Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease

Abstract

In people with advanced respiratory disease, we examined (i) the impact of COVID-19–related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton–Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3–8]-month period, often leading to lower levels of physical activity at home ( n = 94, 47%), and outside home ( n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = −0.28, p < 0.001) and instrumental (r = −0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03–1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.

CRD editor’s corner archive: July-September

“…Many have been concerned however, about a potential adverse consequence on physical activity (PA) and conditioning and on and mental and physical well being. In the journal this month Fettes et al 5 highlight this by measuring PA, self-reported disability and limits to performance of activities of daily living in people with advanced lung disease. PA in many patients was lower and was associated with self reported disability with a knock on effect on independence.…”

Physical and social isolation during COVID-19 – How did it impact the functional status of people with advanced respiratory disease?

“…Importantly, only 10% and 5% of participants received physiotherapy or occupational therapy interventions, respectively, within the month prior to the survey. 11…”

“…The authors concluded that health and social care services will need to consider rehabilitation of those deemed clinically vulnerable as well as of those recovering from COVID-19. 11 The authors identified several risk factors to help identify the need for rehabilitation of individuals with chronic respiratory disease including (1) length of time spent in physical and social isolation, (2) presenting difficulty with and not only disability in daily activities, (3) symptom severity and (4) level of social support. They also proposed some strategies to prevent a further decline in disability in this population in case of a future pandemic: (1) minimize time spent in isolation, (2) maintain physical activity, (3) continue rehabilitation services or/and offer online alternatives, and (5) increase social support.…”

“…10 Importantly, in addition to the increased risk of developing severe symptoms and increased mortality, 2,7 during the lockdown periods, many individuals with chronic respiratory disease were denied access to medical care and rehabilitation services which put them at a disadvantage in maintaining their general health and functional status. 10,11…”

“…In this issue of the Chronic Respiratory Disease Journal, Fettes and colleagues 11 provided important data on the relationship between physical and social isolation during the COVID-19 pandemic and physical inactivity and disability in activities of daily living (ADLs) among people with advanced respiratory disease. The authors reported baseline data of 201 patients from a prospective cohort study conducted in the United Kingdom.…”