Safety and efficacy of pulmonary physiotherapy in hospitalized patients with severe COVID-19 pneumonia (PPTCOVID study): A prospective, randomised, single-blind, controlled trial

Abstract

Background Pulmonary physiotherapy (PPT) is an important treatment in the management of patients with different types of pulmonary disorders. We aimed to evaluate safety and efficacy of PPT in hospitalized patients with severe COVID-19 pneumonia. Methods In this randomised, single-blind, controlled trial, we enrolled hospitalized, non-intubated patients (18 to 75 years with oxygen saturation (Spo2) in free-air breathing ≤90%) with COVID-19 pneumonia at a referral hospital. Participants were randomly assigned (1:1) to receive PPT (six sessions PPT with breathing exercises and airway clearance techniques) or basic care. The primary outcomes were venous blood O2 (pO2) and CO2 (pCO2) pressures, Spo2, and three-minute walking test (3MWT) that were assessed before and end of sixth session. Secondary outcomes included level of dyspnea, venous blood PH, one-month mortality, three-month mortality and short form-36 (SF-36) after one and three months. The assessor was blinded to the assignment. This trial is registered with ClinicalTrials.gov (NCT04357340). Findings In April-May 2020, 40 participants were randomly assigned to PPT or basic care groups. While at the end of intervention, pO2 (adjusted mean difference to baseline measure (AMD) 6.43 mmHg [95%CI 2.8, 10.07], P<0.01), Spo2 (AMD 4.43% [95%CI 2.04, 6.83], P = 0.0011), and 3MTW (AMD 91.44 m [95%CI 68.88, 113.99], P<0.01) were higher in PPT group and basic care group, pCO2 was not improved (AMD -2.1 mmHg [95%CI-6.36, 2.21], P = 0.33). Based on the logistic model adjusted to baseline Spo2, the risks of mortality were reduced 81% ([95%CI: 97% reduction to 30% increase], P = .09) and 84% ([95%CI 74% reduction to 5% increase], P = .06) at one-month and three-month, respectively. There were no significant differences in most SF-36 domains scores after one and three months. No serious adverse event was observed during PPT sessions. Conclusion Early PPT can be considered a safe and relatively effective therapeutic choice for patients with severe COVID-19.

Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis

“…32,44,62,63,71,77,79,82,83,89,90,106,118,119,126,127 It is noteworthy that the studies with significantly improved mental component scores 71,89,90 often involved three or more types of training interventions, in contrast to studies that showed no improvement in mental component scores. 43,49,87,113,126,137 Additionally, the intervention delivery mode and supervision method appeared to exert minimal influence on QOL.…”

“…Exercise capacity outcomes, including the Six-Minute Walk Test (6MWD) and the Sit-To-Stand Test (STS), were synthesized from data obtained in 16 RCTs. Out of these, 12 RCTs 31,[43][44][45][46][47]49,54,56,60,61,63,64 assessed 6MWD, revealing moderate-level evidence of improved walking outcomes in patients who underwent rehabilitation interventions compared to those receiving standard care (MD 38.18 [25.33, 51.03], I² = 88%) (Figure 4). Subgroup analysis by delivery mode indicated that tele-rehabilitation (MD 66.89 [32.15, 101.62], I² = 90%) appeared more effective than in-person rehabilitation 93.21], I² = 92%).…”

“…54,73,101 As for patients in the acute phase, it was acknowledged that this intensity should be appropriately reduced. 64,92 Two out of these 26 studies reported negative results. 55,56 Physical function outcomes, as assessed through the physical function item in the Short Form 36 Item Health Survey (SF-36) or Short Form 12 Item Health Survey (SF-12), were synthesized from data originating from five RCTs.…”

Current Pathogenetic and Diagnostic Aspects of Dyspnea in Long Covid

“…Since they are the most informa-tive about disorders of the function of external breathing [31,32,33], especially obstructive disorders [32,34,35], in Long COVID, their results are often ambiguous and require careful interpretation because of the understanding of the physiology of the new disease [12]. Thus, obstructive or restrictive changes were found in 17% of people, mainly after severe pneumonia, which later transformed into pulmonary fibrosis [36,37].…”

“…An alternative technique for judging the mechanisms of shortness of breath in Long COVID is the assessment of saturation in physical exercise tests: the 3 -or 6-minute walk test (3/6MWT) or the 1-minute sit-to-stand test (1MSTST) [36,[38][39][40]. Desaturation (decrease in SpO 2 to 80%) during exercise has a direct correlation with spirometry and X-ray examination data [37], pO 2 and pCO 2 values in venous blood [40], the severity of clinical symptoms and DLCO level, which may be a consequence parenchymal and/or pulmonary vascular phenomena [41].…”