Developing Pulmonary Rehabilitation for COVID-19: Are We Linked with the Present Literature? A Lexical and Geographical Evaluation Study Based on the Graph Theory

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic is a severe ongoing global emergency. Despite high rates of asymptomatic patients, in many cases, the infection causes a rapid decline in pulmonary function due to an acute respiratory distress-like syndrome, leading to multi-organ failure and death. To date, recommendations about rehabilitation on COVID-19 are based on clinical data derived from other similar lung diseases. Rehabilitation literature lacks a standard taxonomy, limiting a proper evaluation of the most effective treatments for patients after COVID-19 infection. In this study, we assessed the clinical and rehabilitative associations and the geographical area involved in interstitial lung diseases (ILD) and in COVID-19, by a mathematical analysis based on graph theory. We performed a quantitative analysis of the literature in terms of lexical analysis and on how words are connected to each other. Despite a large difference in timeframe (throughout the last 23 years for ILD and in the last 1.5 years for COVID-19), the numbers of papers included in this study were similar. Our results show a clear discrepancy between rehabilitation proposed for COVID-19 and ILD. In ILD, the term “rehabilitation” and other related words such as “exercise” and “program” resulted in lower values of centrality and higher values of eccentricity, meaning relatively less importance of the training during the process of care in rehabilitation of patients with ILD. Conversely, “rehabilitation” was one of the most cited terms in COVID-19 literature, strongly associated with terms such as “exercise”, “physical”, and “program”, entailing a multidimensional approach of the rehabilitation for these patients. This could also be due to the widespread studies conducted on rehabilitation on COVID-19, with Chinese and Italian researchers more involved. The assessment of the terms used for the description of the rehabilitation may help to program shared rehabilitation knowledge and avoid literature misunderstandings.

Changes in lung function and dyspnea perception in Colombian Covid-19 patients after a 12-week pulmonary rehabilitation program

“…This might be associated with changes in the small airway that are equivalent to approximately 80% of the extension of the lung parenchyma (35). Given that FEF 25-75% is the only spirometric measurement that assesses the small-caliber airway, additional studies that include more specific diagnostic methods for assessing changes in lung function in the small-caliber airway are needed (36)(37)(38). The long-term impacts of the sequelae of Covid-19 also merit further investigation; the use of a large sample of patients is needed to improve the ability to detect changes in respiratory function before and after therapy.…”

Cardiac and Pulmonary Rehabilitation: Two Underutilized Approaches with Some Unexpected Benefits

“…Of course, specifically designed programs for COVID-19 patients were not available and, pending guidelines dedicated to this new clinical condition, most of the authors have borrowed or adapted pulmonary rehabilitation programs designed for other pathologies [12]. An interesting lexical analysis of the literature showed that rehabilitation in patients with COVID-19 has been focused more on exercises and physical training for the recovery of multiorgan disability and motor impairments, rather than on lung disease [13]. Thus, while providing a comprehensive literature overview, the authors highlighted a discrepancy between the rehabilitation programs proposed for COVID-19 patients and those usually delivered to patients with interstitial lung disease of different etiology.…”