Effectiveness of a telerehabilitation program for COVID-19 survivors (TERECO) on exercise capacity, pulmonary function, lower limb muscle strength, and quality of life: a randomized controlled trial

Abstract

Objectives To investigate superiority of a telerehabilitation program for Covid-19 (TERECO) over no rehabilitation with regard to functional exercise capacity, lower-limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL), and perceived dyspnoea. Design Parallel-group randomised controlled-trial with 1:1 block-randomisation. Setting Three major hospitals from Jiangsu and Hubei provinces, China. Participants 120 Covid-19 survivors with modified Medical Research Council (mMRC) dyspnoea score of 2-3 who had been discharged from hospital were randomised. 61 were allocated to the control group and 59 to the TERECO group. Intervention The control group received educational instructions. The TERECO group participated in a 6-week home-based, pulmonary rehabilitation program delivered via smartphone and monitored with chest-worn heart rate telemetry. Exercise types comprised breathing control and thoracic expansion, aerobic exercise, and LMS exercise. Outcomes Primary outcome was 6-minute walking distance (6MWD) in metres. Secondary outcomes were LMS measured as squat time in seconds; pulmonary function assessed by spirometry with parameters being forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, maximum voluntary ventilation (MVV), and peak expiratory flow; HRQOL measured with SF-12 physical component score (PCS) and mental component score (MCS); and mMRC dyspnoea, favourable outcome (no dyspnoea). Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up). Results 120 patients were randomised, 15 (12.5%) were lost to follow-up at study endpoint. No serious adverse events occurred. 38 participants in the TERECO group complied with the exercise protocol (64.41% of randomized). The adjusted between-group difference in change in 6MWD from baseline was 65.45 metres (95% CI 43.8-87.1, p<0.001) at post-treatment and 68.62 metres (95% CI 46.39-90.85, p<0.001) at follow-up. Treatment effects for LMS were 20.12 seconds (95% CI 12.34-27.9, p<0.001) post-treatment and 22.23 seconds (95% CI 14.24-30.21, p<0.001) at follow-up. No group differences were found for lung function apart from post-treatment MVV (10.57 litres/minute, 95% CI 0.26-17.88, p=0.005). Increase in SF-12 PCS was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24-6.35, p=0.004) at post-treatment and 2.69 (95% CI 0.06-5.32, p=0.045) at follow-up. No significant between-group differences were found for improvements in SF-12 MCS. At post-treatment 90.4% endorsed a favourable outcome for mMRC dyspnoea in the TERECO group vs. 61.7% in control (adjusted RR 1.46, 1.17-1.82, p=0.001). Conclusions This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and SF-12 PCS. We found no persistent effects on pulmonary function, SF-12 MCS, and perceived dyspnoea. Trial registration: Chinese Clinical Trial Registry: ChiCTR2000031834, 11 Apr 2020, URL: http://www.chictr.org.cn/showproj.aspx?proj=52216

Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study

“…Several studies have focused on persistent symptoms and rehabilitation in hospitalized patients. 20 , 21 In contrast, few studies have included people who were not hospitalized (the majority of individuals affected by COVID-19) or those without laboratory confirmation of infection. There are several explanations for the lack of laboratory confirmation, including lack of access to testing, false negatives , 22 inconclusive tests , 23 and the numerous disincentives to seeking or accessing testing that can disproportionately affect disadvantaged populations.…”

Chronic fatigue and post-exertional malaise in people living with long COVID

“…Several studies have focused on persistent symptoms, recovery or rehabilitation after hospital admission due to COVID-19 [3,[23][24][25][26]. In contrast, few studies have included people who were not hospitalized (the majority of individuals affected by COVID- 19) or did not have a laboratory diagnosis of COVID-19, but who have experienced an acute illness equivalent to the acute symptomatic presentation of COVID-19 and/or had a known exposure to the virus.…”

Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a systematic review and meta-analysis

“…A randomised controlled trial (RCT) aimed to evaluate exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL), and dyspnoea found that remotely delivered rehabilitation improves functional exercise capacity, LMS, and physical HRQOL but no improvements reported in pulmonary function tests and mental aspect of quality of life. 3 A systematic review on rehabilitation of patients in post-COVID-19 infection suggested that respiratory rehabilitation interventions improve pulmonary function, physical and psychological efficiency, and quality of life, 13 but this study had limitations due to the lack of RCTs included in the review. Another systematic review was done to evaluate the impact of home-based telerehabilitation among community-dwelling elderly people reported an average 81%±11 intervention completion rate 14 but it has limited evidence for home-based telerehabilitation.…”

“…COVID-19 has clinical manifestations of cough, shortness of breath, chest pain, fatigue and severe viral pneumonia with respiratory failure and/or death. Respiratory rehabilitation improves symptoms of dyspnoea, relieves anxiety, reduces complications, minimises disability, preserves function, and improves the quality of life both in the acute phase and after discharge 2–4. Telerehabilitation is the provision of rehabilitation services through telecommunication networks or the internet offering remote treatments to the people in their homes or from a distance 5 6.…”