Electrical stimulation to regain lower extremity muscle perfusion and endurance in patients with post‐acute sequelae of SARS CoV‐2: A randomized controlled trial

Abstract

Muscle deconditioning and impaired vascular function in the lower extremities (LE) are among the long‐term symptoms experienced by COVID‐19 patients with a history of severe illness. These symptoms are part of the post‐acute sequelae of Sars‐CoV‐2 (PASC) and currently lack evidence‐based treatment. To investigate the efficacy of lower extremity electrical stimulation (E‐Stim) in addressing PASC‐related muscle deconditioning, we conducted a double‐blinded randomized controlled trial. Eighteen (n = 18) patients with LE muscle deconditioning were randomly assigned to either the intervention (IG) or the control (CG) group, resulting in 36 LE being assessed. Both groups received daily 1 h E‐Stim on both gastrocnemius muscles for 4 weeks, with the device functional in the IG and nonfunctional in the CG. Changes in plantar oxyhemoglobin (OxyHb) and gastrocnemius muscle endurance (GNMe) in response to 4 weeks of daily 1 h E‐Stim were assessed. At each study visit, outcomes were measured at onset (t0), 60 min (t60), and 10 min after E‐Stim therapy (t70) by recording ΔOxyHb with near‐infrared spectroscopy. ΔGNMe was measured with surface electromyography at two time intervals: 0–5 min (Intv1) and: 55–60 min (Intv2). Baseline OxyHb decreased in both groups at t60 (IG: p = 0.046; CG: p = 0.026) and t70 (IG = p = 0.021; CG: p = 0.060) from t0. At 4 weeks, the IG's OxyHb increased from t60 to t70 (p < 0.001), while the CG's decreased (p = 0.003). The IG had higher ΔOxyHb values than the CG at t70 (p = 0.004). Baseline GNMe did not increase in either group from Intv1 to Intv2. At 4 weeks, the IG's GNMe increased (p = 0.031), whereas the CG did not change. There was a significant association between ΔOxyHb and ΔGNMe (r = 0.628, p = 0.003) at 4 weeks in the IG. In conclusion, E‐Stim can improve muscle perfusion and muscle endurance in individuals with PASC experiencing LE muscle deconditioning.

Transcutaneous Electrical Nerve Stimulation for Fibromyalgia-like Syndrome in Patients with Post-Acute Sequelae of Sars-Cov-2: A Pilot Randomized Clinical Trial

“…The high-dose TENS group showed slightly higher perceived usefulness compared to the low-dose group (~ 71.2% vs ~ 61.4%), consistent with a previous RCT in FM patients undergoing TENS therapy for 3 weeks 74 . Moreover, all other acceptability items were similar to our previous trial involving PASC individuals undergoing electrical stimulation for musculoskeletal sequelae 75 .…”

Atuação fisioterapêutica na reabilitação pós-COVID-19: conhecimento e experiência de fisioterapeutas

“…Na época da coleta de dados, a Assobrafir já havia emitido recomendações para a reabilitação pós-COVID-19 5 , além disso, vários documentos científicos nacionais e internacionais sobre o tema estavam disponíveis para a leitura [9][10][11][12][13][14] . Entretanto, apenas 29% conheciam alguma diretriz e/ou associação que informasse sobre recomendações para avaliação e reabilitação em pacientes do paciente, prejudicando sua capacidade de realizar atividades de vida diária, além de alterar o desempenho profissional e dificultar sua interação social 29 .…”

“…Esses guias têm por objetivo demonstrar que, com a avaliação direcionada para cada apresentação clínica, o fisioterapeuta conseguirá elaborar um programa de reabilitação pós-COVID-19 capaz de atender as necessidades e limitações individuais dos pacientes conforme as sequelas adquiridas após o período agudo da doença 5,9,10 . Entre algumas recomendações, está a prescrição de exercícios fisioterapêuticos encontrados na literatura, podendo incluir treinamento aeróbio de intensidade leve com aumento gradual e treinamento intermitente para pacientes com fadiga acentuada, além de treinamento de força muscular, com auxílio de estimulação elétrica neuromuscular, especialmente para aqueles que necessitam de prolongados períodos de desuso ou imobilização, e treinamento de equilíbrio corporal, exercícios respiratórios e higiene brônquica, se necessário, preferencialmente em sessões individuais [11][12][13][14] .…”

Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID

“…Although guidelines published in other countries have not specifically recommended a dedicated treatment for dyspnea in patients with long COVID, some studies suggest that respiratory rehabilitation can be beneficial in the absence of other dyspnea-inducing conditions [ 105 106 107 108 109 110 111 112 ]. The cause of persistent dyspnea should be evaluated, and if a new condition is diagnosed, appropriate treatment should be applied.…”

“…For instance, a RCT conducted in the United States examined the effect of electrical stimulation (E-slim) on 18 individuals diagnosed with lower extremity muscle weakness related to PASC after COVID-19 hospitalization. The study, which divided participants into an E-slim application group and a control group, observed improvements in plantar oxyhemoglobin and gastrocnemius muscle endurance in the E-slim group compared to the control group after four weeks of treatment [ 105 ]. Similarly, an RCT in Poland compared traditional respiratory rehabilitation conducted in a hospital setting to virtual reality-based respiratory rehabilitation over three weeks, five times per week at high intensity [ 106 ].…”