Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study

Liu, Kai; Zhang, Weitong; Yang, Yadong; Zhang, Jinpeng; Li, Yunqian; Chen, Ying

doi:10.1016/j.ctcp.2020.101166

Cited by 586 publications

(1,004 citation statements)

References 15 publications

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“…Follow-up study lasting for one year found that the persistent functional limitation in the survived ARDS patients was largely a result of muscle wasting and weakness, due to their immobilization during hospitalization 6 .Thus, pulmonary alveolar edemas, interstitial brous proliferation, and muscle wasting collectively resulted in impaired lung function. Previous study found that respiratory rehabilitation could clearly enhance improvements in the respiratory functions of elderly COVID-19 patients 21 . However, we only found signi cant promotions in lung volume and diffusing capacity, potentially due to the differences in our patients' disease severity, baseline comorbidities, and smoking history.…”

Section: Discussionmentioning

confidence: 89%

“…For example, one case report shared the early pulmonary rehabilitation experiences of a 41-year-old severe patient with SARS-CoV-2 pneumonia 20 . Another study found that a six-week respiratory rehabilitation program produced positive impacts on COVID-19 patients aged over 65 by improving respiratory functions, quality of life, and exercise endurance, as well as relieving anxiety 21 . However, no study has systematically assessed the effects of early physical and pulmonary rehabilitation on severe COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Early Physical and Pulmonary Rehabilitation for Severely and Critically ill COVID-19 Patients: A Retrospective, Cohort, and Multicenter Study

Yan

Xiang

et al. 2020

Preprint

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BackgroundEffects of early rehabilitation therapy in severe and critical COVID-19 patients remains to be elucidated. MethodsWe recruited 80 severely and critically ill COVID-19 patients in Chongqing from January 21 to March 15, 2020, who had received rehabilitation therapies or standard treatments within 72 h of intensive care unit (ICU) admission. We analyzed mortality rates, length of stay in the ICU and hospital, ventilator-free days, and adverse events during hospitalization. Respiratory function, independent functional status, muscle strength, exercise capacity and life quality were measured at hospital discharge and during a three-month follow-up. ResultsWe found no significant differences between the intervention and control groups in terms of ICU, hospital, and 28-day mortality rates, and lengths of stay in the ICU and hospital. Additionally, early rehabilitation enhanced the duration of ventilator-free days, with no increased adverse events and complications. Total lung capacity and carbon monoxide diffusion capacity, Barthel index, and functional independence measure for patients in the intervention group were all higher than those in the control group at hospital discharge and one month after discharge. Compared to the control group, patients in the intervention group had significantly higher Medical Research Council scores and greater walking distance capacities within 6 min at hospital discharge, as well as one month and three months after discharge. The St. George's Respiratory Questionnaire score was lower in the intervention group than in the control group at one month and three months after hospital discharge.ConclusionsEarly physical and pulmonary rehabilitation is safe and effective for severely and critically ill COVID-19 patients to promote their functional, physical, and psychological recovery.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Effects of Early Physical and Pulmonary Rehabilitation for Severely and Critically ill COVID-19 Patients: A Retrospective, Cohort, and Multicenter Study

Yan

Xiang

et al. 2020

Preprint

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“…38 In an RCT of 72 COVID-19 patients (median age 69), Liu et al reported that a six-week respiratory rehabilitation program could improve pulmonary function and quality of life. 39 Finally, ethical standards should facilitate inclusion of elderly adults with more adapted informed consent, including the possibility to obtain consent by proxy if the patient has diminished capacity. It should be noted that since older patients are at risk of severe disease, concerns are raised regarding their inclusion in placebo-controlled trials.…”

Section: Discussionmentioning

confidence: 99%

A systematic review assessing the under-representation of elderly adults in COVID-19 trials

Prendki¹,

Tau

Avni

et al. 2020

Preprint

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Background Coronavirus disease (COVID-19) has caused a pandemic threatening millions of people worldwide. Yet studies specifically assessing the geriatric population are scarce. We aimed to examine the participation of elderly patients in therapeutic or prophylactic trials on COVID-19.Methods In this review, randomized controlled trials (RCTs; n=12) comparing therapeutic or prophylactic interventions registered on preprint repositories and/or published since December 2019 were analyzed. We searched in PubMed, leading journals websites, and preprint repositories for RCTs and large observational studies. We aimed to describe the age of included patients, the presence of an upper age limit and of adjusted analyses on age, any exclusion criteria that could limit participation of elderly adults such as comorbidities, cognitive impairment, limitation of life expectancy; and the assessment of long-term outcomes such as the need of rehabilitation or institutionalization. Mean participant ages were reported and compared with observational studies. Results Twelve RCTs assessing drug therapy for COVID-19 were included. Mean age of patients included in RCTs was 56.3 years. An upper age limit was applied in three published trials (25%) and in 200/650 (31%) trials registered at clinicaltrials.gov. One trial reported a subgroup analysis in patients ≥65. Patients were excluded for liver-function abnormalities in eight trials, renal disease in six, cardiac disease or risk of torsade de pointes in five, and four for cognitive or mental criteria, which are frequent comorbidities in the oldest patients. Only three trials allowed a family member to provide consent. Patients enrolled in RCTs were on average 20 years younger than those included in large (n≥1000) observational studies. Seven studies had as their primary outcome a clinical endpoint, but none reported cognitive, functional or quality of life outcomes or need for rehabilitation or long-term care facility placement.Conclusions Elderly patients are clearly underrepresented in RCTs, although they comprise the population hardest hit by the COVID-19 pandemic. Long-term outcomes such as the need of rehabilitation or institutionalization were not reported. Future investigations should target specifically this vulnerable population.

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“…In einer aktuellen randomisiert, kontrollierten Studie aus China 43 wurden die Effekte eines Atemmuskeltrainings in Kombination mit atemphysiotherapeutischen Übungen (Hustentraining, Zwerchfelltraining, Lippenbremse, Dehnübungen) bei 72 post-COVID-19-Patienten (≥ 65 Jahre) untersucht. Nach 6 Wochen kam es in der Trainingsgruppe zu signifikanten Verbesserungen der 6-Minuten-Gehteststrecke, der Lungenfunktion, des Gasaustauschs und der Lebensqualität im Vergleich zu einer Usual Care-Gruppe.…”

Section: Empfehlungen Zur Rehabilitation Bei Covid-19unclassified

DGP-Empfehlungen zur pneumologischen Rehabilitation bei COVID-19

et al. 2020

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ZusammenfassungVor dem Hintergrund der Pandemie durch Infektionen mit dem SARS-CoV-2 hat die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP e. V.) die Sektion 12 „Rehabilitation, Prävention und Tabakkontrolle“ beauftragt, Empfehlungen zur Umsetzung pneumologischer Rehabilitation bei Patienten nach COVID-19 zu erstellen. Dieses Positionspapier basiert auf dem momentanen aktuellen Wissen, das sich täglich weiterentwickelt. Neben einer Beschreibung der gesundheitlichen Folgen von COVID-19 wird die Indikationsstellung aufgezeigt. Rehabilitative Therapien bei COVID-19 sind bereits auf der Normalstation bzw. Intensivstation indiziert, setzen sich fort als pneumologische Frührehabilitation im Akutkrankenhaus und als Anschlussheilbehandlung oder Reha-Heilverfahren in pneumologischen Rehabilitationskliniken. Im Fokus dieses Positionspapiers stehen Empfehlungen zur inhaltlichen Durchführung einer multimodalen, interdisziplinären pneumologischen Rehabilitation bei COVID-19.

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Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study

Cited by 586 publications

References 15 publications

Effects of Early Physical and Pulmonary Rehabilitation for Severely and Critically ill COVID-19 Patients: A Retrospective, Cohort, and Multicenter Study

Effects of Early Physical and Pulmonary Rehabilitation for Severely and Critically ill COVID-19 Patients: A Retrospective, Cohort, and Multicenter Study

A systematic review assessing the under-representation of elderly adults in COVID-19 trials

DGP-Empfehlungen zur pneumologischen Rehabilitation bei COVID-19

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