COVID-19 and pulmonary rehabilitation: preparing for phase three

Polastri, Massimiliano; Nava, Stefano; Clini, Enrico; Vitacca, Michele; Gosselink, Rik

doi:10.1183/13993003.01822-2020

Cited by 86 publications

(98 citation statements)

References 28 publications

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“…Nonetheless, only 36% of the variance in symptom burden at follow-up could be explained by the age of the participants, self-reported health status before the onset of symptoms, self-reported pre-existing comorbidities, and the number of symptoms during the infection. This provides a clear rationale for additional assessment of the underlying physical, emotional, cognitive and social factors by a multidisciplinary team, which is needed to better understand the persistence of these symptoms and to identify possible traits for pharmacological and non-pharmacological treatment [20,21]. Previously, interventions for chronic fatigue syndrome or post-viral fatigue were developed [22].…”

Section: Discussionmentioning

confidence: 99%

Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

et al. 2020

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BackgroundMany patients with COVID-19 do not require hospitalisation, let alone have undergone COVID-19 testing. There is anecdotal evidence that patients with “mild” COVID-19 may complain about persistent symptoms, even weeks after the infection. This suggests that symptoms during the infection may not resolve spontaneously. The objective of this study was to assess whether multiple relevant symptoms recover following the onset of symptoms in hospitalised and non-hospitalised patients with COVID-19.Methods2113 members of two Facebook groups for coronavirus patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, date of symptoms onset, COVID-19 diagnosis, healthcare utilisation, and the presence of 29 symptoms at the time of the onset of symptoms (retrospectively) and at follow-up (79±17 days after symptoms onset).Results112 hospitalised patients and 2001 non-hospitalised patients (confirmed COVID-19, n=345; symptom-based COVID-19, n=882; and suspected COVID-19, n=774) were analysed. The median number of symptoms during the infection reduced significantly over time (14 (11–17) versus6 (4–9), p<0.001). Fatigue and dyspnoea were the most prevalent symptoms during the infection and at follow-up (fatigue: 95% versus 87%; dyspnoea: 90% versus 71%).ConclusionIn previously hospitalised and non-hospitalised patients with confirmed or suspected COVID-19, multiple symptoms are present about 3 months after symptoms onset. This suggests the presence of a “post-COVID-19 syndrome” and highlights the unmet healthcare needs in a subgroup of patients with “mild” or “severe” COVID-19.

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Section: Discussionmentioning

confidence: 99%

Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

et al. 2020

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“…It is very likely that a proportion of the COVID-19 patients will have a need for rehabilitative interventions during and directly after the hospitalization (3)(4)(5)(6). This approach is also recommended by the World Health Organization (7).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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BackgroundPatients with COVID-19 or post-COVID-19 will most probably have a need for rehabilitation during and directly after the hospitalisation. Data on safety and efficacy are lacking. Healthcare professionals cannot wait for published randomised controlled trials before they can start these rehabilitative interventions in daily clinical practice, as the number of post-COVID-19 patients increases rapidly. The Convergence of Opinion on Recommendations and Evidence process was used to make interim recommendation for the rehabilitation in the hospital and post-hospital phase in COVID-19 and post-COVID-19 patients, respectively.Methods93 experts were asked to fill out 13 multiple choice questions. Agreement of directionality was tabulated for each question. At least 70% agreement on directionality was necessary to make consensus suggestions.Results76 experts (82%) reached consensus on all questions based upon indirect evidence and clinical experience on the need for early rehabilitation during the hospital admission, the screening for treatable traits with rehabilitation in all patients at discharge and 6–8 weeks after discharge, and around the content of rehabilitation for these patients. It advocates for assessment of oxygen needs at discharge and more comprehensive assessment of rehabilitation needs including physical as well as mental aspects 6–8 weeks after discharge. Based on the deficits identified multidisciplinary rehabilitation should be offered with attention for skeletal muscle and functional as well as mental restoration.ConclusionsThis multinational task force recommends early, bedside rehabilitation for patients affected by severe COVID-19. The model of pulmonary rehabilitation may suit as a framework, particularly in a subset of patients with long term respiratory consequences.

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“…There is insufficient understanding of the recovery phase of COVID-19, but increasing recognition that patients need a multifaceted approach to the evaluation of residual symptoms and dysfunction. 2 , 19 , 20 , 21 , 22 , 23 Clinicians are commonly faced with patients who present with unexplained persistent chest pain, breathlessness, exercise limitation, and fatigue, weeks after hospitalisation or the onset of symptoms. 22 , 23 The causes of such symptoms are not fully understood, but various factors might be involved, such as restricted lung function, impairment in gas exchange, cardiac dysfunction, and partially resolved thrombus with flow limitation.…”

Section: Pulmonary Sequelae After Covid-19mentioning

confidence: 99%

Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19

Dhawan

Gopalan

Howard

et al. 2021

The Lancet Respiratory Medicine

137

100

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COVID-19 and pulmonary rehabilitation: preparing for phase three

Abstract: Considering the expected high burden of respiratory, physical and psychological impairment following the acute phase of COVID-19, a huge number of patients should be referred early to a rehabilitation programme https://bit.ly/3d0s0hu

Cited by 86 publications

References 28 publications

Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

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

Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19

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