the quality of life in patients with moderate to severe COVID-19 pneumonia.
HIGHLIGHTS
- COVID-19 pneumonia results in dyspnea and persistent symptoms, impacting quality of life.
- Early pulmonary rehabilitation, from inpatient to a 12-week outpatient program for moderate and severe cases, is safe and improves dyspnea, quality of life, and patient reported symptoms.
GRAPHICAL ABSTRACT
Downloads
Metrics
References
B Hu, H Guo, P Zhou and ZL Shi. Characteristics of SARS-CoV-2 and COVID-19. Nat. Rev. Microbiol. 2021; 19, 141-54.
The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) - China, 2020. China CDC Wkly. 2020; 2, 113-22.
NM Habashi, L Camporota, LA Gatto and G Nieman. Functional pathophysiology of SARS-CoV-2-induced acute lung injury and clinical implications. J. Appl. Physiol. 2021; 130, 877-91.
A Carfì, R Bernabei and F Landi. Gemelli against COVID-19 post-acute care study group. JAMA 2020; 324, 603-5.
SJ Yong. Long COVID or post-COVID-19 syndrome: Putative pathophysiology, risk factors, and treatments. Infect. Dis. 2021; 53, 737-54.
R Simpson and L Robinson. Rehabilitation after critical illness in people with COVID-19 infection. Am. J. Phys. Med. Rehabil. 2020; 99, 470-4.
S Negrini, JA Mills, C Arienti, C Kiekens and A Cieza. “Rehabilitation research framework for patients with COVID-19” defined by cochrane rehabilitation and the World Health Organization rehabilitation programme. Arch. Phys. Med. Rehabil. 2021; 102, 1424-30.
MA Spruit, AE Holland, SJ Singh, T Tonia, KC Wilson and T Troosters. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European respiratory society and American thoracic society-coordinated international task force. Eur. Respir. J. 2020; 56, 2002197.
P Thomas, C Baldwin, B Bissett, I Boden, R Gosselink, CL Granger, C Hodgson, AY Jones, ME Kho, R Moses, G Ntoumenopoulos, SM Parry, S Patman and LVD Lee. Physiotherapy management for COVID-19 in the acute hospital setting: Clinical practice recommendations. J. Physiother. 2020; 66, 73-82.
TJ Wang, B Chau, M Lui, GT Lam, N Lin and S Humbert. PM&R and Pulmonary Rehabilitation for COVID-19. Am. J. Phys. Med. Rehabil. 2020; 99, 769-74.
MR Stutz, AG Leonhard, CM Ward, SD Pearson, PL Osorio, PR Herbst, KS Wolfe, AS Pohlman, JB Hall, JP Kress and BK Patel. Early rehabilitation feasibility in a COVID-19 ICU. Chest 2021; 160, 2146-8.
C Ubolsakka-Jones, W Tasangkar and DA Jones. Comparison of breathing patterns, pressure, volume, and flow characteristics of three breathing techniques to encourage lung inflation in healthy older people. Physiother. Theor. Pract. 2019; 35, 1283-91.
S Kluayhomthong, C Ubolsakka-Jones, P Domthong, W Reechaipichitkul and DA Jones. The immediate effects of breathing with oscillated inspiratory and expiratory airflows on secretion clearance in intubated patients with cervical spinal cord injury. Spinal Cord 2019; 57, 308-16.
TJ Witek and DA Mahler. Minimal important difference of the transition dyspnoea index in a multinational clinical trial. Eur. Respir. J. 2003; 21, 267-72.
E Garrigues, P Janvier, Y Kherabi, AL Bot, A Hamon, H Gouze, L Doucet, S Berkani, E Oliosi, E Mallart, FCV Zarrouk, JD Moyer, A Galy, V Honsel, B Fantin and Y Nguyen. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J. Infect. 2020; 81, e4-e6.
SVDSVD Brugge, S Talman, LJMBD Winter, MD Mol, E Hoefman, RWV Etten and ICD Backer. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir. Med. 2021; 176, 106272.
G Scaramuzzo, L Ronzoni, G Campo, P Priani, C Arena, RL Rosa, C Turrini, CA Volta, A Papi, S Spadaro and M Contoli. Long-term dyspnea, regional ventilation distribution and peripheral lung function in COVID-19 survivors: A 1 year follow up study. BMC Pulm. Med. 2022; 22, 408.
R Gloeckl, D Leitl, I Jarosch, T Schneeberger, C Nell, N Stenzel, CF Vogelmeier, K Kenn and AR Koczulla. Benefits of pulmonary rehabilitation in COVID-19: A prospective observational cohort study. ERJ Open Res. 2021; 7, 00108-2021.
A Jimeno-Almazán, A Martínez-Cava, Á Buendía-Romero, F Franco-López, JA Sánchez-Agar, BJ Sánchez-Alcaraz, JJ Tufano, JG Pallarés and J Courel-Ibáñez. Relationship between the severity of persistent symptoms, physical fitness, and cardiopulmonary function in post-COVID-19 condition. A population-based analysis. Intern. Emerg. Med. 2022; 17, 2199-208.
M Weatherall, S Marsh, P Shirtcliffe, M Williams, J Travers and R Beasley. Quality of life measured by the St George’s respiratory questionnaire and spirometry. Eur. Respir. J. 2009; 33, 1025-30.
LM Mundy, TL Leet, K Darst, MA Schnitzler and WC Dunagan. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest 2003; 124, 883-9.
C Fernández-de-las-Peñas, D Palacios-Ceña, V Gómez-Mayordomo, LL Florencio, ML Cuadrado, G Plaza-Manzano and M Navarro-Santana. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur. J. Intern. Med. 2021; 92, 55-70.
J Ghosn, L Piroth, O Epaulard, PL Turnier, F Mentré, D Bachelet and C Laouénan. Persistent COVID-19 symptoms are highly prevalent 6 months after hospitalization: results from a large prospective cohort. Clin. Microbiol. Infect. 2021; 27, 1041.e1-1041.e4.
A Asimakos, S Spetsioti, A Mavronasou, P Gounopoulos, D Siousioura, E Dima, N Gianniou, I Sigala, G Zakynthinos, A Kotanidou, I Vogiatzis and P Katsaounou. Additive benefit of rehabilitation on physical status, symptoms and mental health after hospitalisation for severe COVID-19 pneumonia. BMJ Open Respir. Res. 2023; 10, e001377.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Walailak University
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
